Sudden Sensorineural Hearing Loss: Long-term Follow-up Results

Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health

OBJECTIVE

To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL).

STUDY DESIGN

Prospective, cohort study.

SETTING

Outpatient otology clinic in a tertiary care hospital.

SUBJECTS AND METHODS

Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness.

CONCLUSION

Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.

Time from sudden sensory neural hearing loss to treatment as a prognostic factor

Introduction

The widely accepted treatment for sudden sensorineural hearing loss (SSNHL) is corticosteroid treatment (oral or intratympanic). The main goal of this work is to define the significance of the time between symptom onset and treatment initiation, as well as other prognostic factors, for hearing improvement.

Methods

This retrospective study included 666 patients treated for SSNHL. Demographic data, audiometry, treatment method, time since symptom onset, and associated symptoms were recorded for each patient. The patients were divided into five groups according to the treatment initiation time-half a week, one week, 2 weeks, 3 weeks, or 4 weeks and over-after symptom onset. The degree of improvement was assessed by comparing the audiometry at the beginning and the end of the treatment.

Results

The average period of hearing loss from symptom onset to treatment initiation was 10.8 days. Significant differences were found between the groups of half a week, one week, and 2 weeks and the groups of 3 weeks and 4 weeks and over (each separately, p < 0.001). No difference was found between the half-week, one-week, and two-week groups, nor was there a difference between the three-week and four-week-and-over groups. A correlation was found between the treatment initiation time in days and the degree of improvement in hearing for both speech recognition threshold (SRT) and discrimination, R = 0.26 p < 0.001 and R = 0.17 p < 0.001, respectively. No correlation was found for gender, age of the patients, comorbidities, or associated symptoms.

Conclusion

The threshold for treatment initiation time is up to 2 weeks, after which the amplitude of hearing improvement decreases significantly. The other prognostic factors measured were not found to be statistically significant predictors.

Prognostic factors in elderly patients after an intra-tympanic steroid injection for idiopathic sudden sensorineural hearing loss

BACKGROUND

Idiopathic sudden sensorineural hearing loss (ISSNHL) presents with emergent hearing impairment and is mainly treated with steroids. However, limited data exist regarding the prognostic factors among elderly patients (>65 years old) who receive an intra-tympanic steroid injection (ITSI). Therefore, we investigated the prognostic factors in these patients.

METHODS

Between July 2016 and March 2022, we retrospectively enrolled 105 elderly patients (>65 years old) with unilateral ISSNHL who were treated with an ITSI, and recorded their clinical and audiological variables.

RESULTS

The patients had a mean age of 72.03 ± 6.33 years and mean hearing level gain of 22.86 ± 21.84 dB, speech reception threshold (SRT) gain of 15.77 ± 35.27 dB, and speech discrimination score (SDS) gain of 19.54 ± 27.81 %. According to Siegel's criteria, 5 (4.76 %), 44 (41.91 %), 46 (43.81 %), and 10 (9.52 %) patients had complete recovery, partial recovery, slight improvement, and no improvement, respectively. In the univariate analysis, vertigo (odds ratio [OR] = 0.290, 95 % confidence interval [CI]: 0.130-0.651, p = 0.002) and profound hearing loss on pure tone audiometry (PTA; OR = 0.233, 95 % CI: 0.101-0.536, p = 0.004) were negative prognostic factors among elderly ISSNHL patients. In the multivariate analysis, vertigo (OR = 0.300, 95 % CI: 0.128-0.705, p = 0.005) and profound pure tone audiometry (OR = 0.240, 95 % CI: 0.101-0.570, p = 0.001) were independent adverse prognostic factors among elderly ISSNHL patients.

CONCLUSIONS

We demonstrated the treatment outcomes of 105 elderly ISSNHL patients after an ITSI. Vertigo and profound PTA are independent adverse risk factors among elderly ISSNHL patients, and patients with these risk factors require active treatment.

Delayed Recovery in Idiopathic Sudden Sensorineural Hearing Loss

Sudden hearing loss is an easily encountered disease in clinics, but its prognosis has not been completely elucidated. In the present study, we investigated the long-term prognosis of sudden hearing loss with 130 patients who were diagnosed based on strict criteria and provided uniform treatment. The patients with incomplete recovery were reevaluated after 2 months without receiving additional treatment. Hearing levels at different time points were compared. Moreover, the associated factors affecting the degree of hearing improvement over time were evaluated using stepwise multiple linear regression. After treatment, 73 out of the 130 (56.1%) patients attained incomplete recovery and were reevaluated after 2 months. Seventeen out of the seventy-three (23.3%) patients showed a grade promotion, fifty-four (74%) were constant, and two (2.7%) were aggravated. The mean interaural hearing differences (IHDs) showed significant improvement. Old age, poor initial IHD, and poor recovery grade were significantly associated with a profitable delayed hearing gain. Poorer hearing level at the time of onset might be a sign for slower recovery rather than a poorer prognostic factor. The treatment outcome of idiopathic sudden sensorineural hearing loss (ISSNHL) should be evaluated at least 2 months after treatment completion, and counseling is required due to the need for long-term follow-up in patients with ISSNHL.

Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review

Although idiopathic sudden sensorineural hearing loss (ISSNHL) is uncommon, recurrent ISSNHL is even rarer. The knowledge about factors associated with patient recovery from recurrent episodes is needed to counsel and treat the patients. Medical records of patients admitted for high dose oral steroid therapy for recurrent ISSNHL between January 2009 and December 2021 were reviewed. Their demographic and clinical characteristics, co-morbid symptoms, and audiologic results were analyzed. The 38 patients admitted for treatment of recurrent ISSNHL included 14 men and 24 women. Recovery rates after the first and recurrent episodes of ISSNHL were 78.9% and 63.2%, respectively. Patients who recovered after recurrent episodes showed significantly higher rates of ear fullness symptoms and early treatment onset than those who did not recover (p < 0.05 each). Of the 30 patients who recovered after the first episode, those who had ear fullness symptoms (p < 0.05, odds ratio (OR) 0.1, 95% confidence interval (CI) 0.01−0.76) and who showed a lower initial hearing threshold (p < 0.05, OR 1.06, 95% CI 1.01−1.12) during the recurrent episode showed significantly better or similar recovery than after the first episode. Ear fullness symptoms and less initial hearing loss were associated with a more favorable prognosis after intial than after recurrent ISSNHL.

Long-term administration of vitamin B12 and adenosine triphosphate for idiopathic sudden sensorineural hearing loss: a retrospective study

Background

In idiopathic sudden sensorineural hearing loss (ISSNHL), the relationship between the administration duration of vitamin B12 (vit B12) with adenosine triphosphate (ATP) and their therapeutic effect is not fully understood.

Objective

To investigate the therapeutic effect of long-term 16 (≥weeks) administration of vit B12 with ATP on the prognosis of ISSNHL patients and compare it with those of short-term (<8 weeks) and middle-term (≥8 weeks, <16 weeks) administration.

Methods

We retrospectively reviewed the medical records of 117 patients with ISSNHL treated between 2015 and 2018.

Results

The overall recovery rate was 32.5%. Initial higher hearing threshold and initial higher grade of hearing loss (HL) were associated with a poor prognosis. However, the administration duration of vit B12 and ATP did not influence the overall hearing improvement. With regard to the time course of hearing recovery, there was no significant difference in hearing recovery among the long-, middle-, and short-term administration groups until 16 weeks after treatment. However, at 16–24 weeks after initial treatment, the short-term administration group exhibited significantly lower hearing recovery than did the long-term administration groups.

Conclusions

The administration duration of vit B12 and ATP did not influence the overall hearing prognosis in ISSNHL, but long-term administration of vit B12 and ATP helped prevent the progression of HL after ISSNHL. Our results suggest that long-term administration of vit B12 and ATP is not necessarily required to treat ISSNHL patients, except for slowly progressing HL in the affected ears.

Recurrences in Sudden Sensorineural Hearing Loss: A Long-Term Observational Study

Purpose Long-term outcomes of sudden sensorineural hearing loss (SSNHL) are poorly studied. The recurrence rate is heterogeneous, and the prognosis of relapses is uncertain. The aim of this retrospective study was to evaluate the recurrence rate of SSNHL and to analyze the correlation with clinical and audiometric characteristics. Method Seventy-three patients with idiopatic SSNHL were evaluated. Clinical and audiometric features were recorded. Seventy patients (95.8%) had at least a 2-year follow-up, whereas 50 (68.4%) had a 5-year follow-up. Results Two- and 5-year recurrence rates were 5.60% and 10.34%, respectively. Mean time lapse between 1st episode and recurrence was 29.33 ± 26.60 months. About 70% of patients had a partial recovery at recurrence. The same ear was affected in 42.8% of patients, the contralateral ear was affected in 42.8% of patients, and recurrence was bilateral in 14.4% of cases. Recurrence correlated only with the presence of tinnitus during follow-up. However, the small number of participants with recurrence represented a limiting factor of our study. Conclusions Recurrences of SSNHL are rare events that can involve ipsilateral or contralateral ear. Further studies are necessary to identify predictors of recurrence.

Association of Vertigo With Hearing Outcomes in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

Importance

Sudden sensorineural hearing loss (SSHL) accompanied by vertigo may portend a negative prognosis in the hearing outcome.

Objective

To investigate the association of vertigo with prognosis of hearing variables in SSHL.

Data Sources

A literature search of eligible studies was performed in PubMed, Web of Science, and Embase from September 26, 1973, through September 26, 2017. Studies published in English were retrieved with no restrictions on the date of publication. References were identified by screening the proceedings of relevant reviews, and annual meeting and other correlative papers were scanned manually for enrollment.

Study Selection

All original research studies and retrospective or prospective studies focusing on the role of vertigo in the prognosis for the hearing outcome of SSHL were systematically retrieved. Studies that did not include data regarding the association between the rate of hearing recovery and vertigo were excluded, as were reviews, comments, case reports, editorials, letters, and practice guidelines.

Data Extraction and Synthesis

Data were extracted and evaluated by 2 researchers. Data extracted included research type, number of participants with or without vertigo, treatment regime, definition of pure-tone average, criteria for hearing improvement, and length of follow-up. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (scores range from 0-9, with a score of ≥6 indicating a high-quality study). The data were synthesized in Mantel-Haenszel models; the aggregate results were estimated in forest plots.

Main Outcomes and Measures

Association of vertigo with the prognosis for the hearing outcome of SSHL.

Results

Of the 4814 unique patients identified in 10 studies, 1709 were included in the SSHL group with vertigo and 3105 were included in SSHL group without vertigo. The Newcastle-Ottawa Scale score of each study selected was greater than 7. The recovery rate of hearing was 42.13% in the group with vertigo, compared with 60.29% in the group without vertigo. Vertigo was significantly associated with a worse hearing recovery (odds ratio, 2.22; 95% CI, 1.54-3.20; I2 = 74%). Similar results were obtained in subgroup analyses of the grading system using the Siegel criteria and systemic corticosteroid therapy. However, no association of vertigo with the prognosis of SSHL was observed within the subgroup receiving intratympanic corticosteroids (odds ratio, 1.78; 95% CI, 0.64-4.94; I2 = 70%).

Conclusions and Relevance

Current evidence revealed that vertigo may be negatively associated with hearing recovery in patients with SSHL, except in a subgroup that received intratympanic corticosteroids. Corticosteroid injection may be more effective for treatment of SSHL accompanied by vertigo; future studies are needed to determine whether treatment of vertigo might contribute to the recovery of SSHL.

Long-term Audiometric Outcomes in Unilateral Sudden Sensorineural Hearing Loss without Recurrence

OBJECTIVES

The recurrence rate of sudden sensorineural hearing loss (SSNHL) varies from 0.8% to 40%. However, to the best of our knowledge, no data on long-term hearing variations are present in the literature. The aim of this observational study was to analyze long-term variations of the hearing threshold in unilateral SSNHL without recurrence.

MATERIALS AND METHODS

A total of 50 patients affected by unilateral SSNHL were evaluated. Patients underwent a treatment consisting of intravenous corticosteroids. Clinical and audiometric features were recorded. Patients underwent pure tone audiometry at a mean follow-up of 5.26±2.28 years. Differences between the affected and unaffected ear were analyzed.

RESULTS

Comparing the post-treatment and follow-up audiograms, there was a worsening of hearing in the unaffected ear. On the contrary, no significant difference over time was found for the affected ear. 54% of patients showed no changes over time, 26% showed worsening, and 20% showed an improvement in hearing. The variation correlated with alcohol consumption and the presence of vasculopathies. An average improvement of hearing over time was observed at low frequencies.

CONCLUSION

The time evolution in SSNHL is not predictable on the basis of the clinical and audiometric data. The majority the patients shows no changes in hearing loss in the affected ear. Patients who consume alcohol or have vasculopathies also have a higher risk of worsening of hearing. Further prospective studies are mandatory to better assess variations over time and their relationship with the effect of aging on hearing.

Pediatric Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied.

The Expression of TNFα, IL-6, IL-2 and IL-8 in the Serum of Patients with Idiopathic Sudden Sensorineural Hearing Loss: Possible Prognostic Factors of Response to Corticosteroid Treatment

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) remains one of the major unsolved otologic emergencies. A viral infection, a systemic inflammatory disorder, as well as physical, mental and metabolic stress can trigger an innate immune response in the inner ear resulting in ISSNHL. Proinflammatory cytokines play a central role in this cochlear immunological cascade. Objective: To examine the expression of proinflammatory cytokines in the serum of patients with ISSNHL in correlation with the therapeutic outcome of intravenous administration of corticosteroids. Method: Forty-three patients primarily diagnosed with ISSNHL underwent intravenous corticosteroid treatment for 8 days. The expression of tumor necrosis factor-α (TNFα), interleukin-6 (IL-6), interleukin-2 (IL-2) and interleukin-8 (IL-8) was detected with the use of enzyme-linked immunosorbent assay in serum specimens on the 1st and 8th day of treatment and it was correlated with the treatment outcome. Results: TNFα reduction and IL-6 increase strongly correlate with a good therapeutic result [χ2(2) = 13.12, p = 0.001 and χ2(2) = 16.78, p = 0.0001]. IL-8 increase reflects negatively on the outcome, however, not in a statistically significant way. No association was established between IL-2 variations and the therapeutic outcome. Conclusions: TNFα and IL-6 can be used as prognostic factors for the treatment outcome, whereas the prognostic value of IL-8 requires further statistical confirmation.

Oral steroid treatment for idiopathic sudden sensorineural hearing loss

OBJECTIVES

To describe the efficacy of long-term oral steroids in idiopathic sudden sensorineural hearing loss (ISSHL), and to explore potential prognosis factors, the relationship of hearing recovery outcome, and the recovery time-course in ISSHL.

METHODS

In this retrospective study, we analyzed 215 cases diagnosed with idiopathic unilateral sudden deafness between January 2003 and December 2012 at a regional hospital in southern Taiwan. All of them received oral steroid therapy and were followed for at least 3 months.

RESULTS

Young age, the presence of no other disease (diabetes, hypertension, or cardiovascular disease), treatment within 7 days of the onset of ISSHL, mild hearing loss, and audiograms with ascending curves had a statistically significant better hearing recovery. The average pure-tone audiometry (PTA) was 67.8±23.9 dB initially, and was improved between one month (51.6±28.7 dB) and 2 months post treatment (49.7±28.6 dB). The average last-visit PTA was 49.9±29.2 dB.

CONCLUSION

Approximately one third of patients had full recovery in hearing, one third had partial recovery, and approximately one third did not recover from hearing loss. In addition, the hearing level remained relatively stable following 2 months of treatment. More than 2 months of oral steroid therapy for ISSHL is not recommended because no additional benefits were evidenced.

Delayed restoration of maximum speech discrimination scores in patients with idiopathic sudden sensorineural hearing loss

OBJECTIVE

To assess possible delayed recovery of the maximum speech discrimination score (SDS) when the audiometric threshold ceases to change.

METHODS

We retrospectively examined 20 patients with idiopathic sudden sensorineural hearing loss (ISSNHL) (gender: 9 males and 11 females, age: 24-71 years). The findings of pure-tone average (PTA), maximum SDS, auditory brainstem responses (ABRs), and tinnitus handicap inventory (THI) were compared among the three periods of 1-3 months, 6-8 months, and 11-13 months after ISSNHL onset.

RESULTS

No significant differences were noted in PTA, whereas an increase of greater than or equal to 10% in maximum SDS was recognized in 9 patients (45%) from the period of 1-3 months to the period of 11-13 months. Four of the 9 patients showed 20% or more recovery of maximum SDS. No significant differences were observed in the interpeak latency difference between waves I and V and the interaural latency difference of wave V in ABRs, whereas an improvement in the THI grade was recognized in 11 patients (55%) from the period of 1-3 months to the period of 11-13 months.

CONCLUSION

The present study suggested the incidence of maximum SDS restoration over 1 year after ISSNHL onset. These findings may be because of the effects of auditory plasticity via the central auditory pathway.

Sudden hearing loss: a study of prognostic factors for hearing recovery

OBJECTIVE

Sudden hearing loss (SHL) is a disease, isolated or associated with vertigo, of unknown etiology. The aim of this study was to identify the prognostic factors for hearing recovery.

METHODS

In this retrospective study, we analyzed 287 cases of SHL (mean age 42). Tonal threshold audiometry, BAEP, and RM were the diagnostic procedures for clinical balance of the patient. The therapy used the following: corticosteroids, osmotic diuretic infusion, and vasoactives. All the factors were evaluated through statistical tests, Spearman test, and linear logistic regression.

RESULTS

In our study, we observed that 39.3% of patients improved, 27.9% remained unchanged, 29% had complete recovery, and 3.8% worsened. Therapy was not related to the degree of recovery from hearing loss, whereas young age, delayed diagnosis, and audiometric curve type were the three factors related to the degree of hearing recovery.

CONCLUSIONS

In our study, we report a better overall recovery rate compared with spontaneous recovery. In particular, early treated patients as well as patients with upsloping hearing loss frequently recovered after treatment. Age, time between onset and treatment, and audiogram type were shown to be significantly related to outcome.

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss

Introduction

Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature.

Objective

To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL.

Methods

Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL.

Results

The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%.

Conclusion

In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis.

Corticosteroid therapy for hearing and balance disorders

This review addresses the current status of steroid therapies for hearing and vestibular disorders and how certain misconceptions may be undermining the efficacy in restoring normal ear function, both experimentally and clinically. Specific misconceptions addressed are that steroid therapy is not effective, steroid-responsive hearing loss proves an underlying inflammatory problem in the ear, and steroids only have application to the hearing disorders listed below. Glucocorticoid therapy for hearing and balance disorders has been employed for over 60 years. It is recommended in cases of sudden hearing loss, Meniére's disease, immune-mediated hearing loss, and any vestibular dysfunction suspected of having an inflammatory etiology. The predominant steroids employed today are dexamethasone, prednisone, prednisolone, and methylprednisolone. Despite years of use, little is known of the steroid responsive mechanisms in the ear that are influenced by glucocorticoid therapy. Furthermore, meta-analyses and clinical study reviews occasionally question whether steroids offer any benefit at all. Foremost in the minds of clinicians is the immune suppression and anti-inflammatory functions of steroids because of their efficacy for autoimmune hearing loss. However, glucocorticoids have a strong binding affinity for the mineralocorticoid (aldosterone) and glucocorticoid receptors, both of which are prominent in the ear. Because the auditory and vestibular end organs require tightly regulated endolymph and perilymph fluids, this ion homeostasis role of the mineralocorticoid receptor cannot be overlooked in both normal and pathologic functions of the ear. The function of the glucocorticoid receptor is to provide anti-inflammatory and antiapoptotic signals by mediating survival factors.

Vascular Pathophysiology in Hearing Disorders

The inner ear vasculature is responsible for maintenance of the blood-labyrinth barrier, transport of systemic hormones for ion homeostasis, and supplying nutrients for metabolic functions. Unfortunately, these blood vessels also expose the ear to circulating inflammatory factors resulting from systemic diseases. Thus, while the inner ear blood vessels are critical for normal function, they also are facilitating pathologic mechanisms that result in hearing and vestibular dysfunction. In spite of these numerous critical roles of inner ear vasculature, little is known of its normal homeostatic functions and how these are compromised in disease. The objective of this review is to discuss the current concepts of vascular biology, how blood vessels naturally respond to circulating inflammatory factors, and how such mechanisms of vascular pathophysiology may cause hearing loss.

Effect of intravenous administration of steroids in the management of sudden sensori-neural hearing loss: our experience

The aim of this study was to investigate the efficacy and outcomes of intravenous high dose steroids in patients diagnosed with sudden sensori-neural hearing loss (SSNHL). The study also looked at the various co-morbidities influencing the outcomes of IV steroid therapy and also evaluated the improvement in associated symptoms like vertigo and tinnitus. This prospective study involved 30 patients treated during the 1 year period from January 2010 to 2011 in the Department of Otolaryngology, Madras ENT Research Foundation, Chennai. Male: female ratio was 1.3:1 and age range was 19-80 years. For all patients, pre treatment pure tone audiometry (PTA) was compared with post treatment PTA at 1 month. Treatment was given in the form of intravenous high dose methyl prednisolone. The patients were divided into two groups. Group 1 (20 pts) included SSNHL with no co-morbidity, group 2 (10 pts) included SSNHL with various co-morbidities. The mean hearing level improved from an average of 79.53 dB (HL) before treatment to 42.33 dB (HL) after treatment. In patients with predominantly low frequency HL (16 pts) PTA improved from 76.01 to 32.6 dB while in high frequency HL PTA improved from 83.55 to 53.43 dB. In our study of 30 patients, complete recovery occurred in 56.66% cases and marked improvement (>30 dB) in 16.66% patients. There was no improvement in 26.66% cases. Patients in group 2 had co-morbid factors like diabetes mellitus, dys-thyroidism and hypertension. A statistically significant improvement in the associated symptoms of tinnitus/vertigo, were also noted after IV steroid treatment. According to our results, emergency administration of high dose of Intra-venous corticosteroids to patients with SSNHL is highly recommended. Patients with high frequency preservation have better hearing improvement at the end of treatment. The critical time period for commencing IV treatment is less than 6 h from onset of hearing loss in order to restore normal hearing. High dose Intravenous steroids are a safe and effective treatment in sudden sensori-neural hearing loss.

Pegylated interferon/ribavirin-associated sudden hearing loss in a patient with chronic hepatitis C in Brazil

Sudden hearing loss is defined as a sensorineural hearing loss, equal to or greater than 30 dB, at three or more consecutive frequencies, which takes place within 72 hours. Both peginterferon and ribavirin are well-known to be associated with significant adverse effects, but sudden hearing loss is uncommon. We report a 65-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon-alpha and ribavirin for chronic hepatitis C. Peginterferon and ribavirin may cause sudden hearing loss that may not recover after discontinuation of therapy. Immediate treatment for all possible etiologies is essential, along with targeted investigations and early referral for an ear, nose and throat specialist. Physicians should be aware of the possible ototoxic effects of peginterferon and ribavirin combination therapy requiring appropriate surveillance.

[Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]

Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.

Metabolic disorders prevalence in sudden deafness

OBJECTIVES

The aim of the present study was to establish the frequency of metabolic disorders among patients with sudden deafness and to compare this frequency with data from population surveys.

INTRODUCTION

No consensus has been reached regarding the prevalence of metabolic disorders among sudden deafness patients or their influence as associated risk factors.

METHODS

This cross-sectional study enrolled all sudden deafness patients treated in the Otolaryngology Department of the University of São Paulo between January 1996 and December 2006. Patients were subjected to laboratory exams including glucose and cholesterol levels, low-density lipoprotein cholesterol fraction, triglycerides, free T4 and TSH.

RESULTS

The sample comprised 166 patients. We observed normal glucose levels in 101 (81.5%) patients and hyperglycemia in 23 (18.5%) patients, which is significantly different (p < 0.0001) compared to the diabetes mellitus prevalence (7.6%) in the Brazilian population. Cholesterol levels were normal in 78 patients (49.7%) and abnormal in 79 (50.3%) patients, which is significantly different compared to the Brazilian population (p = 0.0093). However, no differences were observed in low-density lipoprotein cholesterol fraction (p = 0.1087) or triglyceride levels (p = 0.1474) between sudden hearing loss patients and the Brazilian population. Normal levels of thyroid hormones were observed in 116 patients (78.4%), and abnormal levels were observed in 32 (21.6%) patients. Compared with the prevalence of thyroid disorders in the general population (10%), statistical analysis revealed a significant difference (p = 0.0132) between these two groups.

DISCUSSION

Among sudden deafness patients, we observed frequencies of hyperglycemia and thyroid disorders that were more than twice those of the general population.

CONCLUSIONS

Hyperglycemia and thyroid disorders are much more frequent in patients with sudden deafness than in the general population and should be considered as important associated risk factors.

Randomised, double-blinded, placebo-controlled, clinical trial of ozone therapy as treatment of sudden sensorineural hearing loss

OBJECTIVE

To investigate the safety and efficacy of ozone therapy in adult patients with sudden sensorineural hearing loss.

DESIGN

Prospective, randomised, double-blinded, placebo-controlled, parallel group, clinical trial.

SUBJECTS

Forty-five adult patients presented with sudden sensorineural hearing loss, and were randomly allocated to receive either placebo (15 patients) or ozone therapy (auto-haemotherapy; 30 patients). For the latter treatment, 100 ml of the patient's blood was treated immediately with a 1:1 volume, gaseous mixture of oxygen and ozone (from an ozone generator) and re-injected into the patient by intravenous infusion. Treatments were administered twice weekly for 10 sessions. The following data were recorded: pre- and post-treatment mean hearing gains; air and bone pure tone averages; speech reception thresholds; speech discrimination scores; and subjective recovery rates.

RESULTS

Significant recovery was observed in 23 patients (77 per cent) receiving ozone treatment, compared with six (40 per cent) patients receiving placebo (p < 0.05). Mean hearing gains, pure tone averages, speech reception thresholds and subjective recovery rates were significantly better in ozone-treated patients compared with placebo-treated patients (p < 0.05).

CONCLUSION

Ozone therapy is a significant modality for treatment of sudden sensorineural hearing loss; no complications were observed.

[Sudden hearing loss--our experience in treatment with vasoactive therapy]

INTRODUCTION

A specific title "sudden hearing loss" refers to illness which is characterized by a sudden, rapid sensoneural hearing loss mostly in one ear without obvious causes, accompanied with dizziness, and without vestibular symptomatology. It is defined as a hearing loss for more than 30 dB on 3 or more successive frequencies which appear in 72 hours.

OBJECTIVE

The main goal of our paper was to estimate success of implementation of vasoactive method in patients with sudden hearing loss of senso-neural type in different ranges in hospital conditions.

METHOD

Our research covered 37 patients hospitalized because of a sudden hearing loss of sensoneural type in different ranges. Diagnosis, in all patients, was established by clinical ORL examination, audiology and vestibular examination. R including CT and MR, neurological, internist and laboratory examinations were used in order to exclude other aetiology. In monitored patients, we started treatment with vasoactive therapy, ampules of xanthinol nicotinate (one ampule of 2 ml, 300 mg) or ampules of pentoxiphylline (one ampule of 5 ml, 100 mg) in form of infusions with addition of vitamins with an everyday gradual increase of dosage up to 12 ampules of xanthinol nicotinate and up to 5 ampules of pentoxiphylline. Then we started with an everyday decrease of dosage down to the first one.

RESULTS

After the complete curing protocol, we found out that in patients with light and medium senso-neural damages of hearing sense (23 or 62%), hearing recovery was complete. In patients with heavy damage of hearing (9 or 24%), partial success was evidenced. The most difficult cases, with complete hearing loss, heavy buzzing and vertiginous problem (5 or 14%) responded to therapy, so buzzing and vertiginous problems disappeared but hearing was not improved.

CONCLUSION

Usage of vasoactive medicaments in hospital conditions in treatment of sudden hearing loss gives good results and it is the closest to aetiological therapy.

Urografin in the treatment of sudden sensorineural hearing loss

The present study was conducted to find out whether combined treatment of intravenous urografin and corticosteroid has a therapeutic advantage over oral corticosteroid therapy in the treatment of Sudden Sensorineural Hearing Loss (SSNHL). The design of the study was an interventional and controlled clinical trial. Between 2003 and 2005, patients with SSNHL were treated in our center in Tabriz, Iran. Patients were selected if they had a hearing loss of at least 30 dB in at least 3 frequencies on audiometric testing. Audiograms were performed before admission, 1 and 2 weeks and 1 and 2 months after treatment. Patients who were put on bed rest and received intravenous urografin and hydrocortisone were compared with outpatients treated with oral steroid alone. Various descriptive analytical calculations and both Chi-square and t-test were used to analyze the data. Sixty patients were included in this study. Fifty-one patients referred to the otological clinics for the appropriate treatment within the first two weeks after the onset of hearing loss. The overall improvement of both groups was 53.3%. Seventeen (56.6%) of 30 patients treated in the inpatient group who received intravenous urografin and intravenous corticosteroid had hearing improvement, while half of the outpatient group received oral corticosteroid responded positively to the treatment (p > 0.05). This study revealed no significant difference in hearing improvement between the hospitalized patients who received intravenous urografin and corticosteroid and the patients who received oral corticosteroid alone.