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Kwak C, Seo YJ, Yoon C, Lee J, Han W. The value of having an initial word recognition score for a precise prognosis of idiopathic sudden sensorineural hearing loss. Auris Nasus Larynx 2021; 49:554-563. [PMID: 34772562 DOI: 10.1016/j.anl.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although the hearing thresholds of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) closely relate to the prognosis that results in progressive floor effects, many studies have usually used hearing thresholds as the main outcome of the measurement of prognostic factors. The present study aimed to identify the prognostic factors related to initial hearing tests and speculates the effects of word recognition score (WRS) on the prognoses for patients with ISSNHL. METHODS Between March 2011 and November 2020, we retrospectively reviewed chart profiles of 2,636 ISSNHL patients. The 180 patients who met the inclusion criteria were asked to participate in the present study. Based on their initial WRS, all these patients were divided into good WRS (GW) and poor WRS (PW) groups with 52% as the cut-off points. Demographic, clinical, and audiological variables, such as age, onset time, duration of treatment, gender, ear side, comorbidities (i.e., hypertension, diabetes mellitus, tinnitus, dizziness), hearing configuration (i.e., ascending, descending, flat, irregular, and profound), treatment options (i.e., systemic corticosteroid therapy per oral, intratympanic steroid injection, and hyperbaric oxygen therapy), and WRS were analyzed as being underlying prognostic factors. RESULTS Both groups showed significantly different distributions for hearing thresholds and hyperbaric oxygen therapy (HBOT) as general characteristics. The results of a multivariate logistic regression analysis showed that the odds ratio (OR) of age (OR: 0.96, 95% CI: 0.59 - 24.25), duration of treatment (OR: 0.98, 95% CI: 0.96 - 1.00), ascending configuration (OR: 4.97, 95% CI: 1.64 - 16.62), irregular configuration (OR: 4.58, 95% CI: 1.62 - 13.79), and WRS (OR: 1.01, 95% CI: 1.00 - 1.02) were the significant prognostic factors for all the patients. Further analysis of those patients with WRS under 52% cut-off points showed that an ascending configuration (OR: 5.87, 95% CI: 1.18 - 35.99), irregular configuration (OR: 8.03, 95% CI: 1.69 - 46.30), and WRS (OR: 1.05, 95% CI: 1.01 - 1.10) significantly affected the prognosis. As the initial WRS of ISSNHL patients decreased, the OR of the WRS itself increased. These results suggested that the importance of WRS as the prognostic factor was stressed for PW patients. CONCLUSION The age, duration of treatment, initial hearing configuration (ascending and irregular types), and WRS were the significant prognostic factors for patients with ISSNHL. It was learned that WRS could be a remarkable prognostic factor to consider, especially for ISSNHL patients with poor WRS.
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Affiliation(s)
- Chanbeom Kwak
- Laboratory of Hearing and Technology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea; Division of Speech Pathology and Audiology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Young Joon Seo
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea; Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - ChulYoung Yoon
- Department of biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - JuHyung Lee
- Department of biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woojae Han
- Laboratory of Hearing and Technology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea; Division of Speech Pathology and Audiology, College of Natural Sciences, Hallym University, Chuncheon, Korea.
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Goshtasbi K, Chua JT, Risbud A, Sarna B, Jamshidi S, Abouzari M, Djalilian HR. Treatment of Long-term Sudden Sensorineural Hearing Loss as an Otologic Migraine Phenomenon. Otol Neurotol 2021; 42:1001-1007. [PMID: 33710150 PMCID: PMC8282717 DOI: 10.1097/mao.0000000000003111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy. METHODS Patients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate. RESULTS Twenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p < 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial < 50% WRS, 8 (73%) had improved posttreatment >50% WRS with an average improvement of 39 ± 9%. CONCLUSIONS Migraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Janice T. Chua
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Adwight Risbud
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Brooke Sarna
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Shahrnaz Jamshidi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Fei YP, Zheng Y, Lai D, Zhong P, Lu JZ, Li G, Liu P. Healthy lifestyle consultation based on traditional Chinese medicine versus routine patient education in the treatment of idiopathic sudden sensorineural hearing loss after failure of systemic therapy: study protocol for a clinical randomised trial. Trials 2019; 20:666. [PMID: 31791370 PMCID: PMC6889698 DOI: 10.1186/s13063-019-3733-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023] Open
Abstract
Background Idiopathic sudden sensorineural hearing loss (ISSNHL) is a major cause of deafness. Despite the advances in systemic therapy, some cases of ISSNHL are untreated, because the exact ISSNHL aetiology is unclear. Traditional Chinese medicine (TCM) has been used to treat diseases for thousands of years and is popular and widely practiced in Asia. TCM includes guidance on a healthy lifestyle. In recent decades, the relationship between lifestyle and disease has been emphasised; an unhealthy lifestyle may lead to illnesses. Thus, this study aims to compare the efficacy of lifestyle modification based on TCM with the usual consultation of ISSNHL after failure of a 2-week systemic therapy to provide a scientific basis for clinical decisions. Methods This study is a clinical randomised trial that involves 56 patients diagnosed with ISSNHL but who have had incomplete recovery after initial management (at least 2 weeks of routine Western medical treatment). The study is performed in accordance with the sudden hearing loss clinical guideline of the American Academy of Otolaryngology–Head and Neck Surgery, published in 2012. Participants are randomly distributed into two groups: the healthy lifestyle modification group based on TCM and the control group (1:1 ratio). Patient follow-up lasts for 3 months. The primary outcome measure is the effective rate of hearing improvement, which is defined as the proportion of patients with at least 15 dB of improvement in the average thresholds of hearing loss frequency. The secondary outcome measures are improvements in word recognition score, Tinnitus Handicap Inventory and visual analogue scale for ear blockage and dizziness. Assessments are made at baseline and after lifestyle modification for 1 and 3 months. Discussion The efficacy of healthy lifestyle modification based on a TCM programme for patients with ISSNHL with incomplete recovery after failure of initial systemic therapy is determined in this trial. Positive results will provide clinical evidence on the effects of a TCM-based healthy lifestyle, which could be recommended as salvage therapy for patients with ISSNHL. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-17011459. Registered on 22 May 2017.
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Affiliation(s)
- Ying-Ping Fei
- Hearing Center/Hearing and Speech Science Laboratory, Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yun Zheng
- Hearing Center/Hearing and Speech Science Laboratory, Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
| | - Dan Lai
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, 25 Taiping street, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
| | - Ping Zhong
- Hearing Center/Hearing and Speech Science Laboratory, Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Jing-Zhe Lu
- Hearing Center/Hearing and Speech Science Laboratory, Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Gang Li
- Hearing Center/Hearing and Speech Science Laboratory, Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Peng Liu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Yard, Airport Road, Guangzhou, 510405, People's Republic of China
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Chen XH, Zeng CJ, Fang ZM, Zhang R, Cheng JM, Lin C. The Natural History of Labyrinthine Hemorrhage in Patients With Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2019; 98:E13-E20. [PMID: 30909739 DOI: 10.1177/0145561319834862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the application of inner ear 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL) accompanied by inner ear hemorrhage. A total of 1252 SSNHL patients who were admitted from January 2010 to April 2018 were included in the study. The patients' clinical features, complete blood counts, coagulation profiles, audiometry data, and MRI scans were retrospectively reviewed. Twenty-four patients had high labyrinth signals on inner ear 3D-FLAIR MRI (24/1252, 1.9%) that were diagnosed as inner ear hemorrhage. One patient had endolymphatic hydrops on the contralesional side. In the 24 patients, pure tone audiometry curves revealed profound deafness (19/24) and flat moderate hearing loss (5/24); most patients had associated vertigo (23/24) and tinnitus (19/24). Patients with SSNHL (N = 24) were treated. Sixteen patients had invalid improvement, 3 patients were markedly improved, 4 patients had effective treatment, and only 1 patient was cured, for a therapeutic efficacy of 33.3% (8/24). Follow-up 3D-FLAIR MRI in patients showed absorbance of labyrinthine hemorrhage and disappearance of the high signal intensity in the inner ear within 2 weeks to 4 months. Inner ear 3D-FLAIR MRI indicate that most cases of inner ear hemorrhage are spontaneous and that high labyrinth signals are absorbed within 4 months. The site of labyrinth hemorrhage is irregular and independent of hearing loss. Conventional treatment is not very effective, and an appropriate therapy for SSNHL requires further investigation.
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Affiliation(s)
- Xi-Hang Chen
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Chao-Jun Zeng
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Zhe-Ming Fang
- 2 Department of Radiology, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Rong Zhang
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Jin-Mei Cheng
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
| | - Chang Lin
- 1 Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou, China
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Chen K, Wen L, Zong L, Liu M, Sun J, Wu X. Audiological outcomes in sudden sensorineural hearing loss with presumed inner ear hemorrhage. Am J Otolaryngol 2019; 40:274-278. [PMID: 30473168 DOI: 10.1016/j.amjoto.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the hearing outcomes and prognostic factors in patients with sudden sensorineural hearing loss resulting from inner ear hemorrhage. METHODS 42 patients (22 male and 20 female) were recruited from January 2016 to December 2017. Intravenous methylprednisolone and/or intratympanic corticosteroid were used as salvage therapy. The main measures included systemic risk factors and audiometric outcomes as proposed by American Academy of Otolaryngology-Head and Neck Surgery Hearing Loss Scale. All individuals were assessed at baseline, discharge (2 weeks post-treatment) and at 1, 3 and 6 months. RESULTS The mean ages of patients were 39.3 ± 14.8 yrs. Cardiovascular disorders were seen in 19.0-33.3% of cases. Restoration of hearing and speech discrimination abilities were assessed at the first month post-treatment versus initial levels (95.5 ± 15.5 vs. 109.2 ± 9.6 dB, p = 0.000; and 17.6 ± 24.4 vs. 1.3 ± 4.0%, p = 0.003, respectively). Word recognition scores continued to recover at month 6 (38.7 ± 35.4%, p = 0.000), whereas puretone ceased to change (90.8 ± 16.2 dB, p = 0.139). The final percentages of complete, partial and no recovery were 0%, 57.1% and 42.9% respectively. The prognosis was independent of accompanying systemic risk factors as analyzed in this study. Intratympanic intervention was associated with improved word recognition scores, although intravenous corticosteroid was not. CONCLUSIONS Profound sudden sensorineural hearing loss caused by inner ear hemorrhage often has an unsatisfactory prognosis. However, this cohort did experience partial audiological recovery with delayed onset. Immediate and effective intratympanic corticosteroid may have therapeutic potential for this intractable disease.
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MESH Headings
- Adrenal Cortex Hormones/administration & dosage
- Adult
- Auditory Perception
- Cohort Studies
- Female
- Hearing
- Hearing Loss, Sensorineural/drug therapy
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/rehabilitation
- Hearing Loss, Sudden/drug therapy
- Hearing Loss, Sudden/etiology
- Hearing Loss, Sudden/physiopathology
- Hearing Loss, Sudden/rehabilitation
- Hemorrhage/complications
- Humans
- Infusions, Intravenous
- Injection, Intratympanic
- Labyrinth Diseases/complications
- Male
- Methylprednisolone/administration & dosage
- Middle Aged
- Prognosis
- Risk Factors
- Salvage Therapy
- Treatment Outcome
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Affiliation(s)
- Kaitian Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Lanying Wen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Ling Zong
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, PR China
| | - Min Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Jincangjian Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Xuan Wu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China.
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