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Conway RM, Mallany HP, Shareef Z, Anthony N, Fan CJ, Lucas JC, Babu SC. Effect of pre-incident antiplatelet therapy on sudden sensorineural hearing loss. Am J Otolaryngol 2024; 45:104431. [PMID: 39059167 DOI: 10.1016/j.amjoto.2024.104431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Identify if pre-incident aspirin influences severity and outcome of idiopathic sudden sensorineural hearing loss (SSNHL). STUDY DESIGN Retrospective review. SETTING Tertiary care center. METHODS Patients with idiopathic SSNHL were identified and separated into aspirin and non-aspirin groups. Variables, including demographics, comorbid conditions, audiologic outcomes were identified and compared between groups. RESULTS One hundred forty-eight patients were included that met inclusion criteria. There were 38 patients who were on pre-incident aspirin therapy and 110 patients not on aspirin prior to the onset of SSNHL. Pre- and post-treatment audiologic status was worsened in the aspirin group. Other comorbid conditions, including hyperlipidemia, coronary artery disease (CAD), cerebrovascular accident (CVA), and vertigo symptoms had an effect as well. With multivariate analysis, CAD, CVA, and vertigo symptoms appeared to have an effect more than aspirin. CONCLUSIONS Patients on aspirin have a worsened pre- and post-treatment audiologic status. This appears to be more due to the underlying CAD or history of CVA rather than aspirin use itself.
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Affiliation(s)
| | - Hugh P Mallany
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, NY, USA
| | - Zaid Shareef
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | | | - Caleb J Fan
- Michigan Ear Institute, Farmington Hills, MI, USA
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Shon S, Lim K, Chae M, Lee H, Choi J. Predicting Sudden Sensorineural Hearing Loss Recovery with Patient-Personalized Seigel's Criteria Using Machine Learning. Diagnostics (Basel) 2024; 14:1296. [PMID: 38928711 PMCID: PMC11202901 DOI: 10.3390/diagnostics14121296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Accurate prognostic prediction is crucial for managing Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). Previous studies developing ISSHL prognosis models often overlooked individual variability in hearing damage by relying on fixed frequency domains. This study aims to develop models predicting ISSHL prognosis one month after treatment, focusing on patient-specific hearing impairments. METHODS Patient-Personalized Seigel's Criteria (PPSC) were developed considering patient-specific hearing impairment related to ISSHL criteria. We performed a statistical test to assess the shift in the recovery assessment when applying PPSC. The utilized dataset of 581 patients comprised demographic information, health records, laboratory testing, onset and treatment, and hearing levels. To reduce the model's reliance on hearing level features, we used only the averages of hearing levels of the impaired frequencies. Then, model development, evaluation, and interpretation proceeded. RESULTS The chi-square test (p-value: 0.106) indicated that the shift in recovery assessment is not statistically significant. The soft-voting ensemble model was most effective, achieving an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.864 (95% CI: 0.801-0.927), with model interpretation based on the SHapley Additive exPlanations value. CONCLUSIONS With PPSC, providing a hearing assessment comparable to traditional Seigel's criteria, the developed models successfully predicted ISSHL recovery one month post-treatment by considering patient-specific impairments.
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Affiliation(s)
- Sanghyun Shon
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul 02708, Republic of Korea; (S.S.); (M.C.)
| | - Kanghyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea;
| | - Minsu Chae
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul 02708, Republic of Korea; (S.S.); (M.C.)
| | - Hwamin Lee
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul 02708, Republic of Korea; (S.S.); (M.C.)
| | - June Choi
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul 02708, Republic of Korea; (S.S.); (M.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea;
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Aliyeva A, Edizer DT. Efficacy of intratympanic steroid therapy for severe and profound sudden sensorineural hearing loss. Am J Otolaryngol 2024; 45:104170. [PMID: 38101127 DOI: 10.1016/j.amjoto.2023.104170] [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: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Intratympanic steroids (ITS) in treating sudden sensorineural hearing loss (SSNHL) have become more widespread. AIM This study investigates whether ITS treatment provides additional benefits when combined with systemic steroids (SS) in patients with severe and profound SSNHL. MATERIALS AND METHODS Patients diagnosed with severe and profound SSNHL were divided into two groups: SS group and SS combined with ITS group. Pure-tone audiometry was performed before and three months after treatment completion. The pure-tone average (PTA), frequency-specific hearing gains, and average values were compared between the groups. RESULTS The study included 57 patients (27 SS, 30 ITS), with a mean age of 50.09 ± 15.56. Before treatment: SS PTA 84.40 ± 15 dB HL, ITS 87.50 ± 9.38 dB HL (p = 0.36). After treatment: SS 62.2 ± 23.13 dB HL, ITS 65.17 ± 12.19 dB HL (p = 0.55). Average hearing gain: SS 22.19 ± 13.81 dB HL, ITS 22.33 ± 12.24 dB HL (p = 0.96). Frequency-specific gains were similar (p > 0.05). SS group: 12 slight improvement, 10 no improvement, 3 partial, 2 complete recovery. ITS group: 23 slight improvement, 6 no improvement, 1 partial. CONCLUSION In our study, combining ITS with SS treatment did not provide additional benefits in treating severe and profound SSNHL.
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Affiliation(s)
- Aynur Aliyeva
- The Division of the Otolaryngology, The Cincinnati Children's Hospital Medical Center, OH, USA; Neuroscience Doctoral Program, Yeditepe University, Istanbul, Turkey.
| | - Deniz Tuna Edizer
- Department Of Otorhinolaryngology, School of Medicine, Acibadem University, Istanbul, Turkey
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Choi Y, Han SJ, Kim SK, Hong SM. The therapeutic effect of hyperbaric oxygen therapy in patients with severe to profound idiopathic sudden sensorineural hearing loss. Sci Rep 2024; 14:3321. [PMID: 38337013 PMCID: PMC10858205 DOI: 10.1038/s41598-024-53978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
The optimal treatment for sudden sensorineural hearing loss (SSNHL) is unclear. Hyperbaric oxygen therapy (HBOT) has been suggested as a viable option for treatment of SSNHL as it improves vascular dysfunction. In this study, we evaluated the therapeutic effects of HBOT by retrospectively reviewing the records of 2206 patients with SSNHL. 54 who had received HBOT were selected for the HBOT groups, while 59 age-matched controls who had not were selected for the control groups. The HBOT and control groups were divided into subgroups according to intratympanic steroid (ITS) use. Groups A-D had received oral steroids + HBOT, oral steroids only, oral steroids + ITS + HBOT, and oral steroids + ITS, respectively. Of the 113 SSNHL patients, 21 had diabetes mellitus (DM) (2, 0, 9, and 10 patients in Groups A-D, respectively). There was no notable difference in hearing improvement between patients receiving HBOT and those in the control group. However, among diabetic patients, those who underwent HBOT demonstrated a significant improvement in hearing when compared to the control group. The combination of HBOT and steroids could potentially be beneficial for treating severe to profound SSNHL patients with DM.
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Affiliation(s)
- Yeso Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong-si, 18450, Korea
| | - Sung Jun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong-si, 18450, Korea
| | - Sung Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong-si, 18450, Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong-si, 18450, Korea.
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Lemons K, Archambault E, Anderson M, Kaizer A, Baiduc RR. Recovery From Idiopathic Sudden Sensorineural Hearing Loss: Association With Cardiovascular Disease Risk. Am J Audiol 2023; 32:865-877. [PMID: 37748022 DOI: 10.1044/2023_aja-22-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The purpose of this study is to investigate the association between cardiovascular disease (CVD) risk factors and idiopathic sudden sensorineural hearing loss (ISSNHL) disease severity and recovery. METHOD A retrospective medical chart review was performed on 90 patients (n = 48 men; Mage = 59.8 years, SD = 15.8) evaluated for ISSNHL. Major CVD risk factors (current tobacco smoking, diabetes, total cholesterol ≥ 240 mg/dl or treatment, and hypertension [systolic blood pressure [BP]/diastolic BP ≥ 140/ ≥ 90 mmHg or treatment]) determined two CVD risk groups: lower (no major risk factors) and higher (one or more risk factors). Two pure-tone averages (PTAs) were computed: PTA0.5,1,2 and PTA3,4,6,8. Complete recovery of ISSNHL was defined as PTAinitial - PTAfollow-up ≥ 10 dB. Logistic regression estimated the odds of ISSNHL recovery by CVD risk status adjusting for age, sex, body mass index, noise exposure, and treatment. RESULTS Most patients (67.8%) had one or more CVD risk factors. Severity of initial low- and high-frequency hearing loss was similar between CVD risk groups. Recovery was 53.2% for PTA0.5,1,2 and 32.9% for PTA3,4,6,8. With multivariable adjustment, current/former smoking was associated with lower odds of PTA0.5,1,2 recovery (OR = 0.27; 95% CI [0.08, 0.92]). Neither higher CVD risk status nor individual CVD risk factors had a significant association with recovery. For every one-unit increase in Framingham Risk Score, odds of PTA3,4,6,8 recovery were 0.95 times lower (95% CI [0.90, 1.00]) after accounting for age, sex, body mass index, noise exposure, and treatment/time-to-treatment grouping (p = .056). CONCLUSIONS The prognosis of low-frequency ISSNHL recovery is worse among current/former smokers than nonsmokers. Other CVD risk factors and aggregate risk are not significantly related to recovery.
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Affiliation(s)
- Katherine Lemons
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
| | - Emily Archambault
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
| | - Melinda Anderson
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Alexander Kaizer
- Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, University of Colorado School of Public Health, Aurora
| | - Rachael R Baiduc
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
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Ushio M, Kitazawa Y, Tamura Y, Yoshida T, Uchiyama M, Takanami T, Tanaka T, Ikemiyagi Y, Ikemiyagi F, Ohta Y. High Cardio-Ankle Vascular Index Values in Idiopathic Sudden Sensorineural Hearing Loss Patients Indicate Better Prognosis. Cureus 2023; 15:e49400. [PMID: 38149140 PMCID: PMC10750140 DOI: 10.7759/cureus.49400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Vascular disorders and viral infections are the presumed etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) and acute sensorineural hearing loss, with no identifiable cause. However, no clinical test for estimating the extent of vascular involvement in ISSNHL has been reported despite its potential impact on prognosis and treatment. We investigated the correlation between the cardio-ankle vascular index (CAVI), which reflects arterial stiffness and elasticity, and hearing improvement to ascertain its usefulness as an additional indicator of ISSNHL prognosis and etiology. METHODS We enrolled 182 patients diagnosed with definite ISSNHL. The percentage of mild ISSNHL patients and that of patients experiencing no change were compared between the high-CAVI and low-CAVI groups. Age, initial and final pure-tone average (PTA) values, CAVI, presence or absence of vertigo, and medical histories were retrospectively reviewed and included in univariate and multivariate analyses. RESULTS The percentage of mild ISSNHL patients was smaller in the high-CAVI group than in the low-CAVI group, whereas the percentage of patients experiencing no change was smaller in the high-CAVI group than in the low-CAVI group, although patients in the high-CAVI group were significantly older than those in the low-CAVI group. The Cox proportional hazard model revealed that high CAVI, hypertension, younger age, and initial PTA <90 dB were associated with hearing improvement. CONCLUSIONS ISSNHL in patients with high CAVI was more severe but had a better prognosis than that in those with low CAVI. CAVI may help evaluate diseases of vascular and other etiologies, as well as ISSNHL.
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Affiliation(s)
- Munetaka Ushio
- Otolaryngology, Toho University Sakura Medical Center, Sakura, JPN
| | | | - Yuya Tamura
- Otolaryngology, Matsudo Ear Nose Throat Clinic, Matsudo, JPN
| | - Tomoe Yoshida
- Clinical Support Service, Toho University Sakura Medical Center, Sakura, JPN
| | | | - Taro Takanami
- Otolaryngology, Toho University Sakura Medical Center, Sakura, JPN
| | - Toshitake Tanaka
- Otolaryngology, Toho University Sakura Medical Center, Sakura, JPN
| | | | | | - Yasushi Ohta
- Otolaryngology, Toho University Sakura Medical Center, Sakura, JPN
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Vofo G, de Jong MA, Kaufman M, Meyler J, Eliashar R, Gross M. The impact of vestibular symptoms and electronystagmography results on recovery from sudden sensorineural hearing loss. J Basic Clin Physiol Pharmacol 2023; 34:489-494. [PMID: 34284525 DOI: 10.1515/jbcpp-2020-0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. METHODS An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. RESULTS Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). CONCLUSIONS The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.
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Affiliation(s)
- Gaelle Vofo
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
| | - Marrigje Aagje de Jong
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
| | - Michal Kaufman
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
| | - Julia Meyler
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
| | - Menachem Gross
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Medical Centre, Jerusalem, Israel
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Klein L, Handzel O, Shilo S, Oron Y, Abu Eta R, Muhanna N, Ungar OJ. Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses. Otol Neurotol 2023; 44:216-222. [PMID: 36728176 DOI: 10.1097/mao.0000000000003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome. METHODS A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days. RESULTS The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25-0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I 2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26-0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I 2 = 52.1%). The OR was 0.31 (95% CI, 0.21-0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I 2 = 0.0%). CONCLUSION Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Linor Klein
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alhussaini MA, Mohamed SA, El-Razek MAA, Mohamed ES, Gad MOA. Predictive factors for recovery in idiopathic sudden sensory neural hearing loss. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered a clinical symptom of various conditions. Circulatory disorders, viral infection, labyrinthine membrane rupture, and autoimmune reactions are considered as the common causes, but the exact cause remains unestablished. Various drugs and methods have been used empirically for the treatment of ISSHL. The current study aimed at evaluation factors contributing to the success of standardized medical therapy in cases of ISSNHL.
Methods
In period between 2019 and 2021, a total 40 patients with ISSNHL were enrolled. All patients were subjected to history taking, physical and ENT evaluation. Patients were managed according to the recent guidelines for managing ISSNHL included systemic steroid and salvage therapy.
Results
Mean age of studied patients was 42.55 ± 13.14 years with range between 19 and 70 years. Out of the studied patients; 26 (65%) patients were males and 14 (35%) patients were females. Majority (80%) of patients had no comorbidities. Based on the current study, we found that only 12 (30%) patients were improved while 28 (70%) patients were not improved. It was found that majority (58.3%) of improved patients was females. Frequency of vertigo was significantly higher among patients who were not improved. Three (10.7%) patients of not-improved group and 5 (41.7%) patients of improved group had low lymphocyte:monocytes ratio.
Conclusion
Patients with ISSNHL, the presence of vertigo and late onset of presentation may carry a risk for poor prognosis. Multiple centers studies with large number of patients are warranted to confirm such findings.
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Yuan H, Liu CC, Ma PW, Chen JW, Wang WL, Gao W, Lu PH, Ding XR, Lun YQ, Lu LJ. Systemic steroid administration combined with intratympanic steroid injection in the treatment of a unilateral sudden hearing loss prognosis prediction model: A retrospective observational study. Front Neurol 2022; 13:976393. [PMID: 36203999 PMCID: PMC9530985 DOI: 10.3389/fneur.2022.976393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency ear disease that is referred to as a sensorineural hearing loss of at least 30 dB in three sequential frequencies and occurs over a period of < 72 h. Because of its etiology, pathogenesis, and prognostic factors, the current treatment methods are not ideal. Previous studies have developed prognostic models to predict hearing recovery from ISSNHL, but few studies have incorporated serum biochemical indicators into previous models. The aim of this study was to explore the factors influencing the ISSNHL prognosis of combination therapy (combined intratympanic and systemic use of steroids, CT), among the patient population data, the serum biochemical indicators before the treatment, and the clinical features of ISSNHL. The new prediction model was developed through these factors. From November 2015 to April 2022, 430 patients who underwent CT at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for ISSNHL, were reviewed retrospectively. We found significant differences in age (P = 0.018), glucose (P = 0.035), white blood cell (WBC) (P = 0.021), vertigo (P = 0.000) and type (P = 0.000) with different therapeutic efficacies. Multivariate logistic regression analysis showed that age (OR = 0.715, P = 0.023), WBC (OR = 0.527, P = 0.01), platelet to lymphocyte ratio (PLR) (OR = 0.995, P = 0.038), vertigo (OR = 0.48, P = 0.004), course (time from onset to treatment) (OR = 0.681, P = 0.016) and type (OR = 0.409, P = 0.000) were independent risk factors for ISSNHL prognosis. Based on independent risk factors, a predictive model and nomogram were developed to predict hearing outcomes in ISSNHL patients. The area under the curve (AUC) value of the model developed in this study was 0.773 (95% CI = 0.730–0.812), which has a certain predictive ability. The calibration curve indicated good consistency between the actual diagnosed therapeutic effectiveness and the predicted probability. The model and nomogram can predict the hearing prognosis of ISSNHL patients treated with CT and can provide help for medical staff to make the best clinical decision. This study has been registered with the registration number ChiCTR2200061379.
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Chen SL, Hu CY, Chan KC, Chin SC, Ho CY. Prognostic factors in elderly patients after an intra-tympanic steroid injection for idiopathic sudden sensorineural hearing loss. Am J Otolaryngol 2022; 43:103528. [PMID: 35691052 DOI: 10.1016/j.amjoto.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
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.
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12
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Lee HJ, Park Y, Lee JM, Yoon C, Kong TH, Jeon E. Comparison of Auditory Outcomes between Inpatient- and Outpatient-Based Treatment in Sudden Sensorineural Hearing Loss. J Clin Med 2022; 11:jcm11113123. [PMID: 35683508 PMCID: PMC9181492 DOI: 10.3390/jcm11113123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: The primary treatment for sudden hearing loss is high-dose steroid therapy. In some countries, hospitalization has been taken for granted. Although most countries appear to treat sudden hearing loss on an outpatient basis, some other countries have considered hospitalization as necessary. Only a few studies have been conducted on the effect of hospitalization on hearing outcomes. Therefore, we compared the hearing outcome of inpatient- and outpatient-based treatments to determine whether hospitalization affects the recovery of sudden hearing loss. Methods: We conducted a retrospective case review of patients diagnosed with sudden sensorineural hearing loss (SSNHL). In total, 439 patients with SSNHL were enrolled and categorized as either inpatients (group I) or outpatients (group O). Pure-tone audiometry was initially performed before the treatment and 3 months post-treatment. “Recovery” was defined as a hearing gain of 15 dB HL and a final hearing of better than 25 dB. “No recovery” was defined as an improvement of hearing gain of <15 dB 3 months after treatment. To exclude the effect of the level of pretreatment hearing loss, we divided the patients into three subgroups based on their hearing level: <40 dB, 40−70 dB, and >70 dB. To assess the effect of the treatment modality, the patients were divided into three treatment subgroups: systemic steroids (SS), intratympanic steroids (ITS), and a combination of both (SS and ITS). Results: The pretreatment hearing level was significantly higher in group I (61.5 ± 25.4 dB) than in group O (50.3 ± 23.0 dB; p < 0.05). The hearing gain was significantly higher in group I (33.3 ± 24.4 dB) than in group O (24.0 ± 21.8 dB; p < 0.05). The “Recovery” ratio was significantly higher in group I (70.2%) than in group O (63.1%) (p < 0.05). A repeated measures ANOVA was performed to assess the statistical differences between hospitalization, treatment modalities, and pretreatment subgroups. The inpatient group showed a significant hearing improvement in all SSNHL patients (p < 0.05). There was a significant hearing improvement in the inpatient group with pretreatment hearing <40 and 40−70 dB (p < 0.05). There was no significant difference between the inpatient and outpatient groups in pretreatment hearing >70 dB (p > 0.05). Conclusions: This retrospective study showed that inpatient treatment for sudden hearing loss is more beneficial for hearing improvement than outpatient treatment. The positive effect of inpatient treatment appears to be significant in patients with a pretreatment hearing level of 70 dB or less.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
| | - Yesai Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
| | - Jeon-Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea;
| | - Chulyoung Yoon
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Tae-Hoon Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Eunju Jeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
- Correspondence: ; Tel.: +82-32-280-5903; Fax: +82-50-4411-7964
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Maia NDPD, Lopes KDC, Ganança FF. Vestibular function assessment in sudden hearing loss. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S81-S88. [PMID: 35697630 DOI: 10.1016/j.bjorl.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES To perform vestibular assessment using cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing in patients with sudden hearing loss. Moreover, to evaluate the correlation of dizziness with vestibular tests and the correlation of vestibular tests with hearing prognosis. METHODS This is an observational, longitudinal and prospective study, including participants diagnosed with sudden hearing loss. The participants underwent cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing. The audiometric assessment was performed at the beginning and at the end of the follow-up. A value of p≤0.05 was considered statistically significant. RESULTS Seventeen patients were included in the study sample, with a mean age of 45.4±11.1 years. Five participants (29.41%) had dizziness and 15 (88.23%) had tinnitus. All participants underwent vestibular evaluation through cervical and ocular vestibular evoked myogenic potential and video head impulse test, and 13 of them were evaluated through caloric testing. The cervical vestibular evoked myogenic potential was considered altered in five (29.41%) participants, while 11 (64.71%) showed alterations at the ocular vestibular evoked myogenic potential. The video head impulse test and the caloric testing were considered altered in seven (41.18%) and five (38.46%) participants, respectively. There was no statistically significant correlation between the clinical data and the results of vestibular tests or hearing recovery, nor between the results of vestibular tests and hearing recovery. CONCLUSION The assessment through vestibular evoked myogenic potential, video head impulse test and caloric testing showed vestibular involvement in some participants. However, it cannot be stated that the results of the vestibular tests are related to the hearing prognosis of sudden hearing loss.
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Affiliation(s)
- Nathalia de Paula Doyle Maia
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ambulatório de Otoneurologia, São Paulo, SP, Brazil.
| | - Karen de Carvalho Lopes
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ambulatório de Otoneurologia, São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ambulatório de Otoneurologia, São Paulo, SP, Brazil
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Huang CY, Cheng YF, Yang AC, Lin CJ, Ieong PI, Hsueh CY. The moderating effect of personality traits on acute tinnitus sensation in idiopathic sudden sensorineural hearing loss. J Chin Med Assoc 2022; 85:633-638. [PMID: 35266917 DOI: 10.1097/jcma.0000000000000710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND People may experience tinnitus after sudden hearing impairment. The details of the relationship between tinnitus improvement and hearing recovery are still unclear. Personality traits may play a role in the modulation of tinnitus sensation. We investigated the moderating effect of personality traits on pretreatment and posttreatment tinnitus sensation in patients with idiopathic sudden sensorineural hearing loss (ISSHL). METHODS This prospective longitudinal study enrolled 33 patients diagnosed with unilateral ISSHL and acute tinnitus in 2018-2019 at one institute. Clinical data were collected before and after treatment, including results of pure-tone audiometry (PTA), the Clinical Tinnitus Questionnaire (CTQ), the Tinnitus Handicap Inventory (THI), tinnitus loudness and annoyance (Visual Analog Scale; VAS), the Hospital Anxiety and Depression Scale (HADS), and the Big Five Inventory (BFI)-44. RESULTS Eighteen men and 15 women with an average age of 48.3 ± 15.8 years were enrolled. The pretreatment hearing threshold and THI score were 58.0 ± 27.4 dB HL and 42.9 ± 26.2 (range: 0-88), respectively; the posttreatment values were 39.8 ± 22.4 dB HL and 20.7 ± 22.5 (range: 0-64), respectively. There were significant differences between pretreatment and posttreatment hearing thresholds as well as THI, VAS, and HADS scores (p < 0.001) but not BFI-44 results. Neuroticism and openness had significant positive and negative correlations, respectively, with acute tinnitus stress before treatment (r = 0.561, p = 0.001; r = -0.359, p = 0.040). After 3 months of follow-up, all patients were analyzed separately by dividing them into recovery (n = 16) and nonrecovery groups (n = 14) according to their hearing improvement status by Siegel's criteria. Neuroticism showed a significant moderating effect on acute tinnitus sensation in the ISSHL recovery group (p < 0.001) but not in the nonrecovery group (p = 0.106). CONCLUSION Neuroticism and openness may affect acute tinnitus stress in ISSHL patients. Practitioners should consider personality traits when managing ISSHL patients with bothersome tinnitus.
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Affiliation(s)
- Chii-Yuan Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institude of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
- Digital Medicine Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Albert C Yang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institude of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
- Digital Medicine Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Ju Lin
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pak-In Ieong
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chien-Yu Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
- Institude of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Tapei, Taiwan, ROC
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Cho Y, Kim J, Oh SJ, Kong SK, Choi SW. Clinical features and prognosis of severe-to-profound sudden sensorineural hearing loss. Am J Otolaryngol 2022; 43:103455. [PMID: 35398740 DOI: 10.1016/j.amjoto.2022.103455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Sudden sensorineural hearing loss (SSNHL) is an otologic emergency. Despite multiple efforts to clarify the factors affecting the prognosis of severe-to-profound SSNHL, various studies showed inconsistent results and lack of clinical significance. Therefore, we examined the clinical features and outcomes of severe-to-profound SSNHL. MATERIALS AND METHODS We included patients who experienced SSNHL between 2018 and 2021 and were diagnosed according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; hearing loss over 70 dB on initial pure tone audiometry (PTA) was used to define severe-to-profound SSNHL. We retrospectively examine the demographic, laboratory, radiologic, and audiometric data of SSNHL patients. We also evaluated the final hearing gain of these patients by assessing their PTA findings and word-recognition scores. RESULTS Of the 178 patients, 94 (52.81%) and 84 (47.19%) showed profound (>90 dB) and severe (>70 to 90 dB) hearing loss, respectively. The presence of vertigo and hypertension differed significantly between the severe and profound groups (p < 0.001 and p = 0.012, respectively), as did the initial serum creatinine level (p = 0.043). Recovery in PTA showed a reliable correlation with the interval between onset and treatment in the severe group and periventricular white-matter findings in the profound group (p < 0.001 and p = 0.011, respectively). The presence of hypertension was related to recovery of low tone (p = 0.023 for 250 Hz; p = 0.034 for 500 Hz), while glycated hemoglobin level was related to recovery of high tone in the severe group (p = 0.049 for 4000 Hz; p = 0.047 for 8000 Hz). CONCLUSIONS Severe-to-profound SSNHL showed poor prognosis for hearing gain. The interval from onset to treatment was a significant prognostic factor for severe SSNHL, while the presence of vertigo, estimated glomerular filtration rate, and periventricular white-matter findings were significant prognostic factors for profound SSNHL.
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Xiong W, Dai Q, Wang Y, Hou Z, Lu K, Sun X, Duan F, Wang H, Zhang D, Wang M. Idiopathic Sudden Sensorineural Hearing Loss in Different Ages: Prognosis of Patients With Initial Total Hearing Loss. Front Psychol 2022; 13:818967. [PMID: 35401359 PMCID: PMC8987369 DOI: 10.3389/fpsyg.2022.818967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objective This study aimed to analyze the hearing improvement and prognosis factors of idiopathic sudden sensorineural hearing loss (ISSNHL) in different ages with initial total hearing loss. Methods We reviewed the medical records of 5,711 hospitalized patients with ISSNHL from 2016 to 2021 in our center. All of the patients had been treated with uniform combination drug therapy. After excluding the patients with initial partial hearing loss and those diagnosed with clear etiology, 188 patients were enrolled in this study and divided into six age groups (18–30, 31–40, 41–50, 51–60, 61–70, ≥ 71 years). In all groups, decreases in pure-tone average (PTA) 1 month posttreatment, effective rate, and clinical characteristics (vertigo, tinnitus, hospital stay, comorbidity, and inner ear magnetic resonance imaging) were analyzed. Results Among the 188 enrolled patients, 86% had vertigo. Complete recovery was seen in 0.5% of patients, and marked recovery was seen in 43% of patients. The mean 1 month posttreatment PTAs were as follows: 18–30 years: 80 ± 7.5 dB; 31–40 years: 100 ± 9.0 dB; 41–50 years: 99 ± 8.3 dB; 51–60 years: 101 ± 8.6 dB; 61–70 years: 96 ± 9.6 dB; and ≥ 71 years: 88 ± 13.0 dB. Compared with the other groups, the 18–30- years group showed better recovery of hearing threshold in five frequencies (0.25, 0.5, 1, 2, and 4 kHz, respectively, at octave or semioctave frequencies under air conduction), and the recovery of hearing threshold at 0.25 and 0.5 Hz was better than the recovery at 1, 2, and 4 kHz. According to the results of the chi-square test statistical analysis, vertigo and comorbidities were associated with a poor prognosis of ISSNHL. Conclusion In summary, the treatment outcomes of patients with ISSNHL with initial total hearing loss were poor. There was a significant age-related difference with respect to marked recovery 1 month posttreatment, and the 18–30- years group showed better recovery than the other age groups.
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Huang CY, Li DS, Tsai MH, Chen CH, Cheng YF. The Impact of Acute Tinnitus on Listening Effort: A Study Based on Clinical Observations of Sudden Sensorineural Hearing Loss Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063661. [PMID: 35329346 PMCID: PMC8955353 DOI: 10.3390/ijerph19063661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
This study investigates the relationship between listening effort and acute tinnitus over the clinical course of sudden sensorineural hearing loss (SSNHL) before and after treatment. Thirty SSNHL patients with acute tinnitus were enrolled in this prospective study. Each patient was evaluated before treatment and after 1 and 3 months of follow-up. Listening effort was evaluated in the unaffected ears in two conditions (with and without background noise) using a dual-task paradigm, which included a primary (speech recognition) task and a secondary (visual reaction time) task. Tinnitus severity was assessed with the Tinnitus Handicap Inventory (THI). It was observed that background noise significantly increased listening effort in SSNHL patients with acute tinnitus before and after treatment. THI scores and listening effort in quiet conditions (** p = 0.009) were significantly decreased three months after treatment. In an analysis of the relation between tinnitus severity and listening effort, it was found that the THI total score was significantly correlated with listening effort in quiet (* p = 0.0388) and noisy conditions (* p = 0.044) before treatment. We concluded that SSNHL patients with acute tinnitus exerted greater listening effort in the presence of background noise than in quiet conditions. Furthermore, listening effort was reduced as tinnitus improved in SSNHL patients during the three months after treatment. Both before and after 3 months of treatment, patients who were more affected and emotionally distressed by tinnitus tended to exert more listening effort in both quiet and noisy environments.
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Affiliation(s)
- Chii-Yuan Huang
- Department of Otolaryngology Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (C.-Y.H.); (D.-S.L.); (C.-H.C.)
- Faculty of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
| | - Dian-Sian Li
- Department of Otolaryngology Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (C.-Y.H.); (D.-S.L.); (C.-H.C.)
- Faculty of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
| | - Ming-Hsien Tsai
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
| | - Chih-Hao Chen
- Department of Otolaryngology Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (C.-Y.H.); (D.-S.L.); (C.-H.C.)
| | - Yen-Fu Cheng
- Department of Otolaryngology Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (C.-Y.H.); (D.-S.L.); (C.-H.C.)
- Faculty of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence:
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Hu CY, Lien KH, Chen SL, Zhang BY, Chan KC. Complications and prognosis associated with intra-tympanic steroid injection to treat sudden sensorineural hearing impairment. Am J Otolaryngol 2022; 43:103221. [PMID: 34536925 DOI: 10.1016/j.amjoto.2021.103221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to measure the incidence of complications in sudden sensorineural hearing loss (SSNHL) patients treated with intra-tympanic steroid injection (ITSI) and compare hearing recovery rates. MATERIALS AND METHODS 123 patients with unilateral SSNHL receiving ITSIs were included in this study. Post-ITSI complications were documented including otalgia, dysgeusia, vertigo (duration>1 h), and persistent eardrum perforation. The pain intensity was evaluated with visual analog scale (VAS). Hearing was measured before ITSI and at 1 month after the final ITSI. We compared our patients' hearing threshold between presence and absence of different complications. RESULTS 47.2% patients experienced post-injection otalgia with the average VAS score 3.2 (range 2-6). Five (4.1%) and six (4.9%) patients exhibited vertigo and persistent eardrum perforations, respectively. The patients were divided into three groups based on the absence of complications and the presence of vertigo and eardrum perforation. The hearing threshold improvements did not differ significantly among the three groups (p = 0.366). Although the difference was not significant (p = 0.664), the proportion of patients experiencing post-ITSI vertigo who were on contemporaneous oral steroids was lower than the proportion of non-vertigo patients on such steroids. CONCLUSION The incidences of otalgia, vertigo, and persistent eardrum perforation in SSNHL patients treated with ITSI were 47.2%, 4.1% and 4.9%, respectively. We found no association between concurrent oral steroid use and the incidence of post-ITSI eardrum perforation or vertigo. Although statistical significance was lacking, patients who did not take contemporaneous oral steroids may have a higher rate of prolonged post-ITSI vertigo.
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Affiliation(s)
- Chih-Yu Hu
- Division of Otology, Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan
| | - Kuang-Hsu Lien
- Division of Otology, Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - Shih-Lung Chen
- Division of Otology, Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Bang-Yan Zhang
- New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan
| | - Kai-Chieh Chan
- Division of Otology, Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan.
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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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Perez Ferreira Neto A, da Costa Monsanto R, Dore Saint Jean L, Sonzzini Ribeiro de Souza L, de Oliveira Penido N. Clinical Profile of Patients With Unilateral Sudden Sensorineural Hearing Loss: Correlation With Hearing Prognosis. Otolaryngol Head Neck Surg 2021; 165:563-570. [PMID: 33557702 DOI: 10.1177/0194599820986571] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize, with a standard systematic protocol, the clinical and audiometric profile of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to correlate the findings with hearing recovery prognosis. STUDY DESIGN Retrospective cohort of patients with ISSNHL. SETTING Outpatients of a tertiary referral center followed for 20 years. METHODS We collected clinical information, including the presence of tinnitus, vertigo, and comorbidities, as well as initial pure tone averages, degree of hearing loss, audiogram curves, and time between hearing loss onset and treatment. These variables were statistically analyzed for their impact on hearing recovery prognosis. All patients were treated with oral corticosteroids, following a standard treatment protocol. Hearing recovery was defined according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, and hearing outcomes were reported via a standardized method (scattergrams). RESULTS Our final study group comprised 186 patients. Most patients were between 41 and 60 years of age. Univariate analysis revealed that vertigo; presence of severe or profound initial hearing loss; flat, U-shaped, and descending audiogram curves; and initiating treatment ≥15 days were correlated with worse hearing recovery. However, the multivariate logistic model revealed that only the presence of severe or profound hearing loss (odds ratio, 6.634; 95% CI, 2.714-16.216; P < .001) and initiating treatment ≥15 days (odds ratio, 0.250; 95% CI, 0.102-0.610; P = .008) were independent risk factors for worse hearing recovery prognosis. CONCLUSION This study demonstrated that the presence of severe or profound hearing loss at the first audiogram and initiating treatment after 14 days from ISSNHL onset were independent risk factors associated with a worse hearing recovery prognosis.
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Affiliation(s)
- Adriana Perez Ferreira Neto
- Department of Otorhinolaryngology-Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Rafael da Costa Monsanto
- Department of Otorhinolaryngology-Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Line Dore Saint Jean
- Department of Otorhinolaryngology-Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Lucas Sonzzini Ribeiro de Souza
- Department of Otorhinolaryngology-Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Norma de Oliveira Penido
- Department of Otorhinolaryngology-Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Early hearing improvement predicts the prognosis of idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2021; 278:4251-4258. [PMID: 33389010 DOI: 10.1007/s00405-020-06532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine pre- and post-treatment factors that are useful for predicting the prognosis of hearing improvement in idiopathic sudden sensorineural hearing loss (ISSHL). METHODS This retrospective study included 332 patients with ISSHL. Patients received intravenous steroid treatment (prednisolone sodium succinate; 120 mg/day followed by dose tapering). Complete recovery of hearing levels was defined as a final pure-tone audiometry of ≤ 20 dB HL or the same level as the contralateral ear. Patients' age; sex; side of hearing loss; initial hearing level; days from onset to treatment; presence of vertigo, diabetes, and hypertension; and hearing improvement on days 3-4 and 6-7 after treatment initiation were analyzed as potential prognostic factors. RESULTS Overall, 109 patients (32%) had complete recovery. Results of the multivariate logistic regression model identified age (odds ratio [OR] = 0.974), initial hearing level (OR = 0.949), vertigo (OR = 0.409), and hearing improvement on days 6-7 after treatment initiation (OR = 1.11) as significant independent predictors of complete recovery. Age ≥ 60 years, initial hearing level ≥ 72.5 dB HL, and vertigo contributed to poor prognosis. Patients without these three factors and a hearing improvement of ≥ 10 dB HL on days 6-7 post-treatment had a complete recovery rate of 80%. Only 1.5% of the patients with 2-3 of these factors and a hearing improvement of < 10 dB HL on days 6-7 after treatment initiation achieved complete recovery. CONCLUSION Age, initial hearing level, vertigo, and hearing improvement on days 6-7 after treatment initiation were independent predictors of hearing recovery in ISSHL.
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Wang Y, Wang L, Jing Y, Yu L, Ye F. Association Between Hearing Characteristics/Prognosis and Vestibular Function in Sudden Sensorineural Hearing Loss With Vertigo. Front Neurol 2020; 11:579757. [PMID: 33391149 PMCID: PMC7773829 DOI: 10.3389/fneur.2020.579757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) patients with vertigo have a poorer prognosis. However, the factors associated with hearing recovery remain uncertain. This retrospective study was to evaluate the association between hearing characteristics/hearing recovery and the patterns of vestibulocochlear lesions in SSNHL patients with vertigo. Patients were classified into groups according to the patterns of vestibular dysfunction. We not only compared hearing characteristics and prognosis among subgroups but also determined the potential association between vestibular lesion location and hearing recovery. The shapes of the audiogram differed significantly between patients with normal vestibular function and patients with vestibular dysfunction (p = 0.022). Patients whose audiogram indicated profound hearing loss were 3.89 times more likely to have vestibular dysfunction than those whose audiogram shape indicated low-frequency hearing loss (95% CI, 1.02–14.86, p = 0.047). Patients who had saccule dysfunction were 0.11 times as likely to have hearing recovery than those who had normal saccule function (95% CI, 0.11–0.31, p = 0.001). When adjusted for sex and age, patients who had saccule dysfunction were 0.07 times as likely to have hearing recovery than those who had normal saccule function (95% CI, 0.02–0.22, p = 0.001). Abnormal results following cVEMP testing may be a potential predictive factor for poor hearing recovery.
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Affiliation(s)
- Yixu Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Le Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Fanglei Ye
- Department of Otorhinolaryngology, Head and Neck Surgery, First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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Huafeng Y, Hongqin W, Wenna Z, Yuan L, Peng X. Clinical characteristics and prognosis of elderly patients with idiopathic sudden sensorineural hearing loss. Acta Otolaryngol 2019; 139:866-869. [PMID: 31452421 DOI: 10.1080/00016489.2019.1641218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: This study aimed to explore clinical characteristics and prognosis of elderly cases with sudden sensorineural hearing loss. Methods: Fifty-five elderly cases with sudden sensorineural hearing loss and 55 younger cases with sudden sensorineural hearing loss were enrolled in the study. Recovery rates of hearing between elderly group and younger group were compared. In elderly group, the recovery rate of hearing in the patients with normal hearing of the contralateral ear was compared to those with hearing loss of the contralateral ear. Results: The overall recovery rate in the elderly group was 50.9%, significantly lower than 74.5% in the younger group (p < .01). Among the elderly group, the patients with normal hearing of the contralateral ear recovered better than those with hearing loss of the contralateral ear (recovery rates, 76.7% versus 20.0%). Among the elderly group, the recovery rate of cases with treatment onset ≤14 days was 64.7%, while the recovery rate of those with treatment onset longer than 14 days was only 28.6%, with significant difference (p < .01). Conclusion: Elderly cases with sudden sensorineural hearing loss had poor prognosis. Prognosis of elderly cases with sudden sensorineural hearing loss was associated with hearing of the contralateral ear and treatment onset.
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Affiliation(s)
- Yan Huafeng
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Wang Hongqin
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Zuo Wenna
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Liu Yuan
- Department of Otolaryngology, Cangxian Hospital, Cangzhou, China
| | - Xu Peng
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
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Yu H, Li H. Association of Vertigo With Hearing Outcomes in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 144:677-683. [PMID: 29931169 DOI: 10.1001/jamaoto.2018.0648] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Huiqian Yu
- ENT Institute, Otorhinolaryngology Department, Eye and ENT Hospital of Fudan University, Shanghai, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Huawei Li
- ENT Institute, Otorhinolaryngology Department, Eye and ENT Hospital of Fudan University, Shanghai, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
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Suzuki H, Kawaguchi R, Wakasugi T, Do BH, Kitamura T, Ohbuchi T. Efficacy of Intratympanic Steroid on Idiopathic Sudden Sensorineural Hearing Loss: An Analysis of Cases With Negative Prognostic Factors. Am J Audiol 2019; 28:308-314. [PMID: 31046392 DOI: 10.1044/2018_aja-18-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose We retrospectively studied the efficacy of intratympanic steroid administration in comparison with hyperbaric oxygen (HBO) therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) with negative prognostic factors. Method We enrolled 301 patients (302 ears) with ISSNHL (average hearing level at 250-4000 Hz ≥ 40 dB; time from onset to treatment ≤ 30 days). From August 2002 to March 2009, 174 patients (174 ears) received systemic steroid plus HBO therapy (HBO group), and from June 2015 to January 2018, 127 patients (128 ears) received systemic plus intratympanic steroid (IT group). Hearing outcomes were evaluated by 6 indices: cure rate, marked-recovery rate (percent of patients with hearing gain ≥ 30 dB), recovery rate (percent of patients with hearing gain ≥ 10 dB), hearing gain, hearing level after treatment, and percent hearing improvement compared to the unaffected contralateral ear. Results The recovery rate was significantly higher in the IT group than in the HBO group (80.5% vs. 68.4%, p = .019). The IT group showed a higher recovery rate than the HBO group in patients aged ≥ 60 years ( p = .010), patients with early (≤ 7 days from onset) treatment ( p = .005), patients with initial hearing levels ≥ 90 dB ( p = .037), and patients with vertigo/dizziness ( p = .040). The IT group also showed higher hearing gain and percent hearing improvement than the HBO group in patients with vertigo/dizziness ( p = .046 and p = .026, respectively). Conclusions Systemic plus intratympanic steroid is more effective for ISSNHL than systemic steroid plus HBO, particularly in patients with negative prognostic factors, such as old age, profound hearing loss, and/or presence of vertigo/dizziness.
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Affiliation(s)
- Hideaki Suzuki
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
| | - Rintaro Kawaguchi
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
| | - Tetsuro Wakasugi
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
| | - Ba Hung Do
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
| | - Takuro Kitamura
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
| | - Toyoaki Ohbuchi
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu
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DELGADO-GIL JE, KRSTULOVIC C, PÉREZ-GUILLÉN V, GARCÍA-ZAMORA E, PÉREZ-GARRIGUES H. Sordera súbita idiopática. Revisión de 58 casos. REVISTA ORL 2019. [DOI: 10.14201/orl.20151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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SENS-401 Effectively Reduces Severe Acoustic Trauma-Induced Hearing Loss in Male Rats With Twice Daily Administration Delayed up to 96 hours. Otol Neurotol 2019; 40:254-263. [DOI: 10.1097/mao.0000000000002088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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The effectiveness of hyperbaric oxygen in patients with idiopathic sudden sensorineural hearing loss: a systematic review. Eur Arch Otorhinolaryngol 2018; 275:2893-2904. [PMID: 30324404 PMCID: PMC6244669 DOI: 10.1007/s00405-018-5162-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022]
Abstract
Objective To evaluate the effectiveness of hyperbaric oxygen in the treatment of patients with idiopathic sudden sensorineural hearing loss (ISSHL). Data sources An Embase, MEDLINE and Cochrane search were utilised to identify various clinical trials on the treatment of ISSHL. Studies that were published between 2002 and 2018 and written in the English, Dutch or German language were included. Search terms included synonyms for idiopathic sudden hearing loss. Data synthesis A total of 16 articles were identified regarding hyperbaric oxygen therapy. All patients were evaluated with pure-tone audiometry. A major part of the cases presented with unilateral hearing loss(bilateral hearing loss less than 5%). In several studies, the average of the mean hearing gain at five contiguous frequencies was significantly higher in the hyperbaric oxygen (HBO) therapy and systemic steroid (SS) group in patients with severe or profound hearing impairment. They recorded a significant treatment effect (p = 0.005) of HBO + SS therapy on patients with an initial hearing loss of ≥ 81 dB. Conclusions On the whole group of ISSHL patients, no significant difference was demonstrated between the intervention and control group. However, in severe or profound hearing-impaired ISSHL patients, significant benefit was observed in the intervention group. These results likely indicate that adding HBO to steroid therapies might be of benefit in cases of severe and profound hearing impairment.
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Heuschkel A, Geißler K, Boeger D, Buentzel J, Esser D, Hoffmann K, Jecker P, Mueller A, Radtke G, Guntinas-Lichius O. Inpatient treatment of patients with idiopathic sudden sensorineural hearing loss: a population-based healthcare research study. Eur Arch Otorhinolaryngol 2018; 275:699-707. [PMID: 29330597 DOI: 10.1007/s00405-018-4870-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim was to determine inpatient treatment rates of idiopathic sudden sensorineural hearing loss (ISSNHL) with focus on diagnostics, treatment, and outcome. METHODS A retrospective population-based study in the federal state Thuringia in 2011 and 2012 was performed on all 490 inpatients (51% females, median age: 60 years) treated for ISSNHL (Median duration: 7 days). The association between analyzed parameters and the probability of recovery was tested using univariable and multivariable statistics. RESULTS The inpatient treatment rate for ISSNHL was 11.23 per 100,000. 172 patients (35%) had an outpatient treatment prior to inpatient treatment. For pure-tone audiometry of the three most affected frequencies (3PTAmax), the initial median hearing loss was 66.67 dB, the median absolute hearing gain ΔPTAabs was 10.0 dB, and the median relative hearing gain in relation with the contralateral side ΔPTArel contral was 30.86%. 51% of the patients reached a ΔPTAabs of ≥ 10 dB. About 2 of 5 patients recovered to a ΔPTArel contral ≥ 50% or reached ≤ 10 dB of contralateral ear. The multivariate analysis revealed that an ISSNHL on the left side [Hazard ratio (HR) = 1.6.88; confidence interval (CI) = 1.161-2.454], no down-sloping audiogram type (HR = 2.016; CI = 1.391-2.921), and no prior outpatient prednisolone treatment (HR = 2.374; CI = 1.505-3.745) were independent factors associated with better recovery (ΔPTAabs ≥ 10 dB). CONCLUSION Inpatient treatment of ISSNHL is variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. More standardization and clearer criteria for outpatient, inpatient, and salvage therapy are needed.
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Affiliation(s)
- Anne Heuschkel
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Dirk Esser
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany
| | - Peter Jecker
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Nam Y, Choo OS, Lee YR, Choung YH, Shin H. Cascade recurring deep networks for audible range prediction. BMC Med Inform Decis Mak 2017; 17:56. [PMID: 28539112 PMCID: PMC5444043 DOI: 10.1186/s12911-017-0452-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Hearing Aids amplify sounds at certain frequencies to help patients, who have hearing loss, to improve the quality of life. Variables affecting hearing improvement include the characteristics of the patients’ hearing loss, the characteristics of the hearing aids, and the characteristics of the frequencies. Although the two former characteristics have been studied, there are only limited studies predicting hearing gain, after wearing Hearing Aids, with utilizing all three characteristics. Therefore, we propose a new machine learning algorithm that can present the degree of hearing improvement expected from the wearing of hearing aids. Methods The proposed algorithm consists of cascade structure, recurrent structure and deep network structure. For cascade structure, it reflects correlations between frequency bands. For recurrent structure, output variables in one particular network of frequency bands are reused as input variables for other networks. Furthermore, it is of deep network structure with many hidden layers. We denote such networks as cascade recurring deep network where training consists of two phases; cascade phase and tuning phase. Results When applied to medical records of 2,182 patients treated for hearing loss, the proposed algorithm reduced the error rate by 58% from the other neural networks. Conclusions The proposed algorithm is a novel algorithm that can be utilized for signal or sequential data. Clinically, the proposed algorithm can serve as a medical assistance tool that fulfill the patients’ satisfaction.
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Affiliation(s)
- Yonghyun Nam
- Department of Industrial Engineering, Ajou University, Suwon, Korea
| | - Oak-Sung Choo
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yu-Ri Lee
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea.
| | - Hyunjung Shin
- Department of Industrial Engineering, Ajou University, Suwon, Korea.
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Bulğurcu S, Şahin B, Akgül G, Arslan İB, Çukurova İ. The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss. Int Arch Otorhinolaryngol 2017; 22:33-37. [PMID: 29371896 PMCID: PMC5783685 DOI: 10.1055/s-0037-1603108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/01/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.
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Affiliation(s)
- Suphi Bulğurcu
- Department of Otorhinolaryngology, Başkale State Hospital, Başkale, Van, Van 65600, Turkey
| | - Behçet Şahin
- Department of Otorhinolaryngology, Amasya Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Gökhan Akgül
- Department of Otorhinolaryngology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İlker Burak Arslan
- Department of Otorhinolaryngology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İbrahim Çukurova
- Department of Otorhinolaryngology, Tepecik Training and Research Hospital, İzmir, Turkey
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Kitoh R, Nishio SY, Ogawa K, Kanzaki S, Hato N, Sone M, Fukuda S, Hara A, Ikezono T, Ishikawa K, Iwasaki S, Kaga K, Kakehata S, Matsubara A, Matsunaga T, Murata T, Naito Y, Nakagawa T, Nishizaki K, Noguchi Y, Sano H, Sato H, Suzuki M, Shojaku H, Takahashi H, Takeda H, Tono T, Yamashita H, Yamasoba T, Usami SI. Nationwide epidemiological survey of idiopathic sudden sensorineural hearing loss in Japan. Acta Otolaryngol 2017; 137:S8-S16. [PMID: 28394652 DOI: 10.1080/00016489.2017.1297537] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Using a large-scale nationwide survey database, we investigated the epidemiological characteristics for idiopathic SSNHL in Japan. METHODS The subjects for this analysis were patients registered in a Japanese multicentre database between April 2014 and March 2016. A total of 3419 idiopathic SSNHL patients were registered in the database, and the clinical characteristics of the idiopathic SSNHL patients were obtained. Several factors associated with the severity of hearing impairment and prognosis were then investigated. Statistical analysis was performed to clarify the factors associated with the severity of hearing impairment and prognosis. RESULTS There were significant correlations between the severity of hearing loss and diabetes mellitus, kidney disease, past history of brain infarction, heart disease, age (under 16 years/elderly), and symptoms of vertigo/dizziness. We also analyzed the prognostic factors for idiopathic SSNHL, and found that the severity of hearing loss (Grade 3 or 4), heart disease, aged 65 years or over, time from onset to treatment (over 7 days), and symptoms of vertigo/dizziness were all significantly related to poor prognosis. CONCLUSION The present large-scale clinical survey revealed current epidemiological trends for idiopathic sudden sensorineural hearing loss (SSNHL) and various factors associated with the severity of hearing impairment and prognosis.
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Affiliation(s)
- Ryosuke Kitoh
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otorhinolaryngology Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Hato
- Department of Otolaryngology, Ehime University School of Medicine, Toon, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Hara
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuo Ikezono
- Department of Otorhinolaryngology, Saitama School of medicine, Moroyama, Japan
| | - Kotaro Ishikawa
- Department of Otolaryngology, Hospital, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Satoshi Iwasaki
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Kimitaka Kaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Seiji Kakehata
- Department of Otorhinolaryngology, Yamagata University School of Medicine, Yamagata, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuo Matsunaga
- Division of Hearing and Balance Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takaaki Murata
- Department of Otolaryngology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmacy, Okayama, Japan
| | - Yoshihiro Noguchi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hajime Sano
- Department of Otolaryngology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroaki Sato
- Department of Otorhinolaryngology, Iwate Medical University, Morioka, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Hideo Shojaku
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Toyama, Toyama, Japan
| | - Haruo Takahashi
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Hidehiko Takeda
- Department of Otolaryngology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Testuya Tono
- Department of Otolaryngology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Yamashita
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
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Weiss D, Böcker AJ, Koopmann M, Savvas E, Borowski M, Rudack C. Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss. J Otolaryngol Head Neck Surg 2017; 46:27. [PMID: 28376930 PMCID: PMC5379569 DOI: 10.1186/s40463-017-0207-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Sudden sensorineural hearing loss (SSHL) is a disease, which severely affects the patient’s social and relational life. The underlying pathomechanisms have not been finally clarified yet and outcome is not predictable. Methods We conducted a retrospective study in order to identify parameters that influence hearing recovery. The data base contains results of basic otoneurological tests and clinical parameters of 198 patients with idiopathic SSHL of at least 60 dB in at least four frequencies, diagnosed and treated at the University Hospital of Münster, Germany, between 1999 and 2015. Hearing recovery was measured by pure tone audiometry. Results Multivariate linear and logistic regression analyses indicate that the chance as well as the magnitude of hearing recovery is higher for patients with normal caloric testing than for patients with pathological caloric testing. However, for the subgroup of patients who attained a hearing recovery, the caloric testing result was not found to influence the magnitude. Instead, the magnitude was noticeably lower for patients within this subgroup who had a previous hearing loss. Furthermore, we found indications that the magnitude is higher for men than for women and that receiving a high-dose steroid therapy is associated with a higher chance and magnitude of a hearing recovery. Conclusions We conclude that SSHL associated with disorders of the vestibular system or previous hearing loss represent special sub-entities of SSHL that may be caused by unique pathophysiological mechanisms and are associated with worse outcome. Furthermore, our data support the importance of elevated dosage of steroids in SSHL therapy.
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Affiliation(s)
- Daniel Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany.
| | - Armin Julius Böcker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
| | - Mario Koopmann
- Practice for Otorhinolaryngology, Head and Neck Surgery, Meckenemstrasse 26, Bocholt, 46395, Germany
| | - Eleftherios Savvas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstrasse 56, Münster, 48149, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, Münster, 48149, Germany
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Härkönen K, Kivekäs I, Rautiainen M, Kotti V, Vasama JP. Quality of Life and Hearing Eight Years After Sudden Sensorineural Hearing Loss. Laryngoscope 2016; 127:927-931. [PMID: 27328455 DOI: 10.1002/lary.26133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To explore long-term hearing results, quality of life (QoL), quality of hearing (QoH), work-related stress, tinnitus, and balance problems after idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN Cross-sectional study. METHODS We reviewed the audiograms of 680 patients with unilateral ISSNHL on average 8 years after the hearing impairment, and then divided the patients into two study groups based on whether their ISSNHL had recovered to normal (pure tone average [PTA] ≤ 30 dB) or not (PTA > 30 dB). The inclusion criteria were a hearing threshold decrease of 30 dB or more in at least three contiguous frequencies occurring within 72 hours in the affected ear and normal hearing in the contralateral ear. Audiograms of 217 patients fulfilled the criteria. We reviewed their medical records; measured present QoL, QoH, and work-related stress with specific questionnaires; and updated the hearing status. RESULTS Poor hearing outcome after ISSNHL was correlated with age, severity of hearing loss, and vertigo together with ISSNHL. Quality of life and QoH were statistically significantly better in patients with recovered hearing, and the patients had statistically significantly less tinnitus and balance problems. During the 8-year follow-up, the PTA of the affected ear deteriorated on average 7 dB, and healthy ear deteriorated 6 dB. CONCLUSION Idiopathic sudden sensorineural hearing loss that failed to recover had a negative impact on long-term QoL and QoH. The hearing deteriorated as a function of age similarly both in the affected and the healthy ear, and there were no differences between the groups. The cumulative recurrence rate for ISSNHL was 3.5%. LEVEL OF EVIDENCE 4 Laryngoscope, 127:927-931, 2017.
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Affiliation(s)
- Kati Härkönen
- Department of Otorhinolaryngology, Tampere University Hospital and School of Medicine, University of Tampere, Finland.,Department of Anatomy, Tampere University Hospital and School of Medicine, University of Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, Tampere University Hospital and School of Medicine, University of Tampere, Finland.,Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology, Tampere University Hospital and School of Medicine, University of Tampere, Finland.,Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Voitto Kotti
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Juha-Pekka Vasama
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
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Ezerarslan H, Sanhal EO, Kurukahvecioğlu S, Ataç GK, Kocatürk S. Presence of vascular loops entering internal acoustic channel may increase risk of Sudden sensorineural hearing loss and reduce recovery of these patients. Laryngoscope 2016; 127:210-215. [DOI: 10.1002/lary.26054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Hande Ezerarslan
- Department of Otorhinolaryngology; Ufuk University Medical School; Ankara Turkey
| | - Ebru Ozan Sanhal
- Department of Radiology; Ufuk University Medical School; Ankara Turkey
| | - Selma Kurukahvecioğlu
- Department of Otorhinolaryngology; Ankara Numune Education and Training Hospital; Ankara Turkey
| | - Gökçe Kaan Ataç
- Department of Radiology; Ufuk University Medical School; Ankara Turkey
| | - Sinan Kocatürk
- Department of Otorhinolaryngology; Ufuk University Medical School; Ankara Turkey
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Atay G, Kayahan B, Çınar BÇ, Saraç S, Sennaroğlu L. Prognostic Factors in Sudden Sensorineural Hearing Loss. Balkan Med J 2016; 33:87-93. [PMID: 26966623 DOI: 10.5152/balkanmedj.2015.15216] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is still a complex and challenging process which requires clinical evidence regarding its etiology, treatment and prognostic factors. Therefore, determination of prognostic factors might aid in the selection of proper treatment modality. AIMS The aim of this study is to analyze whether there is correlation between SSNHL outcomes and (1) systemic steroid therapy, (2) time gap between onset of symptoms and initiation of therapy and (3) audiological pattern of hearing loss. STUDY DESIGN Retrospective chart review. METHODS Patients diagnosed at our clinic with SSNHL between May 2005 and December 2011 were reviewed. A detailed history of demographic features, side of hearing loss, previous SSNHL and/or ear surgery, recent upper respiratory tract infection, season of admission, duration of symptoms before admission and the presence of co-morbid diseases was obtained. Radiological and audiological evaluations were recorded and treatment protocol was assessed to determine whether systemic steroids were administered or not. Treatment started ≤5 days was regarded as "early" and >5 days as "delayed". Initial audiological configurations were grouped as "upward sloping", "downward sloping", "flat" and "profound" hearing loss. Significant recovery was defined as thresholds improved to the same level with the unaffected ear or improved ≥30 dB on average. Slight recovery was hearing improvement between 10-30dB on average. Hearing recovery less than 10 dB was accepted as unchanged. RESULTS Among the 181 patients who met the inclusion criteria, systemic steroid was administered to 122 patients (67.4%), whereas 59 (32.6%) patients did not have steroids. It was found that steroid administration did not have any statistically significant effect in either recovered or unchanged hearing groups. Early treatment was achieved in 105 patients (58%) and 76 patients (42%) had delayed treatment. Recovery rates were no different in these two groups; however, when unchanged hearing rates were compared, it was statistically significantly lower in the early treatment group (p<0.05). When hearing outcomes were compared according to initial audiological pattern, significant recovery and unchanged hearing rates did not differ between groups; however, slight recovery rate was highest in the "flat" type audiological configuration (p<0.05). CONCLUSION According to this patient series, oral steroid therapy does not have any influence on the outcomes of SSNHL. However, mid-frequency hearing loss of flat type and initiation of treatment earlier than 5 days from the onset of symptoms, seem to have positive prognostic effects. Further randomized controlled subject groups might contribute to determine prognostic factors of SSNHL.
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Affiliation(s)
- Gamze Atay
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bahar Kayahan
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Betül Çiçek Çınar
- Department of Audiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sarp Saraç
- Department of Otolaryngology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Levent Sennaroğlu
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract
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.
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Lee HY, Choi MS, Chang DS, Kim AY, Cho CS. Acute-Onset Tinnitus Is Associated with Contralateral Hearing in Sudden Deafness. Audiol Neurootol 2015; 20:370-5. [DOI: 10.1159/000438919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022] Open
Abstract
Objective: We aimed to evaluate the prognostic factors for acute-onset tinnitus associated with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) and to assess the relationship between these factors and the final recovery. Methods: A total of 770 patients with unilateral ISSNHL were enrolled retrospectively and their medical records reviewed. Patients were classified into two groups according to the presence of acute-onset tinnitus at the initial examination. Patient characteristics and the results of pure-tone audiometry were compared between the two groups initially and 3 months later. Results: A total of 70.9% (n = 546) of patients had tinnitus initially. There was no significant difference in the mean hearing thresholds of the affected ear irrespective of accompanying tinnitus. In contrast, patients with tinnitus in the affected ear tended to have significantly better mean hearing thresholds in the nonaffected ear (p < 0.05). The logistic regression analysis revealed that better mean hearing thresholds in the nonaffected ear were associated with tinnitus occurrence (p < 0.05). Better hearing thresholds in the nonaffected ear, younger age, absence of dizziness, low-tone hearing loss, and combined intratympanic dexamethasone injection were associated with full recovery (p < 0.05). However, tinnitus was not an independent risk factor for full recovery. Conclusion: Better contralateral hearing was associated with both an increased incidence of concurrent tinnitus and a better final recovery. However, tinnitus was not related to full recovery.
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Bogaz EA, Maranhão ASDA, Inoue DP, Suzuki FADB, Penido NDO. Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss. Braz J Otorhinolaryngol 2015; 81:520-6. [PMID: 26248967 PMCID: PMC9449058 DOI: 10.1016/j.bjorl.2015.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/14/2014] [Indexed: 11/03/2022] Open
Abstract
Introduction The establishment of an individualized prognostic evaluation in patients with a diagnosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains a difficult and imprecise task, due mostly to the variety of etiologies. Determining which variables have prognostic value in the initial assessment of the patient would be extremely useful in clinical practice. Objective To establish which variables identifiable at the onset of idiopathic sudden sensorineural hearing loss have prognostic value in the final hearing recovery. Methods Prospective, longitudinal cohort study. Patients with ISSHL followed by the Department of Otology-Neurotology of a quaternary hospital were included. The following variables were evaluated and correlated with final hearing recovery: age, gender, vertigo, tinnitus, initial degree of hearing loss, contralateral ear hearing, and elapsed time to treatment. Results 127 patients with ISSHL were evaluated. Rates of absolute and relative recovery were 23.6 dB and 37.2% respectively. Complete hearing improvement was observed in 15.7% patients; 27.6% demonstrated significant improvement and improvement was noted in 57.5%. Conclusion During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.
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Outcomes of Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss. Clin Exp Otorhinolaryngol 2015; 8:206-10. [PMID: 26330913 PMCID: PMC4553349 DOI: 10.3342/ceo.2015.8.3.206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/15/2014] [Accepted: 06/27/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives While a severe to profound sudden sensorineural hearing loss (SSNHL) may cause serious disability in verbal communication, there have been little studies focusing on this high degree SSNHL. The present study was aimed to investigate the characteristics of hearing recovery in a high degree SSNHL (>70 dB). Methods Three hundred and two SSNHL patients were enrolled. For a long-term follow-up, 46 patients were evaluated. Hearing level was examined by pure tone audiometry on day 1, week 3, month 3, month 6, and year 1 or after. According to the degree of the initial hearing loss, the patients were divided into 4 groups from 70 to ≥100 dB. Results After 3 weeks, the recovery rate and mean hearing gain was 61%, 23.85 dB in the 70 dB group, whereas 10%, 6.61 dB in the ≥100 dB group. There was a significant correlation between 3-week recovery and final hearing outcome. However, there was almost no recovery after 3 months. Conclusion An early recovery can be a prognostic factor for the final recovery in severe to profound SSNHL. Since recovery after 3 months is rare, an early hearing intervention like hearing aid or cochlear implantation should be considered in the high degree SSNHL to restore the patient's verbal communication.
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Otoacoustic Emissions in the Prediction of Sudden Sensorineural Hearing Loss Outcome. Otol Neurotol 2014; 35:1691-7. [DOI: 10.1097/mao.0000000000000627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bogaz EA, Suzuki FADB, Rossini BAA, Inoue DP, Penido NDO. Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss. Braz J Otorhinolaryngol 2014; 80:213-9. [PMID: 25153105 PMCID: PMC9535483 DOI: 10.1016/j.bjorl.2014.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 02/01/2014] [Indexed: 12/02/2022] Open
Abstract
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.
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Recent advances in acute hearing loss due to posterior circulation ischemic stroke. J Neurol Sci 2014; 338:23-9. [DOI: 10.1016/j.jns.2013.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
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Kim HA, Lee BC, Hong JH, Yeo CK, Yi HA, Lee H. Long-term prognosis for hearing recovery in stroke patients presenting vertigo and acute hearing loss. J Neurol Sci 2014; 339:176-82. [PMID: 24581671 DOI: 10.1016/j.jns.2014.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/15/2014] [Accepted: 02/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Vertebrobasilar ischemic stroke (VBIS) can cause acute hearing loss (AHL) because the vertebrobasilar system supplies most of the auditory system including the inner ear. The aim of this study was to assess the long-term prognosis of AHL associated with VBIS. METHODS Over 12.5 years, 62 patients with AHL of a vascular cause who were followed for at least 1 year (mean, 49.2 months; SD, 24.4 months) were enrolled in this study. Quantitative audiovestibular function testing was performed during the acute (mostly within 10 days after symptom onset) and last follow-up periods in all patients. RESULTS On the last follow-up, approximately 65% (39/62) of the patients showed a partial (n=24) or complete (n=15) hearing recovery. All but 2 (97%) patients had acute vertigo and 56 (56/62, 90%) had a unilateral canal paresis to caloric stimulation on the side of the AHL. The most commonly infarcted territory on brain MRI was in the distribution of the anterior inferior cerebellar artery (55/62, 89%). Multivariable analysis showed that multiple risk factors for stroke [odds ratio (OR) 10.46, 95% confidence interval (CI) 1.72 to 13.7, p=0.011] and profound hearing loss [OR 3.92, 95% CI 1.03 to 14.97, p<0.046] predicted a poor outcome for recovery of hearing loss. CONCLUSIONS Acute hearing loss associated with posterior circulation ischemic stroke exhibits a relatively good long-term outcome. Two or more risk factors for stroke and profound hearing loss are adverse prognostic factors for recovery of hearing loss of a vascular cause.
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Affiliation(s)
- Hyun-Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung-Chan Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Chang-Ki Yeo
- Department of Otorhinolaryngology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyon-Ah Yi
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, Republic of Korea.
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Prognostic factors of profound idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2013; 271:1423-9. [DOI: 10.1007/s00405-013-2593-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/05/2013] [Indexed: 11/24/2022]
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Masuda M, Kanzaki S, Minami S, Kikuchi J, Kanzaki J, Sato H, Ogawa K. Correlations of inflammatory biomarkers with the onset and prognosis of idiopathic sudden sensorineural hearing loss. Otol Neurotol 2013; 33:1142-50. [PMID: 22872174 DOI: 10.1097/mao.0b013e3182635417] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HYPOTHESIS We investigated whether inflammatory biomarkers and stress are involved in the pathophysiology of idiopathic sensorineural hearing loss (ISHL). STUDY DESIGN Individual cohort study. SETTING Two tertiary centers. PATIENTS Forty-three ISHL and 10 non-ISHL patients seen in our ENT departments from 2004 to 2010 within a week from the onset of new symptoms and without steroid administration before visiting our departments. INTERVENTION Multiple audiologic evaluations, blood tests including leukocyte counts, natural killer cell activity (NKCA), interleukin 6 (IL-6), tumor necrosis factor, high-sensitivity CRP (hCRP), and the General Health Questionnaire were used to evaluate the systemic stress and inflammatory response. MAIN OUTCOME MEASURES Correlations between biomarkers and ISHL severity and prognosis were evaluated by statistical analysis. RESULTS In the ISHL patients, a neutrophil count above the reference range was associated with severe hearing loss and poor prognosis, and was accompanied by low NKCA and high IL-6. In the non-ISHL patients, these associations were not present. The abnormal neutrophil count was independent of preexisting vascular diseases. The abnormal counts responded to treatment and decreased into the reference range. CONCLUSION Neutrophil counts above the reference range of a facility will be a useful indicator of poor prognosis of ISHL. Synchronism of different types of NF-κB activation pathways could be required to cause severe ISHL. An NKCA decrease, an acute neutrophil count increase, and an IL-6 increase can induce NF-κB activation in the cochlea and cause severe ISHL. Further epidemiologic surveys should be conducted to evaluate whether stressful life events increase the risk of severe ISHL onset.
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Affiliation(s)
- Masatsugu Masuda
- Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan.
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Intratympanic dexamethasone perfusion versus injection for treatment of refractory sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2012; 270:861-7. [DOI: 10.1007/s00405-012-2061-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
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Mori T, Suzuki H, Hiraki N, Hashida K, Ohbuchi T, Katoh A, Udaka T. Prediction of hearing outcomes by distortion product otoacoustic emissions in patients with idiopathic sudden sensorineural hearing loss. Auris Nasus Larynx 2011; 38:564-9. [DOI: 10.1016/j.anl.2010.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/13/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022]
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Kikidis D, Nikolopoulos TP, Kampessis G, Stamatiou G, Chrysovergis A. Sudden sensorineural hearing loss: subclinical viral and toxoplasmosis infections as aetiology and how they alter the clinical course. ORL J Otorhinolaryngol Relat Spec 2011; 73:110-5. [PMID: 21389742 DOI: 10.1159/000324210] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 12/21/2010] [Indexed: 11/19/2022]
Abstract
AIM To explore in a prospective study the evidence of certain viral and toxoplasmosis infections in sudden sensorineural hearing loss (SSHL). METHODS 84 consecutive patients with SSHL meeting certain criteria. All patients were assessed for specific IgM antibodies against cytomegalovirus, herpes simplex virus, toxoplasma and Epstein-Barr virus. All were treated with intravenous steroids and assigned to two groups: 76 IgM negative (NV group) and 8 IgM positive (no history of acute infection - V group). RESULTS The mean hearing level at presentation was 86.5 dB HL (median, 100) in the V group and 60.7 dB HL (median, 61) in the NV group. The difference was statistically significant (p = 0.003). The mean hearing level following treatment was 81.8 dB HL (median, 88) in the V group and 48.7 dB HL (median, 39) in the NV group. The difference was statistically significant (p = 0.004). There was a considerable improvement in hearing after treatment only in the NV group (p < 0.000001). CONCLUSIONS Recent subclinical viral or toxoplasmosis infections may be involved in the pathogenesis of SSHL (in approx. 10% of cases), suggesting that SSHL is not a single disease. When certain viruses or toxoplasmoses are involved, the hearing is much worse in comparison to patients with no such indication of infection. An alteration in treatment dosage or method of steroid administration may be needed in such cases.
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Affiliation(s)
- Dimitrios Kikidis
- Department of Otorhinolaryngology/Head and Neck Surgery, Hippokration University Hospital, Athens, Greece
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Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. Consensus on diagnosis and treatment of sudden hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/s2173-5735(11)70025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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