Sudden sensorineural hearing loss during pregnancy: clinical characteristics, management and outcome

Risk Factors, Complications, and Treatment Modalities for Sudden Sensorineural Hearing Loss in Pregnant Women: A Systematic Review and Meta-analysis

BACKGROUND

Sudden sensorineural hearing loss (SSNHL) during pregnancy is a rare condition and has not been much studied. The study aimed to perform a systematic review and meta-analysis of the risk factors, complications, and treatment modalities for SSNHL in pregnant women.

MATERIALS AND METHODS

PubMed, Web of Science, Scopus, ProQuest, and Google Scholar were used for the literature search. The Cochrane technique for assessing risk of bias was used for the article quality appraisal, and RevMan 5.4 was used for conducting the meta-analysis. Standard mean difference (SMD) and odds ratios with a 95% confidence interval (95% CI) were utilized. Heterogeneity and publication bias were assessed using the I-square (I2) test statistic and the Egger's test, respectively.

RESULTS AND DISCUSSION

The seven primary studies employed prospective and retrospective study designs. The meta-analysis showed that there were fewer risk variables for SSNHL in the experimental group compared with those in the control group (SMD = -0.45 to 3.24, 95% CI = -3.063.63 to 2.16-2.85), indicating that the analysis revealed an insignificant difference. However, the treated patients presented hearing improvement, suggesting a significant analysis (SMD = -0.6710.20, 95% CI = -1.2713.51 to -0.066.88). Furthermore, after therapy, substantial differences were observed in SMD between the two groups (SMD = -0.7415.18, 95% CI = -1.2423.85 to -0.256.40) in favor of the experimental group patients, based on the analysis results of four included studies. However, the I2-value of 0% showed that the heterogeneity was low.

CONCLUSION

SSNHL during pregnancy is a notably rare condition with an unknown cause. However, hormonal fluctuations, particularly increased levels of estrogen and progesterone during pregnancy, have been frequently implicated as potential triggers for SSNHL.

Unexpected Motherhood-Triggered Hearing Loss in the Two-Pore Channel (TPC) Mutant Mouse

Calcium signaling is crucial for many physiological processes and can mobilize intracellular calcium stores in response to environmental sensory stimuli. The endolysosomal two-pore channel (TPC), regulated by the second messenger nicotinic acid adenine dinucleotide phosphate (NAADP), is one of the key components in calcium signaling. However, its role in neuronal physiology remains largely unknown. Here, we investigated to what extent the acoustic thresholds differed between the WT mice and the TPC KO mice. We determined the thresholds based on the auditory brainstem responses (ABRs) at five frequencies (between 4 and 32 kHz) and found no threshold difference between the WT and KO in virgin female mice. Surprisingly, in lactating mothers (at P9–P10), the thresholds were higher from 8 to 32 kHz in the TPC KO mice compared to the WT mice. This result indicates that in the TPC KO mice, physiological events occurring during parturition altered the detection of sounds already at the brainstem level, or even earlier.

Audio-vestibular disorders and pregnancy: A systematic review

PURPOSE

During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders.

MATERIALS AND METHODS

A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database.

RESULTS

After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo.

CONCLUSIONS

According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.

Scrub typhus in pregnancy presenting with permanent hearing loss: A case report

As clinicians, we need to be vigilant about these rare and atypical presentations given the endemic nature of scrub typhus in southern belt of the country. Timely diagnosis and appropriate treatment is the key aspect to prevent further complications.

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

BACKGROUND

As sudden sensorineural hearing loss (SSNHL) rarely occurs in pregnant women, there is a lack of knowledge and relevant research on its management.

AIM

To investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL.

METHODS

A retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery. Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities. The treatment group received intratympanic dexamethasone (2.5 mg) q.o.d. for a total of four times, while the control group received no medication other than bed rest and medical observations. All the patients were under close care of obstetricians. Pure-tone audiograms were performed before and after treatment.

RESULTS

Eleven patients who met the inclusion criteria were assigned to the treatment group (n = 7) and the control group (n = 4). The mean age of patients was 31.2 ± 3.8 years; the right ear was affected in seven (63.64%) cases. Two patients (18.2%) suffered from vertigo, 10 (90.9%) suffered from tinnitus and 6 (54.5%) suffered from aural fullness. The time from onset to clinic visit was relatively short, with a mean time of 1.3 ± 0.9 d. All the women were within the second or third trimester; the average gestation period was 26.0 ± 6.2 wk. The pure-tone averages at onset between the two groups were similar. After one wk of therapy, the treatment group had a curative rate of 57.1% and a significantly better hearing threshold and greater improvement compared to the control group (all P < 0.05). Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest, while none had permanent complications. All patients delivered healthy full-term neonates with an average Apgar score of 9.7 ± 0.5.

CONCLUSION

Intratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

Sudden sensorineural hearing loss with end-stage renal disease: a report of 32 cases

Background: Patients with end-stage renal disease (ESRD) have a higher risk of suffering sudden sensorineural hearing loss (SSNHL), but little is known about this population. Aims and objectives: To investigate the clinical characteristics, treatment and recovery of SSNHL patients with ESRD. Materials and methods: Records of 32 SSNHL patients with ESRD were reviewed, including clinical characteristics and hearing recovery. Patients were divided into intratympanic steroid (ITS) group and oral steroid (OS) group, and hearing recovery was compared between two groups. Results: Twenty-six patients (81.3%) exhibited tinnitus, and 18 patients (56.3%) suffered vertigo. Mean pure-tone threshold at the initial presentation was 73.2 ± 19.4 dB, and the audiogram configuration was ascending in 9.4%, descending in 9.4%, flat in 34.4% and profound in 46.9% cases. At 3-month follow-up, percentages of patients in complete recovery, partial recovery, slight recovery, and no improvement were 18.8%, 31.3%, 21.9% and 28.1%, respectively. Furthermore, the overall recovery rate, complete recovery rate and hearing improvement were significantly higher in the ITS group than those in the OS group. Conclusion: SSNHL patient with ESRD often suffered a severe hearing loss with a high rate of accompanying tinnitus and vertigo. ITS may provide better audiological results for SSNHL with ESRD than OS.

Clinical management and progress in sudden sensorineural hearing loss during pregnancy

Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations, treatments, and prognosis of SSNHL. Some hypotheses have been proposed to explain the pathophysiological mechanism of SSNHL, but most of them have not been identified. This article reviews the existing literature to present a summary of this clinical problem. Most patients suffer from SSNHL in the second or third trimester, and show moderate to profound hearing loss. The interval between the initial treatment and onset of hearing loss is less than 10 days in most patients. Some patients with SSNHL show tinnitus, vertigo, or dizziness, and fullness of the ear. Although some patients have a tendency for self-cure, treatment with intravenous dextran 40 combined with intratympanic corticosteroids is probably a safe and effective therapeutic strategy for pregnant patients with SSNHL. Further clinical research is necessary to identify the best therapeutic strategy for these patients.