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Ying YLM, Tseng CC, Shin J, Rauch S. Natural History of Untreated Idiopathic Sudden Sensorineural Hearing Loss. Laryngoscope 2024. [PMID: 38808803 DOI: 10.1002/lary.31474] [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: 10/25/2023] [Revised: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Although corticosteroids and other treatments for idiopathic sudden sensorineural hearing loss (ISSNHL) have been described, understanding its prognosis without intervention provides valuable information for patient management. The objective of this study is to provide a comprehensive, quantitative statistical analysis of the natural history of untreated idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY TYPE AND DESIGN A systematic review and meta-analyses. METHODS Two independent searches of PubMed, Scopus, Web of Science, and Cochrane Library databases up to June 30, 2022, were performed. Adults with idiopathic sudden sensorineural hearing loss who received placebo or were untreated and had audiometric outcome measures in all study types were reviewed. These data indicative of the natural history of ISSNHL were analyzed, as were study characteristics related to risk of bias. Heterogeneity as assessed via I2 and random effects analyses were performed. RESULTS Six studies meeting the inclusion criteria yielded 319 untreated patients whose natural history could be assessed. Heterogeneity among studies was moderate, with a variety of reported outcomes. A hearing improvement of at least 30 dB HL was observed in 36% (95% CI 0.28-0.44) of untreated patients, and of at least 10 dB HL was observed in 70% (95% CI 0.57-0.82) of untreated patients at 3 months. The mean hearing gain among untreated patients was 24.0 dB HL (95% CI 2.65-45.37) at 2-3 months. CONCLUSIONS The observed natural history of ISSNHL suggests that patients can regain some hearing without active treatment. In the absence of future studies collecting prospective natural history data from untreated or placebo-treated ISSNHL patients, the data presented here provide the best available historical control data for reconsideration of results in past ISSNHL studies, as well as a roadmap for design and interpretation of future ISSNHL treatment clinical trials. Furthermore, knowing there is a statistically significant mean hearing gain of 24.0 dB HL in the untreated/placebo group provides an ethical basis for future placebo study of ISSNHL. The current status on ISSNHL management calls for a multi-institutional, randomized, double-blind placebo-controlled trial with validated outcome measures to provide science-based treatment guidance. Laryngoscope, 2024.
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Affiliation(s)
- Yu-Lan M Ying
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Steven Rauch
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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Plontke SK, Girndt M, Meisner C, Fischer I, Böselt I, Löhler J, Ludwig-Kraus B, Richter M, Steighardt J, Reuter B, Böttcher C, Langer J, Pethe W, Seiwerth I, Jovanovic N, Großmann W, Kienle-Gogolok A, Boehm A, Neudert M, Diensthuber M, Müller A, Dazert S, Guntinas-Lichius O, Hornung J, Vielsmeier V, Stadler J, Rahne T. High-Dose Glucocorticoids for the Treatment of Sudden Hearing Loss. NEJM EVIDENCE 2024; 3:EVIDoa2300172. [PMID: 38320514 DOI: 10.1056/evidoa2300172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Systemic glucocorticoids are commonly used for primary therapy of idiopathic sudden sensorineural hearing loss (ISSNHL). However, the comparative effectiveness and risk profiles of high-dose over lower-dose regimens remain unknown. METHODS: We randomly assigned patients with sudden hearing loss of greater than or equal to 50 dB within 7 days from onset to receive either 5 days of high-dose intravenous prednisolone at 250 mg/d (HD-Pred), 5 days of high-dose oral dexamethasone at 40 mg/d (HD-Dex), or, as a control, 5 days of oral prednisolone (Pred-Control) at 60 mg/d followed by 5 days of tapering doses. The primary outcome was the change in hearing threshold (pure tone average) in the three most affected contiguous frequencies from baseline to day 30. Secondary outcomes included speech understanding, tinnitus, communication competence, quality of life, hypertension, and insulin resistance. RESULTS: A total of 325 patients were randomly assigned. Mean change in 3PTAmost affected hearing threshold from baseline to 30 days was 34.2 dB (95% CI, 28.4 to 40.0) in the HD-Pred group, 41.4 dB (95% CI, 35.6 to 47.2) in the HD-Dex group, and 41.0 dB (95% CI, 35.2 to 46.8) in the Pred-Control group (P=0.09 for analysis of variance). There were more adverse events related to trial medication in the HD-Pred (n=73) and HD-Dex (n=76) groups than in the Pred-Control group (n=46). CONCLUSIONS: Systemic high-dose glucocorticoid therapy was not superior to a lower-dose regimen in patients with ISSNHL, and it was associated with a higher risk of side effects. (Funded by the Federal Ministry of Education and Research [BMBF]; EudraCT number, 2015‐002602‐36.)
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine, University Medicine Halle, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jan Löhler
- Scientific Institute for Applied Oto-Rhino-Laryngology of the German Professional Association of ENT Surgeons, Bad Bramstedt, Germany
| | - Beatrice Ludwig-Kraus
- Department of Laboratory Medicine, Central Laboratory, University Hospital Halle, Halle (Saale), Germany
| | - Michael Richter
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jörg Steighardt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bernd Reuter
- Department of Otorhinolaryngology/Plastic Surgery, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Christoph Böttcher
- Department of Otorhinolaryngology/Plastic Surgery, SRH Zentralklinikum Suhl, Suhl, Germany
- ENT Practice, Bad Neustadt, Germany
| | - Jörg Langer
- ENT Department, AMEOS Clinic Halberstadt, Halberstadt, Germany
| | - Wolfram Pethe
- ENT Department, AMEOS Clinic Halberstadt, Halberstadt, Germany
| | - Ingmar Seiwerth
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
| | - Nebojsa Jovanovic
- Department of Otorhinolaryngology, Head and Neck Surgery, Plastic Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner," Rostock University Medical Center, Rostock, Germany
| | | | - Andreas Boehm
- ENT Department, Hospital St. Georg gGmbH, Leipzig, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical University Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marc Diensthuber
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Müller
- Department Otorhinolaryngology/Plastic Surgery, SRH Wald-Klinikum Gera gGmbH, Gera, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Joachim Hornung
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Joachim Stadler
- Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich-Braun-Klinikum gGmbH, Zwickau, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Halle (Saale), Germany
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Son HJ, Choi EJ, Jeong U, Choi YJ. Effect of Herpes Zoster Treatment and Sudden Sensorineural Hearing Loss Using National Health Insurance Claims Data of South Korea. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040808. [PMID: 37109766 PMCID: PMC10143438 DOI: 10.3390/medicina59040808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Herpes zoster (HZ) is caused by the reactivation of a pre-existing latent varicella zoster virus, which is one of the viruses that causes hearing loss, and hearing loss may occur due to a systemic immune response even if it does not invade the auditory nerve. This study aimed to determine the correlation between sudden sensorineural hearing loss (SSNHL) in older adult patients who received HZ treatment. Materials and Methods: We used the cohort data of patients aged 60 years and above (n = 624,646) between 2002 and 2015 provided by the National Health Insurance Service. The patients were divided into two groups: those who were diagnosed with HZ between 2003 and 2008 (group H, n = 36,121) and those who had not been diagnosed with HZ between 2002 and 2015 (group C, n = 584,329). Results: In the main model (adjusted HR = 0.890, 95% CI = 0.839-0.944, p < 0.001) adjusted for sex, age, and income, and the full model (adjusted HR = 0.894, 95% CI = 0.843-0.949, p < 0.001) adjusted for all comorbidities, group H had a lower risk of SSNHL than group C. Conclusions: This study showed that patients who received HZ treatment had a lower incidence of SSNHL within five years after diagnosis.
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Affiliation(s)
- Hyo Jung Son
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul 05715, Republic of Korea
| | - Eun-Ji Choi
- Department of Dental Anesthesia and Pain Medicine, Dental Research Institute, School of Dentistry, Pusan National University, Yangsan 50612, Republic of Korea
| | - Ukjin Jeong
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul 05715, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
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Liu LM, Xia LL. Efficacy and safety of antivirals in treating hearing loss: A systematic review and network meta-analysis. Front Neurol 2022; 13:1027615. [PMID: 36588899 PMCID: PMC9802665 DOI: 10.3389/fneur.2022.1027615] [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] [Received: 08/25/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aimed to compare and rank the therapeutic effects of antivirals in treating hearing loss using a network meta-analysis approach. Methods We searched the PubMed, Embase, and Cochrane Library databases to identify eligible randomized controlled trials (RCTs) through April 2022. Placebo-controlled or head-to-head RCTs of three categories of antivirals for hearing loss were included, and pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using pairwise and network meta-analyses. Results Six RCTs with 405 patients were included in the final analysis. The results showed that ganciclovir had relatively better effects on the incidence of hearing recovery (surface under the cumulative ranking: 88.8%) compared with other antivirals. However, pairwise comparison analyses found that the use of antivirals significantly increased the incidence of hearing recovery compared with the use of a placebo (RR: 1.27; 95% CI: 1.04-1.54; P = 0.017), while no significant difference was observed between any two categories of antivirals. Finally, the use of antivirals did not increase the risk of adverse events compared with the use of a placebo (RR: 1.27; 95% CI: 0.82-1.98; P = 0.285). Conclusion Antivirals are more efficacious than placebos for hearing recovery in patients with hearing loss, and ganciclovir is the most likely to increase the incidence of hearing recovery.
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Update on the Management of Idiopathic Sudden Sensorineural Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Plontke SK, Girndt M, Meisner C, Böselt I, Ludwig-Kraus B, Richter M, Rahne T. Efficacy and safety of systemic, high-dose glucocorticoid therapy for idiopathic sudden sensorineural hearing loss : Study protocol for a three-armed, randomized, triple-blind, multicenter trial (HODOKORT). HNO 2022; 70:30-44. [PMID: 35725822 PMCID: PMC9208545 DOI: 10.1007/s00106-022-01184-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic glucocorticosteroids ("steroids") are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids without evidence from randomized controlled trials (RCTs) and refers solely to retrospective cohort studies. This RCT aims to assess the efficacy (improvement in hearing) and safety (especially systemic side effects) of high-dose steroids versus standard of care (standard dose systemic steroids) for the treatment of unilateral ISSHL, when given as a primary therapy. METHODS The study is designed as a multicenter (approximately 40 centers), randomized, triple-blind, three-armed, parallel group, clinical trial with 312 adult patients. The interventions consist of 5 days of 250 mg/day intravenous prednisolone (intervention 1) + oral placebo, or 5 days of 40 mg/day oral dexamethasone (intervention 2) + intravenous placebo. The control intervention consists of 60 mg oral prednisolone for 5 days followed by five tapering doses + intravenous placebo. The primary efficacy endpoint is the change in hearing threshold in the three most affected contiguous frequencies between 0.25 and 8 kHz 1 month after ISSHL. Secondary endpoints include further measures of hearing improvement including speech audiometry, tinnitus, quality of life, blood pressure, and altered glucose tolerance. DISCUSSION There is an unmet medical need for an effective medical therapy of ISSHL. Although sensorineural hearing impairment can be partially compensated by hearing aids or cochlear implants (CI), generic hearing is better than using hearing aids or CIs. Since adverse effects of a short course of high-dose systemic corticosteroids have not been documented with good evidence, the trial will improve knowledge on possible side effects in the different treatment arms with a focus on hyperglycemia and hypertension. TRIAL REGISTRATION EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) Nr. 2015-002602-36; Sponsor code: KKSH-127.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Matthias Girndt
- Department of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Meisner
- Robert Bosch Society for Medical Research, Robert Bosch Hospital, Stuttgart, Germany
| | - Iris Böselt
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Michael Richter
- Coordination Centre for Clinical Trials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Jiang LZ, Qian Y. The value of vestibular evoked myogenic potential and electrocochleography in unexplained aural fullness. Acta Otolaryngol 2022; 142:225-228. [PMID: 35445628 DOI: 10.1080/00016489.2022.2044074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Unexplained aural fullness, after excluding external or middle ear diseases and vertigo, is not easily diagnosed. AIM The aim of this study is to determine the vestibular evoked myogenic potential (VEMP) and electrocochleography (ECochG) abnormal rates in patients with unexplained aural fullness, and analyzed the relationship between unexplained aural fullness and endolymphatic hydrops (EH). MATERIAL AND METHODS The VEMP and EcochG abnormal rates in 54 patients with unexplained aural fullness and 21 healthy volunteers, and the VEMP and EcochG abnormal rates in the four hearing loss groups were compared. The distribution of abnormal of VEMP and EcochG in age, sex or hearing loss groups were investigated. RESULTS The VEMP abnormal rate in patients was greater than that in healthy volunteers (p = .000). The abnormal rate of VEMP was greater than the EcochG in patients (p = .003). The VEMP abnormal rate was greater than the EcochG in patient with low-tone or high-tone hearing loss (p = .008). CONCLUSION AND SIGNIFICANCE Abnormal of VEMP in a significant proportion of patients with unexplained aural fullness maybe indicative of EH, and EH was more likely to involve the utricle or saccule in patients with low- or high-tone hearing loss.
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Affiliation(s)
- Li Zhu Jiang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yi Qian
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of 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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Ahmadzai N, Kilty S, Cheng W, Esmaeilisaraji L, Wolfe D, Bonaparte JP, Schramm D, Fitzpatrick E, Lin V, Skidmore B, Moher D, Hutton B. A systematic review and network meta-analysis of existing pharmacologic therapies in patients with idiopathic sudden sensorineural hearing loss. PLoS One 2019; 14:e0221713. [PMID: 31498809 PMCID: PMC6733451 DOI: 10.1371/journal.pone.0221713] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hearing loss is one of the leading causes of disability worldwide. Patients with hearing loss experience impaired quality of life, as well as emotional and financial consequences that affect both themselves and their families. Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common but difficult to treat condition that has a sudden onset of ≤ 72 hour associated with various etiologies, with the majority of cases being idiopathic. There exists a wide range of therapeutic options, however, the uncertainty surrounding their comparative efficacy and safety makes selection of treatment difficult. This systematic review and network meta-analysis (NMA) assessed the relative effects of competing treatments for management of ISSNHL. METHODS A protocol for this review was registered with PROSPERO (CRD42017073756). A detailed search of MEDLINE, Embase and the Cochrane Library from inception to February 8th, 2018 was carried out by an experienced information specialist. Grey literature was also searched. Screening full-text records, and risk of bias assessment were carried out independently by two reviewers, and disagreements were resolved through consensus or third party adjudication, while data was collected by one reviewer and verified by a second reviewer. Bayesian network meta-analyses (NMA) were performed to inform comparisons between interventions for a priori specified outcomes that included pure tone average (PTA) improvement and hearing recovery. RESULTS The search identified a total of 1,138 citations, of which 613 remained for review after removal of duplicates. Of these, 23 publications describing 19 unique studies (total sample size of 1,527) met our a priori eligibility criteria, that were assessed to be at unclear or high risk of bias on several domains. We identified data on several interventions for ISSNHL therapy and were able to construct treatment networks consisting of six intervention groups that included placebo; intratympanic (IT) steroid; IT plus systemic steroid; per oral (PO) steroid; intravenous (IV) steroid; and IV plus PO steroid for our NMAs. IT plus systemic steroids demonstrated the largest difference in PTA improvement compared to placebo (25.85 dB, 95% CrI 7.18-40.58), followed by IV plus PO steroids (22.06 dB, 95% CrI 1.24-39.17), IT steroids (18.24 dB, 95% CrI 3.00-29.81). We observed that the difference of PTA improvement between each intervention and placebo diminished over time, attributed to spontaneous recovery. The binary outcomes of hearing recovery demonstrated similar relative ordering of interventions but were less sensitive than PTA improvement to capture the significant differences between interventions and placebo. CONCLUSION Unclear to high risk of bias trials rated IT plus systemic steroid treatment as the best among the six interventions compared, and all active treatments were better than placebo in improving PTA. However, it should be noted that certain comparisons were based on indirect evidence only or few studies of small sample size, and analyses were unable to control for steroid type and dosage. Given these limitations, further data originating from methodologically sound and rigorous trials with adequate reporting are needed to confirm our findings.
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Affiliation(s)
| | - Shaun Kilty
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of ENT, the Ottawa Hospital, Ottawa, Canada
- Dr. S. Kilty Medicine Prof. Corp, Ottawa, Canada
| | - Wei Cheng
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - David Schramm
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of ENT, the Ottawa Hospital, Ottawa, Canada
| | | | - Vincent Lin
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Canada
- * E-mail:
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Singh A, Kumar Irugu DV. Sudden sensorineural hearing loss - A contemporary review of management issues. J Otol 2019; 15:67-73. [PMID: 32440269 PMCID: PMC7231990 DOI: 10.1016/j.joto.2019.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 01/24/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10-15% of cases. The management of the remaining patients, classified as 'idiopathic', is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- the Medicity, Gurugram, Haryana, India
| | - David Victor Kumar Irugu
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sun H, Hu J, Mao Z, Ma Z. Efficacy of combination therapy in adolescent and adult patients with total-deafness sudden sensorineural hearing loss. Acta Otolaryngol 2019; 139:258-262. [PMID: 30762471 DOI: 10.1080/00016489.2018.1554266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Combination therapy is the first-line option for total-deafness sudden sensorineural hearing loss (SSNHL). Age may act as a crucial prognostic factor. OBJECTIVE The aim of this study was to compare efficacy of combination therapy between adolescent and adult patients with total-deafness SSNHL. MATERIALS AND METHODS Twenty-five adolescent patients (adolescent group) and 106 adult patients (adult group) with total-deafness SSNHL were recruited. All the recruited patients underwent initial treatment with batroxobin, methylprednisolone, and gastrodin. After 10-day treatment, hearing outcomes were determined by pure-tone average measured by audiometry. Moreover, the total effective rates in the hearing recovery and improvement of tinnitus were calculated. RESULTS There existed no significant difference between two groups in the total effective rate of the hearing recovery (p = .110). However, a significant difference was found in the total effective rate of improvement of tinnitus between two groups (p = .016). Both adolescent and adult patients could receive the optimal hearing gains at 500 Hz (20.2 ± 13.3 and 23.1 ± 13.9dB, respectively), followed by those at 1000 Hz (18.8 ± 12.5 and 22.7 ± 14.8dB, respectively). Yet, adult patients could get better hearing gains only at 500 Hz than adolescent patients (p = .02). CONCLUSION Compared with adult patients, adolescent patients with total-deafness SSNHL undergoing combination therapy may be less likely to have hearing recovery and the improvement of tinnitus.
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Affiliation(s)
- Hongcun Sun
- Department of Otolaryngology, Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Otolaryngology, Head and Neck Surgery, Yin Zhou Hospital Affiliated to Medical School Of Ningbo University, Ningbo, China
| | - Jiandao Hu
- Department of Otolaryngology, Head and Neck Surgery, Yin Zhou Hospital Affiliated to Medical School Of Ningbo University, Ningbo, China
| | - Zhenyu Mao
- Department of Otolaryngology, Head and Neck Surgery, Yin Zhou Hospital Affiliated to Medical School Of Ningbo University, Ningbo, China
| | - ZhaoXin Ma
- Department of Otolaryngology, Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc05. [PMID: 29503670 PMCID: PMC5818684 DOI: 10.3205/cto000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews recent aspects of diagnostics, differential diagnostics, and evidence in systemic and local therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss, a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique for the evaluation of sudden hearing loss ("head MRI" instead of "temporal bone MRI" with too high slice thicknesses). Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is possibly today to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to the quality and not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of the threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of an improved hearing threshold than no therapy or placebo. Both, hearing gain and final hearing threshold, however, appear to be independent from the onset of secondary therapy. Based on currently available data from clinical studies, no recommendation can be made with respect to the type of corticosteroid and specifics of the intratympanic application protocol.
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Affiliation(s)
- Stefan K. Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Fazel MT, Jedlowski PM, Cravens RB, Erstad BL. Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy. Pharmacotherapy 2017; 37:1600-1616. [DOI: 10.1002/phar.2044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Maryam T. Fazel
- Department of Pharmacy Practice & Science; College of Pharmacy, University of Arizona; Tucson Arizona
- Department of Medicine; College of Medicine - Tucson, University of Arizona; Tucson Arizona
| | | | | | - Brian L. Erstad
- Department of Pharmacy Practice & Science; College of Pharmacy, University of Arizona; Tucson Arizona
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Swachia K, Sharma D, Singh J. Efficacy of oral vs. intratympanic corticosteroids in sudden sensorineural hearing loss. J Basic Clin Physiol Pharmacol 2017; 27:371-7. [PMID: 26812786 DOI: 10.1515/jbcpp-2015-0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/12/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current standard treatment for sudden sensorineural hearing loss (SSNHL) comprises of tapered course of oral corticosteroids. Intratympanic steroids are introduced as another modality of treatment, but management of SSNHL continues to be debatable. The present study was designed to evaluate the efficacy of steroids given orally and by the intratympanic route. METHODS A prospective, randomized, open-labeled study was conducted involving 42 patients. These were randomly divided into two groups; group I patients received oral prednisone tapered over 14 days, and group II patients were treated with intratympanic methylprednisolone (40 mg/mL). One milliliter of the drug solution containing 40 mg of the drug (40 mg/mL) was injected into the middle ear cavity through the trans-tympanic route. The drug was injected twice a week for 2 weeks. The total duration of the study was 60 days, and hearing outcome was assessed on the basis of change in pure tone average. RESULTS An improvement of 18.24±8.72 dB was recorded in group I patients treated with oral prednisone in comparison to 14.68±12.88 dB improvement in group II. Statistically significant improvement in hearing was observed in both groups, but it was not significant when group I and group II were compared. CONCLUSIONS The post-treatment outcomes among patients who receive either oral prednisone or intratympanic methylprednisolone within 2 weeks of onset of symptoms were comparable. The outcomes were affected by degree of hearing loss and association of SSNHL with vertigo.
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Park SM, Han C, Lee JW, Kong TH, Seo YJ. Does Herpes Virus Reactivation Affect Prognosis in Idiopathic Sudden Sensorineural Hearing Loss? Clin Exp Otorhinolaryngol 2016; 10:66-70. [PMID: 27459199 PMCID: PMC5327584 DOI: 10.21053/ceo.2016.00360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/26/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022] Open
Abstract
Objectives Several etiologies have been proposed to underlie idiopathic sudden sensorineural hearing loss (ISSNHL), including viral infection, vascular disturbance, and immune-mediated mechanisms. However, none of these mechanisms are conclusive. Should ISSNHL be caused by reactivation of a viral infection, antiviral treatment would be an important option. Thus, in this study, we reported the prognosis according to serologic test results of herpes viruses in patients with ISSNHL. We also evaluated treatment response with acyclovir and corticosteroids versus corticosteroids alone in herpes simplex virus (HSV) seropositive ISSNHL patients. Methods We compared hematologic examinations and the results of audiometry testing in 232 patients with ISSNHL. Statistical analyses for initial hearing impairment, progression of hearing impairment, recovery of hearing loss, and laboratory results were performed in all patients. All statistical analyses were performed using SPSS software. Results The 232 ISSNHL patients were divided into two subgroups according to HSV immunoglobulin M (IgM) serologic results (seropositive or seronegative). When the seropositive group was compared to the seronegative group, age, gender, body mass index (BMI), white blood cell, absolute neutrophil count, absolute monocyte count, and platelet count were not significantly different. Initial hearing level, final recovery hearing level, and recovery time were also not significantly different between the two groups (P>0.05). Though there were no significant differences in age, gender, BMI, or viral HSV IgM titer, the two groups had similar initial hearing level, final recovery hearing level, and recovery time. The difference in hearing threshold before and after treatment was larger (18.7±37.1) in the group receiving antiviral medication than in the corticosteroids group (11.0±44.5), but this difference was not significant (P=0.619). Conclusion There was no significant difference of prognosis between the patients with and without reactivation of HSV. In addition, there seems to be no benefit for the treatment of acyclovir combined with the corticosteroids in the patients with ISSNHL.
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Affiliation(s)
- Sang Man Park
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chun Han
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Woo Lee
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Hoon Kong
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Joon Seo
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Övet G, Alataş N, Kocacan FN, Gürcüoğlu SS, Görgülü H, Güzelkara F, Övet H. Sudden sensorineural hearing loss: Is antiviral treatment really necessary? Am J Otolaryngol 2015; 36:542-6. [PMID: 25749542 DOI: 10.1016/j.amjoto.2015.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES It was aimed to investigate the necessity of antiviral agents in the ISSHL treatment. METHODS In this study, the patients, diagnosed with sudden hearing loss and admitted in the first 7 days of hearing loss were divided into two groups; a combination therapy was administered to one of the groups, and famciclovir was administered to the other group as an antiviral treatment in addition to the combined therapy. Both groups were compared in terms of levels of recovery. RESULTS No statistically significant difference was found in the recovery rates between the two groups (p=0.7). CONCLUSION In this study, the additional antiviral treatment was found to have no effect on the remission rates in patients with ISSHL treated with combined therapy.
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Affiliation(s)
- Gültekin Övet
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey.
| | - Necat Alataş
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatma Nur Kocacan
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | | | - Hakan Görgülü
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatih Güzelkara
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Habibe Övet
- Department of Microbiology, Konya Training and Research Hospital, Konya, Turkey
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Hultcrantz E, Nosrati-Zarenoe R. Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: analysis of an RCT and material drawn from the Swedish national database. Eur Arch Otorhinolaryngol 2014; 272:3169-75. [DOI: 10.1007/s00405-014-3360-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE We sought to determine whether the results of audiological tests and tinnitus characteristics, particularly tinnitus pitch and minimum masking level (MML), depend on tinnitus etiology, and what other etiology-specific tinnitus characteristics there are. DESIGN The patients answered questions concerning tinnitus laterality, duration, character, aggravation, alleviation, previous treatment, and circumstances of onset. The results of tympanometry, pure-tone audiometry, distortion-product otoacoustic emissions, tinnitus likeness spectrum, MML, and uncomfortable loudness level were evaluated. STUDY SAMPLE Patients with several tinnitus etiological factors were excluded. The remaining participants were divided into groups according to medical history: acute acoustic trauma: 67 ears; chronic acoustic trauma: 82; prolonged use of oral estrogen and progesterone contraceptives: 46; Ménière's disease: 25; congenital hearing loss: 19; sensorineural sudden deafness: 40; dull head trauma: 19; viral labyrinthitis: 53; stroke: 6; presbycusis: 152. Data of 509 ears were analysed. RESULTS Tinnitus pitch was highest in patients with acute acoustic trauma and lowest in patients receiving estrogen and progesterone. MML was lowest after acute acoustic trauma and in congenital hearing loss, and highest after a stroke and in the case of presbytinnitus. CONCLUSIONS Tinnitus pitch and MML are etiology dependent.
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Affiliation(s)
- Olaf Zagólski
- * ENT Department, St. John Grande's Hospital , Kraków , Poland
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Kaya H, Koç AK, Sayın İ, Güneş S, Altıntaş A, Yeğin Y, Kayhan FT. Vitamins A, C, and E and selenium in the treatment of idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 2014; 272:1119-25. [PMID: 24519034 DOI: 10.1007/s00405-014-2922-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/28/2014] [Indexed: 12/20/2022]
Abstract
This study evaluated the effectiveness of vitamins A, C, and E, with selenium, in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). This was a prospective, controlled study performed at a tertiary teaching and research hospital. Over a 32-month period, patients were treated with either our standard ISSNHL treatment regimen plus vitamins A, C, and E and selenium (ACE+ group) or with only our standard ISSNHL treatment regimen (ACE- group). The demographics, additional symptoms, mean initial and final hearing levels, mean hearing gain, and recovery data were compared between the two groups. The ACE+ group, consisting of 70 (55.5 %) patients, received vitamin A (natural beta-carotene, 26,000 IU), vitamin C (ascorbic acid, 200 mg), vitamin E (d-alpha-tocopherol, 200 IU), and selenium (50 μg) twice daily for 30 days in addition to our ISSNHL treatment regimen: methylprednisolone at an initial dose of 1 mg/kg body weight per day, tapered over 14 days; Rheomacrodex(®) [(10 g of dextran and 0.9 g of NaCl)/100 ml] 500 ml daily for 5 days; Vastarel(®) 20-mg tablet (20 mg of trimetazidine dihydrochloride) three times daily for 30 days; and ten 60-min hyperbaric oxygen (HBO) sessions (2.5 absolute atmospheres of 100 % O2), once daily, starting the day of hospitalization. The ACE- group comprised 56 (44.4 %) patients, who received only our ISSNHL treatment regimen. The mean hearing gains were 36.2 ± 20.3 dB in the ACE+ group and 27.1 ± 20.6 dB in the ACE- group. The mean hearing gain rates were significantly higher in the ACE+ group than in the ACE- group (p = 0.014). Treatment with vitamins A, C, and E and selenium was effective in ISSNHL patients undergoing treatment with methylprednisolone, dextran, trimetazidine dihydrochloride, and HBO, and might be more effective when the initial hearing level is below 46 dB.
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Affiliation(s)
- Hakan Kaya
- E.N.T Clinic, Bakırköy Dr.Sadi Konuk Teaching and Research Hospital, Tevfik Sağlam Cad. No: 11, Zuhuratbaba, 34417, Istanbul, Turkey,
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Langguth B, Elgoyhen AB. Current pharmacological treatments for tinnitus. Expert Opin Pharmacother 2012; 13:2495-509. [DOI: 10.1517/14656566.2012.739608] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE Even though aural fullness is ubiquitous among patients presenting to otolaryngology clinics, the association between aural fullness and disease development has not yet been clearly determined. MATERIALS AND METHODS Our study was performed on outpatients from June 2006 to February 2010 whose major complaint was "ear fullness", "aural fullness", or "ear pressure". We assessed their demographic and clinical characteristics, including sex, associated diseases, symptoms, otoscopic findings, audiology test results, and final diagnoses. RESULTS Among 432 patients, 165 (38.2%) were males and 267 (61.8%) were females, with mean ages of 42±19 years and 47±17 years, respectively. Tinnitus, hearing disturbance, autophony (p<0.01) as well as nasal obstruction and sore throat (p<0.05) showed a statistically significant correlation with aural fullness. Among patients who complained of hearing fullness, tests and measures such as impedance audiometry, speech reception threshold, and pure tone audiometry generated statistically significant results (p<0.05). Ear fullness was most frequently diagnosed as Eustachian tube dysfunction (28.9%), followed by otitis media with effusion (13.4%) and chronic otitis media (7.2%). However, 13.4% of patients could not be definitively diagnosed. CONCLUSION Among patients complaining of ear fullness, Eustachian tube dysfunction, otitis media with effusion, chronic otitis media were most commonly observed. Performance of otoscopy, nasal endoscopy, the Valsalva maneuver, and additional audiological tests is necessary to exclude other diseases.
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Affiliation(s)
- Moon Suh Park
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ho Min Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Eun Woong Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sun Kyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Lee HJ, Park CY, Lee JH, Yang HS, Kim JH, Ban MJ, Moon IS. Therapeutic effects of carbogen inhalation and lipo-prostaglandin E1 in sudden hearing loss. Yonsei Med J 2012; 53:999-1004. [PMID: 22869484 PMCID: PMC3423832 DOI: 10.3349/ymj.2012.53.5.999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Vascular disorders and viral infections are considered the main causes of sudden hearing loss (SHL), although its pathogenesis remain unclear. Treatments include carbogen inhalation and lipo-prostaglandin E1 (lipo-PGE1), both of which have circulation-enhancing effects. We investigated the effectiveness of carbogen inhalation and lipo-PGE1 in SHL. MATERIALS AND METHODS This retrospective review included 202 patients with idiopathic SHL who visited our clinic within 14 days of symptom onset between January 2006 and June 2010. All patients received oral prednisolone for 10 days. Of the 202 patients, 44 received no additional treatment, 106 received additional carbogen inhalation, and 52 received additional lipo-PGE1. Hearing improvement was measured using Siegel's criteria. RESULTS Overall recovery rates were 67.9% in the carbogen group, 53.8% in the lipo-PGE1 group, and 52.3% in the steroid-only control group (p=0.097). Limited to type 1 and type 2 categories of Sigels's criteria, the carbogen group had a significantly higher recovery rate (53.8%) than the lipo-PGE1 group (26.9%) and the steroid-only control group (38.6%) (p=0.005). CONCLUSION Carbogen inhalation added to steroid was a more effective treatment than lipo-PGE1 added to steroid or steroid alone in patients with SHL.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chong Yoon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Heon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hoon-Shik Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joo Hyun Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Idiopathic sudden sensorineural hearing loss (ISSHL) is characterised by sudden loss of hearing of cochlear or retro-cochlear origin without an identifiable cause. Antivirals are commonly prescribed, but there is no consensus on the treatment regimen or their effectiveness. OBJECTIVES To determine the effectiveness and side effect profile of antivirals in the treatment of ISSHL. SEARCH METHODS We systematically searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), PubMed, EMBASE, CINAHL and other databases to 12 June 2012. We also scanned the reference lists of identified studies for further trials. SELECTION CRITERIA Randomised controlled trials comparing different antivirals versus placebo (both with or without other treatment). DATA COLLECTION AND ANALYSIS Two authors independently extracted data, met to resolve disagreements and contacted study authors for further information. We assessed study risk of bias independently. We considered meta-analysis inappropriate and ultimately not possible due to differing treatment protocols of varying dose and duration, together with differing inclusion criteria and outcome measures between studies. The results of each study are reported individually. MAIN RESULTS We included four randomised trials (257 participants). The overall risk of bias in the included studies was low. Two trials compared the addition of intravenous acyclovir to a steroid (prednisolone). One included 43 participants, the other 70 patients. Neither demonstrated any hearing improvement with ISSHL. Another (84 patients) did not show any statistically significant difference between groups with the addition of valacyclovir to prednisolone (compared to steroid plus placebo) with respect to change in pure-tone audiogram. Comparing the addition of intravenous acyclovir to hydrocortisone with hydrocortisone alone, the final trial did not show any statistically significant difference between groups (60 patients). No trial documented any serious adverse effects related to the use of antiviral treatment. One study reported slight to moderate nausea equally in the acyclovir and placebo groups (one patient in each). Another reported insomnia, nervousness and weight gain with valacyclovir (number not specified). Even though no meta-analysis was possible, evidence from the four RCTs has demonstrated no statistically significant advantage in the use of antivirals in the treatment of ISSHL. AUTHORS' CONCLUSIONS There is currently no evidence to support the use of antiviral drugs in the treatment of ISSHL. The four trials included in this review were, however, small and with a low risk of bias. Further randomised controlled trials with larger patient populations, using standardised inclusion criteria, antiviral regimes and outcome measures, are needed in order for adequate meta-analysis to be performed to reach definitive conclusions. A uniform definition of ISSHL should also be established, together with what constitutes adequate recovery.
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Affiliation(s)
- Zaid Awad
- Department of Otolaryngology, Head and Neck Surgery, University College London Hospital, London, UK.
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Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2012; 146:S1-35. [DOI: 10.1177/0194599812436449] [Citation(s) in RCA: 659] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. Purpose. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. Results. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.
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Affiliation(s)
- Robert J. Stachler
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Sanford M. Archer
- Division of Otolaryngology–Head & Neck Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Hospital and Medical Center, Seattle, Washington, USA
| | - David M. Barrs
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Steven R. Brown
- Department of Family and Community Medicine, University of Arizona School of Medicine, Phoenix, Arizona, USA
| | - Terry D. Fife
- Department of Neurology, University of Arizona, Phoenix, Arizona, USA
| | | | - Theodore G. Ganiats
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | | | | - Debara L. Tucci
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Valente
- Department of Otolaryngology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Barbara E. Warren
- Center for LGBT Social Science & Public Policy, Hunter College, City University of New York, New York, New York, USA
| | | | - Peter J. Robertson
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Kuo YL, Young YH. Hearing outcome of recurrent sudden deafness: ipsilateral versus contralateral types. Acta Otolaryngol 2012; 132:247-54. [PMID: 22217185 DOI: 10.3109/00016489.2011.642817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONCLUSION Patients with recurrent sudden deafness demonstrating normal vestibular-evoked myogenic potentials (VEMPs) in the lesion ear of the second episode may indicate a good hearing outcome. OBJECTIVE This study retrospectively reviewed our experience of patients with recurrent sudden deafness during the past 20 years. METHODS Sixteen (1.4 %) of 1156 patients with sudden deafness were diagnosed as having a recurrent episode, including ipsilateral type in 7 and contralateral type in 9. All patients underwent an audiovestibular test battery and blood and MRI examinations. After 2000, nine patients underwent the VEMP test. RESULTS In the ipsilateral type, the mean interval between two episodes was 2 ± 2 years, which did not differ significantly from 3 ± 3 years in the contralateral type. There were no significant differences in relation to age at onset of the second episode, inter-episode interval, gender, presence of vertigo, and abnormal caloric results. However, abnormal rate of VEMP test in the contralateral type (five of five patients) was significantly higher than that in the ipsilateral type (none of four patients). At the second episode, all four patients with normal VEMPs on the lesion ear had improved hearing, while four of five patients with absent or delayed VEMPs showed unchanged hearing. Altogether, the hearing improvement rate in both types of recurrent sudden deafness was 50%.
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Affiliation(s)
- Yen-Lin Kuo
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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Shaikh JA, Roehm PC. Does addition of antiviral medication to high-dose corticosteroid therapy improve hearing recovery following idiopathic sudden sensorineural hearing loss? Laryngoscope 2011; 121:2280-1. [PMID: 21956344 DOI: 10.1002/lary.21963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jamil A Shaikh
- Department of Otolaryngology, New York University School of Medicine, New York, New York 10016, USA
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Coelho DH, Thacker LR, Hsu DW. Variability in the management of idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 2011; 145:813-7. [PMID: 21690271 DOI: 10.1177/0194599811412721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate current trends in the management of idiopathic sudden sensorineural hearing loss (ISSNHL), determine if variance in diagnostic and treatment protocols exists, and compare diagnostic and treatment strategies of ISSNHL between nonotologists/neurotologists (NONs) and otologists/neurotologists (ONs). STUDY DESIGN Cross-sectional survey of practicing otolaryngologists. SETTING Otolaryngology practices within the United States. SUBJECTS AND METHODS In January 2010, a survey was mailed to 500 NONs and 500 ONs. Data were collected and analyzed using χ(2), standard deviations, and variance. RESULTS A variety and distribution of responses were seen in the definition of ISSNHL, including dB loss necessary for diagnosis, number of consecutive frequencies involved, and maximum duration of hearing loss. Differences in diagnostic tools were also seen, with 50.4% of respondents (NON 34.2%, ON 66.7%; P = .0001) always using magnetic resonance imaging in their workup. Of the total respondents, 26.7% (NON 35.0%, ON 18.3%; P < .0001) preferred oral steroids alone; 22.1% (NON 11.7%, ON 32.5%; P < .0001) preferred a combination of oral and intratympanic steroids. Of the respondents, 68.6% (NON 57.5%, ON 80.0%; P = .0003) would continue with additional treatment after partial response; 20.8% (NON 33.3%, ON 8.3%; P < .005) would retreat with oral steroids alone and 46.6% (NON 35.8%, ON 57.3%; P < .05) with intratympanic injections. Overall, 69.2% (NON 45.8%, ON 92.5%; P = .0001) were very comfortable managing ISSNHL. CONCLUSION Significant differences exist in the diagnosis and treatment of ISSNHL. Such lack of uniformity highlights the need for strong evidence-based research-ultimately leading to formalized practice guidelines and educational outreach.
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Affiliation(s)
- Daniel H Coelho
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0146, USA.
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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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Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. [Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:144-57. [PMID: 21112580 DOI: 10.1016/j.otorri.2010.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/09/2010] [Accepted: 09/03/2010] [Indexed: 12/19/2022]
Abstract
Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.
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Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
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Abstract
Delivery of medications to the inner ear has been an area of considerable growth in both the research and clinical realms during the past several decades. Systemic delivery of medication destined for treatment of the inner ear is the foundation on which newer delivery techniques have been developed. Because of systemic side effects, investigators and clinicians have begun developing and using techniques to deliver therapeutic agents locally. Alongside the now commonplace use of intratympanic gentamicin for Meniere's disease and the emerging use of intratympanic steroids for sudden sensorineural hearing loss, novel technologies, such as hydrogels and nanoparticles, are being explored. At the horizon of inner ear drug-delivery techniques, intracochlear devices that leverage recent advances in microsystems technology are being developed to apply medications directly into the inner ear. Potential uses for such devices include neurotrophic factor and steroid delivery with cochlear implantation, RNA interference technologies, and stem-cell therapy. The historical, current, and future delivery techniques and uses of drug delivery for treatment of inner ear disease serve as the basis for this review.
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Edaravone, a free radical scavenger, in the treatment of idiopathic sudden sensorineural hearing loss with profound hearing loss. Auris Nasus Larynx 2010; 37:42-6. [DOI: 10.1016/j.anl.2009.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/26/2009] [Accepted: 04/21/2009] [Indexed: 11/24/2022]
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Sakata T, Esaki Y, Yamano T, Sueta N, Nakagawa T. A comparison between the feeling of ear fullness and tinnitus in acute sensorineural hearing loss. Int J Audiol 2009; 47:134-40. [DOI: 10.1080/14992020701760547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Steven D Rauch
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA.
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Pyykkö I, Zou J. Do Viruses Cause Inner Ear Disturbances? ORL J Otorhinolaryngol Relat Spec 2008; 70:32-40; discussion 40-1. [DOI: 10.1159/000111046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Merchant SN, Durand ML, Adams JC. Sudden deafness: is it viral? ORL J Otorhinolaryngol Relat Spec 2008; 70:52-60; discussion 60-2. [PMID: 18235206 DOI: 10.1159/000111048] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A number of theories have been proposed to explain the etiopathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL), including viral infection, vascular occlusion, breaks of labyrinthine membranes, immune-mediated mechanisms and abnormal cellular stress responses within the cochlea. In the present paper, we provide a critical review of the viral hypothesis of ISSHL. The evidence reviewed includes published reports of epidemiological and serological studies, clinical observations and results of antiviral therapy, morphological and histopathological studies, as well as results of animal experiments. The published evidence does not satisfy the majority of the Henle-Koch postulates for viral causation of an infectious disease. Possible explanations as to why these postulates remain unfulfilled are reviewed, and future studies that may provide more insight are described. We also discuss other mechanisms that have been postulated to explain ISSHL. Our review indicates that vascular occlusion, labyrinthine membrane breaks and immune-mediated mechanisms are unlikely to be common causes of ISSHL. Finally, we review our recently proposed theory that abnormal cellular stress responses within the cochlea may be responsible for ISSHL.
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Affiliation(s)
- Saumil N Merchant
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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Awad Z, Natt RS, Pothier DD. Antivirals for idiopathic sudden sensorineural hearing loss. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Westerlaken BO, de Kleine E, van der Laan B, Albers F. The Treatment of Idiopathic Sudden Sensorineural Hearing Loss Using Pulse Therapy: A Prospective, Randomized, Double-Blind Clinical Trial. Laryngoscope 2007; 117:684-90. [PMID: 17415139 DOI: 10.1097/mlg.0b013e3180316d3b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The etiology and treatment of idiopathic sudden sensorineural hearing loss (ISSHL) is still unclear. The anti-inflammatory effect of corticosteroids is thought to play an important part in the recovery from ISSHL. We aimed to determine whether a more powerful anti-inflammatory technique using pulse therapy is effective in the treatment of ISSHL. METHODS In a randomized, prospective, double-blind, multicenter clinical trial, we recruited 81 patients with ISSHL. Patients were randomly allocated to pulse therapy (300 mg dexamethasone for 3 consecutive days followed by 4 days of placebo) or control treatment (prednisone 70 mg per day tapered in steps of 10 mg per day to 0 mg). The primary outcome was hearing recovery as measured by pure-tone audiometry and speech audiometry after 12 months. Secondary outcomes were subjective parameters such as hearing recovery, tinnitus, vertigo, and a pressure sensation in the ear. RESULTS The overall improvement in pure-tone thresholds and speech discrimination scores was not significantly better in patients who were given dexamethasone than those who were given standard prednisone. Hearing improved from 71 dB HL to 36 dB HL in the dexamethasone group and from 75 dB HL to 42 dB HL in the prednisone group. Speech discrimination scores of 100% were achieved by 64% of dexamethasone-treated patients and by 57% of the prednisone group. CONCLUSION Pulse therapy is equally effective and safe as standard-dose prednisone. Pulse therapy suppresses both humoral and cellular immune responses and therefore has a wider anti-inflammatory effect.
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Affiliation(s)
- Boris O Westerlaken
- Department of Otorhinolaryngology, University Medical Center Groningen, The Netherlands.
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Abstract
PURPOSE To report the clinical course of a rare case of bilateral herpetic linear endotheliitis. METHODS A 70-year-old man presented with bilateral circumferential bullous edema with stromal edema progressing centrally in the left cornea and bilateral sensorineural hearing impairment simultaneously. Serum immunoglobulin G (IgG) and IgM antibodies against herpes simplex virus type 1 (HSV1) were tested for, and aqueous humor from both eyes was examined separately using polymerase chain reaction for the presence of HSV1 DNA. RESULTS Serum antibody titers against HSV1 were positive. In the polymerase chain reaction, the aqueous humor showed HSV1 DNA in both eyes. Forty milligrams of prednisolone was given per day and 200 mg of oral acyclovir was given 4 times daily, but corneal edema progressed. After penetrating keratoplasty surgery in the left eye, recurrent herpetic endotheliitis also seemed to occur. CONCLUSIONS HSV-1 may cause bilateral corneal linear endotheliitis and hearing impairment simultaneously. Linear endotheliitis should be regarded as a manifestation of HSV1 corneal infection. There is a poor prognosis, and severe corneal edema can result if aggressive treatment is not used.
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MESH Headings
- Acyclovir/therapeutic use
- Aged
- Antibodies, Viral/blood
- Aqueous Humor/virology
- DNA, Viral/analysis
- Disease Progression
- Drug Therapy, Combination
- Endothelium, Corneal/virology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/drug therapy
- Hearing Loss, Sensorineural/etiology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/immunology
- Humans
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Keratitis, Herpetic/diagnosis
- Keratitis, Herpetic/drug therapy
- Keratitis, Herpetic/etiology
- Keratoplasty, Penetrating
- Male
- Polymerase Chain Reaction
- Prednisolone/therapeutic use
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Affiliation(s)
- Ying-Cheng Shen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taiwan, China.
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Jing Z, Ya Z, Ilmari P, Hao W. An Animal Model of Sudden Onset Sensorineural Hearing Loss with Vestibular Function Disturbances Induced By Mitochondrial Toxin. J Otol 2006. [DOI: 10.1016/s1672-2930(06)50019-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
CONCLUSIONS This study revealed two characteristic findings of the feeling of ear fullness (FEF) in acute sensorineural hearing loss (ASNHL). First, that the appearance of FEF was not associated with the auditory function on audiograms; and second, that the disappearance of FEF is clearly associated with the hearing prognosis. OBJECTIVE FEF appears frequently in patients with ASNHL. However, there are few reports on this symptom and its mechanism has yet to be clarified. So we tried to investigate the character of FEF in ASNHL. PATIENTS AND METHODS In this study, observations were made during the period from the first medical examination to 2 months after obtaining a steady audiogram on 227 ears from unilateral ASNHL cases, and the relationship between FEF and the audiograms was analyzed. RESULTS The FEF prevalence at the first medical examination was about 80% for any audiogram shape or hearing threshold. Moreover, the better the hearing prognosis, the higher the improvement rate of FEF.
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Affiliation(s)
- Toshifumi Sakata
- Department of Otorhinolaryngology, University of Fukuoka, School of Medicine, Fukuoka, Japan.
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Abstract
CONCLUSION The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden sensorineural hearing loss (SSNHL) has yet to be fully elucidated; however, in cases where deafness is profound and of recent onset, a therapeutic trial is indicated. OBJECTIVES To investigate treatment regimens and their efficacies, as well as evaluating the potential prognostic correlates and allowing comparison between local and national standards of care for SSNHL. PATIENTS AND METHODS A retrospective evidence-based case series of 143 patients seen at the University of Rochester, Department of Otolaryngology between 1999 and 2002 was investigated. Treatment modalities included (1) observation, (2) steroids, and (3) steroids with antivirals. RESULTS The study demonstrates that steroid treatment, alone or in combination with antivirals, results in a significant improvement rate compared with observation. Results indicate that the more expediently a patient with SSNHL is seen by an otolaryngologist, the better their prognosis.
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Affiliation(s)
- Anita Jeyakumar
- Department of Otolaryngology, University of Rochester, Strong Memorial Hospital, Rochester, NY 14624, USA.
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Merchant SN, Adams JC, Nadol JB. Pathology and Pathophysiology of Idiopathic Sudden Sensorineural Hearing Loss. Otol Neurotol 2005; 26:151-60. [PMID: 15793397 DOI: 10.1097/00129492-200503000-00004] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cause and pathogenesis of idiopathic sudden sensorineural hearing loss remain unknown. Proposed theories include vascular occlusion, membrane breaks, and viral cochleitis. AIMS To describe the temporal bone histopathology in 17 ears (aged 45-94 yr) with idiopathic sudden sensorineural hearing loss in our temporal bone collection and to discuss the implications of the histopathologic findings with respect to the pathophysiology of idiopathic sudden sensorineural hearing loss. METHODS Standard light microscopy using hematoxylin and eosin-stained sections was used to assess the otologic abnormalities. RESULTS Hearing had recovered in two ears and no histologic correlates were found for the hearing loss in both ears. In the remaining 15 ears, the predominant abnormalities were as follows: 1) loss of hair cells and supporting cells of the organ of Corti (with or without atrophy of the tectorial membrane, stria vascularis, spiral limbus, and cochlear neurons) (13 ears); 2) loss of the tectorial membrane, supporting cells, and stria vascularis (1 ear); and 3) loss of cochlear neurons only (1 ear). Evidence of a possible vascular cause for the idiopathic sudden sensorineural hearing loss was observed in only one ear. No membrane breaks were observed in any ear. Only 1 of the 17 temporal bones was acquired acutely during idiopathic sudden sensorineural hearing loss, and this ear did not demonstrate any leukocytic invasion, hypervascularity, or hemorrhage within the labyrinth, as might be expected with a viral cochleitis. DISCUSSION The temporal bone findings do not support the concept of membrane breaks, perilymphatic fistulae, or vascular occlusion as common causes for idiopathic sudden sensorineural hearing loss. The finding in our one case acquired acutely during idiopathic sudden sensorineural hearing loss as well as other clinical and experimental observations do not strongly support the theory of viral cochleitis. CONCLUSION We put forth the hypothesis that idiopathic sudden sensorineural hearing loss may be the result of pathologic activation of cellular stress pathways involving nuclear factor-kappaB within the cochlea.
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Affiliation(s)
- Saumil N Merchant
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
PURPOSE OF REVIEW To review the most recent literature regarding the application of transtympanic inner ear perfusion in the treatment of inner ear disorders including Meniere disease, sudden sensorineural hearing loss, and autoimmune inner ear disease. RECENT FINDINGS The use of gentamicin perfusion in the management of Meniere disease with intractable vertigo has been demonstrated to have a very high rate of success, and is much less invasive than alternative surgical procedures such as vestibular nerve section or labyrinthectomy. The technique for achieving the highest rate of success while still minimizing the risk of cochleotoxicity continues to be investigated. Sustained delivery techniques such as the Silverstein MicroWick appear to achieve the best pharmacokinetic profile within the inner ear fluids. The end point of treatment does not necessarily require complete vestibular ablation to cure the patient, and shorter courses of treatment may help to reduce the risk of hearing loss. Cochlear Meniere disease can be treated with dexamethasone 4 mg/cc perfusion of the inner ear, which may improve the hearing, tinnitus, and pressure in the ear. Sudden sensorineural hearing loss has been managed with transtympanic steroid delivery, and this appears to be beneficial for some patients who have failed to respond to oral steroids, or have medical contraindications to systemic steroids. SUMMARY Inner ear perfusion via transtympanic delivery is an emerging technique in the management of inner ear disease. Improved results are expected over time as research in this area answers questions about dosage and delivery techniques, as well as identifying new applications and pharmaceuticals.
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Weissler MC, Scharer S. What’s new in otolaryngology—head and neck surgery1 1No competing interests declared. J Am Coll Surg 2004; 199:114-23. [PMID: 15217639 DOI: 10.1016/j.jamcollsurg.2004.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 03/17/2004] [Indexed: 12/28/2022]
Affiliation(s)
- Mark C Weissler
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
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