Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss

Diagnosis, differential diagnosis, and treatment for sudden sensorineural hearing loss: Current otolaryngology practices in China

Introduction

Although sudden sensorineural hearing loss (SSNHL) has been attempted to be understood for 70 years, diagnosis and treatment strategies still have strong heterogeneity worldwide, which are reflected in the guidelines issued by countries and the clinical practice of otolaryngologists.

Methods

Questionnaires were sent to registered otolaryngologists nationwide via an online questionnaire system. We investigated the current views and clinical practices of otolaryngologists in mainland China about the diagnosis, examination, and treatment strategies of SSNHL.

Results

Most otolaryngologists supported diagnostic classification via audiograms. Regional economic situation and hospital grade affected application strategies for differential diagnosis. Regarding corticosteroid therapy, 54.9% of respondents opted to discontinue the drug 5 days after systemic administration. Both intratympanic therapy and post-auricular injections were selected by more than half of the respondents as initial and salvage treatments.

Discussion

Chinese otolaryngologists exhibit heterogeneity in clinical practices for SSNHL, including distinct approaches to combination therapy and local application of steroids. This study pointed out Chinese doctors' similarities, differences, and unique strategies in diagnosing and treating SSNHL and analyzed the possible reasons to help the world understand the current otolaryngology practices in China.

Clinical Efficacy of Xueshuantong plus Urokinase in the Treatment of Sudden Deafness

Objective

To investigate the clinical effect of Xueshuantong combined with urokinase in the treatment of sudden deafness.

Methods

A total of 90 patients with sudden deafness who were treated in South China Hospital affiliated to Shenzhen University from June 2019 to August 2020 were recruited and assigned (1 : 1) into the control group (n = 45, urokinase) and the experimental group (n = 45, Xueshuantong plus urokinase) according to the different treatment methods. The clinical treatment effect, the degree of tinnitus, the average auditory valve of the damaged frequency, and the changes in hemorheology (plasma viscosity, whole blood high-shear reduced viscosity, whole blood low-shear reduced viscosity, hematocrit, and fibrinogen) were compared between the two groups of patients.

Results

The treatment with urokinase and Xueshuangtong injection in the experimental group resulted in a significantly higher clinical treatment effect when compared with the treatment in the control group (P < 0.05). After treatment, the degree of tinnitus and the average auditory valve of the damaged frequency in the experimental group were significantly lower than those in the control group (P < 0.05). The levels of hemorheology (plasma viscosity, whole blood high-shear reduced viscosity, whole blood low-shear reduced viscosity, hematocrit, and fibrinogen) in the experimental group after treatment were significantly lower than those in the control group (P < 0.05).

Conclusion

The clinical effect of Xueshuantong combined with urokinase in the treatment of patients with sudden deafness is remarkable, and it can effectively improve the hearing level and hemorheology-related indexes of patients, and it thus merits clinical application.

The effect of hyperbaric oxygen therapy on central macular thickness and choroidal thickness in the healthy eyes of patients with idiopathic sudden sensorineural hearing loss

PURPOSE

To evaluate the effect of hyperbaric oxygen therapy (HBOT) for idiopathic sudden sensorineural hearing loss (ISSNHL) on central macular thickness (CMT) and choroidal thickness (CT).

MATERIALS AND METHODS

The study included 42 healthy eyes of 21 patients with ISSNHL (aged 24-61 years) who started HBOT within the first three days of the onset of hearing loss. Duration and severity of hearing loss were noted before starting HBOT. Central macular thickness (CMT), choroidal thickness (CT) 1500 µm nasal and temporal of the fovea, and subfoveal CT were measured by spectral domain optic coherence tomography before the first session of HBOT and after sessions 10 and 20. measurements obtained before and after HBOT were compared.

RESULTS

Eleven patients (52.4%) were men and 10 (47.6%) were women. The mean age was 44.67 ± 10.1 years. The mean duration of sudden hearing loss before HBOT was 2.05 ± 1 day. Hearing loss was mild in 5 patients, moderate in 5 patients, moderate to severe in 2 patients, severe in 4 patients and profound in 5 patients. Comparison of measurements obtained before HBOT and after 10 and 20 sessions of HBOT revealed no significant differences in CMT (219.17 ± 22.91, 220.33 ± 19.66, and 220.21 ± 19.3 µm), subfoveal CT (347.71 ± 66.82, 348.38 ± 74.55, and 345.45 ± 75.39 µm), nasal CT (328.64 ± 82.31, 316.02 ± 79.32, and 313.52 ± 89.92 µm), or temporal CT (321.76 ± 71.29, 317.05 ± 73.94, and 314.05 ± 74.61 µm, respectively) (p > 0.05).

CONCLUSIONS

HBOT for the treatment of ISSNHL had no significant effect on CMT or CT in healthy eyes.

Clinical Value of 3D-FLAIR MRI in Idiopathic Sudden Sensorineural Hearing Loss

BACKGROUND

Three-dimensional fluid-attenuated inversion recovery sequence magnetic resonance imaging (3D-FLAIR MRI) has been used in the diagnosis of inner ear diseases. However, the relevance of 3D-FLAIR MRI appearances with multiple features and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) remains unclear.

METHODS

This study was a retrospective trial. We recruited 1300 patients with unilateral ISSNHL hospitalized from May 2017 to January 2019. They were divided into four groups according to their 3D-FLAIR MRI appearances: normal (n = 739), inner ear hemorrhage (n = 218), increased protein content (n = 288), and blood-labyrinth barrier damage (n = 55). The correlation between 3D-FLAIR MRI appearances and the degree or type of deafness of the participants was analyzed.

RESULTS

There was a statistical difference in the deafness side (p < 0.001) and vestibular dysfunction (p < 0.001) among the four groups. There was a statistical difference in the duration of treatment (p < 0.001) and the incidence of dizziness or vertigo (p < 0.001) for patients among these groups. The degree of deafness in the patients in the inner ear hemorrhage group was significantly more severe than that of the patients in the other three groups (p < 0.001).

CONCLUSION

3D-FLAIR MRI appearances were correlated with the prognosis of patients with ISSNHL.

Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo

Background: Endolymphatic hydrops (EH) is the histopathological hallmark of Ménière's disease (MD) and has been found by in vivo magnetic resonance imaging (MRI) in patients with several inner ear syndromes without definite MD criteria. The incidence and relevance of this finding is under debate.

Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL).

Material and Methods: 170 patients were included, 83 with definite MD, 38 with fluctuating sensorineural hearing loss, 34 with recurrent vertigo, and 15 with ISSNHL. The clinical variables, audiovestibular tests, and EH were evaluated and compared. Logistic proportional hazard models were used to obtain the odds ratio for hydrops development, including a multivariable adjusted model for potential confounders.

Results: No statistical differences between groups were found regarding disease duration, episodes, Tumarkin spells, migraine, vascular risk factors, or vestibular tests; only hearing loss showed differences. Regarding EH, we found significant differences between groups, with odds ratio (OR) for EH presence in definite MD group vs. all other patients of 11.43 (4.5–29.02; p < 0.001). If the ISSNHL group was used as reference, OR was 55.2 (11.9–253.9; p < 0.001) for the definite MD group, 9.9 (2.1–38.9; p = 0.003) for the recurrent vertigo group, and 5.1 (1.2–21.7; p = 0.03) for the group with fluctuating sensorineural hearing loss.

Conclusion: The percentage of patients with EH varies between groups. It is minimal in the ISSNHL group and increases in groups with increasing fluctuating audiovestibular symptoms, with a rate of severe EH similar to the known rate of progression to definite MD in those groups, suggesting that presence of EH by MRI could be related to the risk of progression to definite MD. Thus, EH imaging in these patients is recommended.