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Sanda N, Sawabe M, Kabaya K, Kawaguchi M, Fukushima A, Nakamura Y, Maseki S, Niwa M, Mori H, Hyodo Y, Nishiyama K, Kawakita D, Iwasaki S. Clinical impact of hyperbaric oxygen therapy combined with steroid treatment for sudden sensorineural hearing loss: A case-control study. Laryngoscope Investig Otolaryngol 2024; 9:e1297. [PMID: 38974601 PMCID: PMC11222663 DOI: 10.1002/lio2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives The aim of present study was to evaluate the clinical efficacy of hyperbaric oxygen therapy (HBOT) as a primary therapy combined with standard systemic corticosteroid treatment for sudden sensorineural hearing loss (SSNHL) compared to treatment without the use of HBOT (non-HBOT) through clinical data and advanced analytical approaches. Study Design Case-control study. Methods Conducted across three Japanese medical centers involving 298 SSNHL patients diagnosed between 2020 and 2023. Inclusion criteria encompassed first onset and treatment, WHO grade 3 or 4 initial hearing impairment, receipt of systemic corticosteroid therapy within 14 days of symptom onset, and initiation of HBOT within the same timeframe for the case group. The primary outcome measure was the difference in hearing improvement (mean hearing level in decibels, dB) between the two groups, assessed by pure-tone audiometry at baseline and 3 months post-treatment, using the inverse probability of treatment weighting (IPTW) method adjusted for covariate differences. Results The study included 67 patients in the HBOT group and 68 in the non-HBOT group. The HBOT group exhibited significantly greater hearing improvement (IPTW-adjusted difference: 7.6 dB, 95% CI 0.4-14.7; p = 0.038). Patients without vertigo in the HBOT group demonstrated substantial hearing improvement (11.5 dB, 95% CI 2.3-20.6; p = 0.014), whereas those with vertigo showed no significant improvement (-1.8 dB, 95% CI -11.8-8.3; p = 0.729). The HBOT group also had a significantly higher association with complete recovery (IPTW-adjusted odds ratio: 2.57, 95% CI 1.13-5.85; p = 0.025). Conclusion In SSHNL, HBOT combination therapy yielded slightly but significantly improved hearing outcomes compared to non-HBOT treatment. Level of Evidence 4.
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Affiliation(s)
- Naoya Sanda
- Department of OtorhinolaryngologyToyota Kosei HospitalToyotaJapan
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Michi Sawabe
- Department of OtorhinolaryngologyToyota Kosei HospitalToyotaJapan
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Kayoko Kabaya
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Momoko Kawaguchi
- Department of OtorhinolaryngologyJapanese Red Cross Society Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Akina Fukushima
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Yoshihisa Nakamura
- Department of OtorhinolaryngologyJapanese Red Cross Society Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | | | - Masaki Niwa
- Department of OtorhinolaryngologyToyota Kosei HospitalToyotaJapan
| | - Hiroki Mori
- Department of OtorhinolaryngologyToyota Kosei HospitalToyotaJapan
| | - Yoshiyuki Hyodo
- Department of Clinical Engineering TechnologyToyota Kosei HospitalToyotaJapan
| | - Kazuyoshi Nishiyama
- Department of Clinical Engineering TechnologyToyota Kosei HospitalToyotaJapan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Shinichi Iwasaki
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
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Yang T, Liu J. Development of clinical predictive nomograms for prognosis of idiopathic sudden sensorineural hearing loss. Acta Otolaryngol 2024; 144:293-298. [PMID: 38923921 DOI: 10.1080/00016489.2024.2365303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The outcome of clinical treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) is frequently the primary concern. AIM For the convenient prediction of reference prognosis outcomes in patients with ISSNHL. MATERIALS AND METHODS Patients diagnosed with ISSNHL who were admitted to the otorhinolaryngology ward of Zhejiang Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2023 were included. Univariate and multivariate logistic regression analyses were employed to identify independent prognostic factors for the treatment outcome of ISSNHL, which were subsequently used to develop nomograms. Discrimination, calibration, and clinical utility were assessed to evaluate the performance of the ISSNHL nomograms. RESULTS 371 ISSNHL patients were enrolled in this study. Multivariable logistic regression analysis showed that history of deafness, aural fullness, time of onset, and age were independent prognostic factors for ISSNHL patients, with statistically significant regression coefficients. Predictive nomograms were developed with excellent discrimination, calibration, and clinical value. CONCLUSIONS Leveraging data from ISSNHL patients, we developed a predictive nomogram to assess prognostic factors upon admission. This nomogram facilitates clinicians in approximating the likelihood of favorable prognosis. SIGNIFICANCE By accumulating clinical data from ISSNHL patients, it's anticipated that the possibility of recovery following treatment can be determined.
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Affiliation(s)
- Tianye Yang
- Department of Otorhinolaryngology, Zhejiang Chinese Medical University First Clinical School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jun Liu
- Department of Otorhinolaryngology, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
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Aldajani NF, Aloufi AM, Binhudayb NA, Yahya BJ, Alkarni AF. Approach to Sudden Hearing Loss Among Primary Care Physicians in Riyadh, Saudi Arabia. Cureus 2024; 16:e55849. [PMID: 38463405 PMCID: PMC10924649 DOI: 10.7759/cureus.55849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION A medical emergency known as sudden sensorineural hearing loss (SSNHL) affects the ears suddenly, has a considerable probability of negative cognitive and functional outcomes, and can influence the patient's quality of life. Primary care physicians play a crucial role in diagnosing SSNHL and initiating prompt and efficient management since they are the ones who would likely encounter it initially. This study aims to evaluate the present knowledge, diagnostic, and management perspective of SSNHL among primary care physicians in Riyadh, Saudi Arabia. METHODS A self-generated questionnaire with 17 questions was developed, and a link to the online survey was delivered to primary care physicians (PHPs) in Riyadh, Saudi Arabia, concerning the management of SSNHL. RESULTS The knowledge level regarding SSNHL was evaluated, in which 21 (25%) of the participants had a low knowledge level, 34 (40.5%) had moderate knowledge, and 29 (34.5%) had a high knowledge level. Among 84 participants, 20 (23.8%) were confident in their ability to administer and understand the findings of tuning fork tests (TFT) to differentiate between sensorineural hearing loss and conductive hearing loss, whereas 64 (76.2%) were unsure about it. In addition, to distinguish between sensorineural hearing loss and conductive hearing loss, 62 (73.8%) participants were confident, and 22 (26.2%) participants were skeptical about their ability to interpret a formal audiogram. CONCLUSION Considering SSNHL as a medical emergency, in our survey, many family doctors would make proper referral and treatment decisions. However, TFTs were underutilized for guiding management decisions compared to other ways to distinguish between conductive and sensorineural hearing loss.
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Affiliation(s)
- Nader F Aldajani
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | | | - Nujud A Binhudayb
- Clinical Sciences, College of Medicine-Almaarefa University, Riyadh, SAU
| | - Buthaina J Yahya
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | - Abdullah F Alkarni
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Yoon YS, Straw S. Interactions Between Slopes of Residual Hearing and Frequency Maps in Simulated Bimodal and Electric-Acoustic Stimulation Hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:282-295. [PMID: 38092067 PMCID: PMC11000803 DOI: 10.1044/2023_jslhr-22-00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/16/2023] [Accepted: 10/18/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The aim of this study was to determine the effects of residual hearing slopes and cochlear implant frequency map settings on bimodal and electric-acoustic stimulation (EAS) benefits in speech perception. METHOD Adults with normal hearing were recruited for simulated bimodal and EAS hearing. Sentence perception was measured unilaterally and bilaterally. For the acoustic stimulation, three slopes of high-frequency hearing loss were created using low-pass filters with a cutoff frequency of 500 Hz: steep (96 dB/octave), medium (48 dB/octave), and shallow (24 dB/octave). For the electric stimulation, an eight-channel sinewave vocoder was used with an output frequency range (1000-7938 Hz) with three input frequency ranges to create frequency maps, overlap (188-7938 Hz), meet (500-7938 Hz), and gap (750-7938 Hz), relative to the cutoff frequency in the acoustic stimulation. RESULTS The largest bimodal/EAS benefit occurred with the shallow slope, and the smallest occurred with the steep slope. The effects of the slopes on bimodal/EAS benefit were greatest with the meet or gap map and the least with the overlap map. EAS benefit was greater than bimodal benefit at higher signal-to-noise ratios regardless of frequency map. CONCLUSIONS The results indicate that correlation between bimodal/EAS benefit and residual hearing could potentially improve if slopes were considered. The optimal frequency map differed with different slopes, suggesting that the slopes of residual hearing should be carefully considered in fitting bimodal and EAS hearing. EAS hearing provided greater benefit over bimodal hearing, suggesting that spectrotemporal integration was better within one ear (i.e., EAS) than across ears (i.e., bimodal).
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Affiliation(s)
- Yang-Soo Yoon
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX
| | - Shea Straw
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX
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Huang GJ, Luo MS, Lu BQ, Li SH. Noninvasive prognostic factors and web predictive tools for idiopathic sudden sensorineural hearing loss. Am J Otolaryngol 2023; 44:103965. [PMID: 37413817 DOI: 10.1016/j.amjoto.2023.103965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/10/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To friendly predict a reference prognostic outcome for idiopathic sudden sensorineural hearing loss (ISSNHL) patients with or without anxiety, we identified independent prognostic factors and developed practical predictive tools without invasive tests. METHODS Patients with ISSNHL in our center were enrolled from June 2013 to December 2018. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors of the complete recovery and the overall recovery for ISSNHL, which were subsequently utilized to develop the web nomograms. The discrimination, calibration, and clinical benefit were used to evaluate the performance of nomograms for ISSNHL. RESULTS 704 ISSNHL patients were finally enrolled in this study. Multivariate logistic regression analysis showed that age, time of onset, gender, affected ear, degree, and type of hearing loss were independent prognostic factors of complete recovery. Age, time of onset, affected ear, and type of hearing loss were independent prognostic factors of overall recovery. Web predictive nomograms were developed with excellent discrimination, calibration, and clinical value. CONCLUSION Based on the patients' data with a considerable size, independent noninvasive prognostic factors of complete recovery and overall recovery of ISSNHL were identified. Integrating these prognostic factors without invasive tests, practical web predictive nomograms were developed. Using web nomograms, clinical doctors could provide reference data (the predicted recovery rate) for supporting prognostic consultation of ISSNHL patients, especially those with anxiety.
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Affiliation(s)
- Guan-Jiang Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China
| | - Meng-Si Luo
- Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China
| | - Biao-Qing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China.
| | - Shao-Hua Li
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China.
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Yao Y, Guo Q, Luo W, Yang M, Liu J, Hou J, She W. Inflammatory Indicators in Peripheral Blood in Sudden Sensorineural Hearing Loss Patients With Different Audiogram Shapes. EAR, NOSE & THROAT JOURNAL 2023; 102:90-95. [PMID: 36250504 DOI: 10.1177/01455613221132115] [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: 01/31/2023] Open
Abstract
Objective: A retrospective study was conducted to explore the immune-inflammatory responses in sudden sensorineural hearing Loss (SSNHL) patients with different audiogram shapes. Methods: One hundred and ten inpatients with SSNHL were assigned to 4 subgroups according to the audiogram shape and treated with systemic methylprednisolone. The numbers of white blood cells, neutrophils, lymphocytes, platelets, and monocytes were counted. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the monocyte-to-lymphocyte ratio (MLR) were calculated and statistically analyzed. Results: Neutrophil-to-lymphocyte ratio, MLR, and systemic immune index (SII) of SSNHL patients were significantly higher than the control group, while PLR was not statistically significant. There were no statistical differences in NLR, PLR, MLR, and SII among the 4 subgroups. Conclusion: Immune-inflammatory response may be a common pathogenesis in all SSNHL patients with different audiogram shapes. The predictive value of these hematologic markers needs further research in the future.
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Affiliation(s)
- Yuting Yao
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, 66478Nanjing University of Chinese Medicine, Nanjing, China.,Jinling Hospital Qinhuai Medical Center of Nanjing University, Nanjing, China
| | - Qinghua Guo
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, 66478Nanjing University of Chinese Medicine, Nanjing, China.,66478Nanjing integrated traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Luo
- Jinling Hospital Qinhuai Medical Center of Nanjing University, Nanjing, China
| | - Ming Yang
- 66478Nanjing integrated traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Liu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, 66478Nanjing University of Chinese Medicine, Nanjing, China.,Department of Otolaryngology Head and Neck Surgery, 66506Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Hou
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, 66478Nanjing University of Chinese Medicine, Nanjing, China.,Department of Otolaryngology Head and Neck Surgery, 66506Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wandong She
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, 66478Nanjing University of Chinese Medicine, Nanjing, China.,Department of Otolaryngology Head and Neck Surgery, 66506Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Diao T, Chen Y, Jing Y, Ma X. Clinical characteristics and prognosis of acute low-frequency hearing loss and ascending sensorineural sudden sensorineural hearing loss. Front Neurosci 2023; 16:1076109. [PMID: 36703997 PMCID: PMC9871897 DOI: 10.3389/fnins.2022.1076109] [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: 10/21/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Objective The present study aimed to explore the pathogenesis of the ascending sudden sensorineural hearing (SSNHL) loss by comparing the clinical characteristics and prognosis of acute low-frequency hearing loss (ALFHL) and ascending SSNHL. Methods A total of 43 patients with ALFHL and 122 patients with ascending SSNHL were enrolled in this study. First, the prognosis of patients with ALFHL and ascending SSNHL were compared, and the prognostic factors of AFHL and ascending SSNHL were analyzed. Results Acute low-frequency hearing loss and ascending SSNHL have no remarkable difference in complete recovery rate. Compared to ascending SSNHL, ALFHL has younger onset age, female prevalence, lower hearing threshold, shorter time from onset to recovery, and a lower proportion of combined tinnitus. The PTA at admission and delay from onset to therapy were significantly related to the prognosis of patients with ascending SSNHL, while only delay from onset to therapy was significantly related to the prognosis of patients with ALFHL. The majority of patients with ascending SSNHL and ALFHL recovered completely within 10 days from onset. Conclusion Audiogram shape plays a critical role in the prognosis of SSNHL. Ascending SSNHL and ALFHL may share a common pathological mechanism.
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Evaluation of the Recovery of Idiopathic Sudden Sensorineural Hearing Loss Based on Estimated Hearing Disorders. Audiol Res 2022; 12:476-484. [PMID: 36136855 PMCID: PMC9498508 DOI: 10.3390/audiolres12050048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Various prognostic factors for idiopathic sudden sensorineural hearing loss (SSNHL) have been reported. Hearing loss directly derived from idiopathic SSNHL is important for understanding underlying pathogenesis and outcomes. We assessed the usefulness of evaluating hearing loss and recovery of idiopathic SSNHL on the basis of estimated hearing loss. The study included 115 patients whose characteristics and outcomes of hearing loss were investigated. The effects of vertigo/dizziness and age on hearing thresholds before/after treatment, nonaffected ear threshold, estimated hearing loss, improvement of hearing loss, and estimated remaining hearing loss were investigated. Vertigo/dizziness was a significant prognostic factor for hearing. In vertigo/dizziness patients, significantly more severe hearing loss and poorer improvement of hearing loss were observed above 500 Hz and below 1000 Hz, respectively. Severe hearing disorder remained at all frequencies. Conversely, post-treatment thresholds were significantly higher in the older population (≥65 years), although no differences in pretreatment thresholds were observed between the younger (≤64 years) and older populations. However, on the basis of nonaffected ear thresholds, previously existing hearing loss could have influenced the outcome. Thus, comparison of hearing outcomes between affected and nonaffected ears is essential for understanding hearing loss and outcomes in idiopathic SSNHL cases with existing hearing disorder.
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Lee HJ, Park Y, Lee JM, Yoon C, Kong TH, Jeon E. Comparison of Auditory Outcomes between Inpatient- and Outpatient-Based Treatment in Sudden Sensorineural Hearing Loss. J Clin Med 2022; 11:jcm11113123. [PMID: 35683508 PMCID: PMC9181492 DOI: 10.3390/jcm11113123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: The primary treatment for sudden hearing loss is high-dose steroid therapy. In some countries, hospitalization has been taken for granted. Although most countries appear to treat sudden hearing loss on an outpatient basis, some other countries have considered hospitalization as necessary. Only a few studies have been conducted on the effect of hospitalization on hearing outcomes. Therefore, we compared the hearing outcome of inpatient- and outpatient-based treatments to determine whether hospitalization affects the recovery of sudden hearing loss. Methods: We conducted a retrospective case review of patients diagnosed with sudden sensorineural hearing loss (SSNHL). In total, 439 patients with SSNHL were enrolled and categorized as either inpatients (group I) or outpatients (group O). Pure-tone audiometry was initially performed before the treatment and 3 months post-treatment. “Recovery” was defined as a hearing gain of 15 dB HL and a final hearing of better than 25 dB. “No recovery” was defined as an improvement of hearing gain of <15 dB 3 months after treatment. To exclude the effect of the level of pretreatment hearing loss, we divided the patients into three subgroups based on their hearing level: <40 dB, 40−70 dB, and >70 dB. To assess the effect of the treatment modality, the patients were divided into three treatment subgroups: systemic steroids (SS), intratympanic steroids (ITS), and a combination of both (SS and ITS). Results: The pretreatment hearing level was significantly higher in group I (61.5 ± 25.4 dB) than in group O (50.3 ± 23.0 dB; p < 0.05). The hearing gain was significantly higher in group I (33.3 ± 24.4 dB) than in group O (24.0 ± 21.8 dB; p < 0.05). The “Recovery” ratio was significantly higher in group I (70.2%) than in group O (63.1%) (p < 0.05). A repeated measures ANOVA was performed to assess the statistical differences between hospitalization, treatment modalities, and pretreatment subgroups. The inpatient group showed a significant hearing improvement in all SSNHL patients (p < 0.05). There was a significant hearing improvement in the inpatient group with pretreatment hearing <40 and 40−70 dB (p < 0.05). There was no significant difference between the inpatient and outpatient groups in pretreatment hearing >70 dB (p > 0.05). Conclusions: This retrospective study showed that inpatient treatment for sudden hearing loss is more beneficial for hearing improvement than outpatient treatment. The positive effect of inpatient treatment appears to be significant in patients with a pretreatment hearing level of 70 dB or less.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
| | - Yesai Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
| | - Jeon-Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea;
| | - Chulyoung Yoon
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Tae-Hoon Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Eunju Jeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Korea; (H.-J.L.); (Y.P.)
- Correspondence: ; Tel.: +82-32-280-5903; Fax: +82-50-4411-7964
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Conte G, Di Berardino F, Mastrapasqua RF, Casale S, Scola E, Capaccio P, Triulzi F, Pignataro L, Zanetti D. Prognostic Value of Early Magnetic Resonance Imaging Patterns in Sudden Hearing Loss. Audiol Neurootol 2021; 27:64-74. [PMID: 33895732 DOI: 10.1159/000515153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient's SSHL and with treatment outcomes. METHODS In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later. RESULTS Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea ("pattern+ MRI") correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always "pattern" negative at MRI (p = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (p = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (p = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI. CONCLUSIONS The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient's clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.
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Affiliation(s)
- Giorgio Conte
- Neuroradiology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Di Berardino
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rodolfo Francesco Mastrapasqua
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Casale
- Neuroradiology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Scola
- Neuroradiology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- Otorhinolaryngology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Otorhinolaryngology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diego Zanetti
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ng B, Crowson MG, Lin V. Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study. J Otolaryngol Head Neck Surg 2021; 50:22. [PMID: 33795010 PMCID: PMC8015047 DOI: 10.1186/s40463-021-00498-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. METHODS An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. RESULTS 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. CONCLUSION The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol.
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Affiliation(s)
- Benjamin Ng
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Matthew G Crowson
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Sudden sensorineural hearing loss in patients with vestibular schwannoma. Sci Rep 2021; 11:1624. [PMID: 33479297 PMCID: PMC7820278 DOI: 10.1038/s41598-020-80366-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 01/12/2023] Open
Abstract
Clinical features of sudden sensorineural hearing loss (SSNHL) associated with vestibular schwannoma (VS) are not fully understood. Determining a treatment plan and explaining it to patients requires clinicians to clearly understand the clinical features related to the tumor, including SSNHL. To identify the full range of clinical features of VS-associated SSNHL, especially recovery of hearing following multiple episodes of SSNHL and what factors predict recovery and recurrence. A multicenter retrospective chart review was conducted in seven tertiary care hospitals between April 1, 2011, and March 31, 2020. We collected and analyzed dose of administered steroid, pure-tone audiometry results, and brain MRIs of patients diagnosed with VS-associated SSNHL. Seventy-seven patients were included. They experienced 109 episodes of audiogram-confirmed SSNHL. The highest proportion of complete recoveries occurred in patients with U-shaped audiograms. The recovery rates for the first, second, and third and subsequent episodes of SSNHL were 53.5%, 28.0%, and 9.1%, respectively. Recovery rate decreased significantly with increasing number of SSNHL episodes (P =0 .0011; Cochran-Armitage test). After the first episode of SSNHL, the recurrence-free rate was 69.9% over 1 year and 57.7% over 2 years; the median recurrence time was 32 months. Logarithmic approximation revealed that there is a 25% probability that SSNHL would recur within a year. SSNHL in patients with VS is likely to recur within one year in 25% of cases. Also, recovery rate decreases as a patient experiences increasing episodes of SSNHL.
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13
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Weininger O, Warnecke A, Lesinski-Schiedat A, Lenarz T, Stolle S. Computational analysis based on audioprofiles: A new possibility for patient stratification in office-based otology. Audiol Res 2019; 9:230. [PMID: 31728177 PMCID: PMC6843421 DOI: 10.4081/audiores.2019.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/22/2019] [Indexed: 12/27/2022] Open
Abstract
Genetic contribution to progressive hearing loss in adults is underestimated. Established machine learning-based software could offer a rapid supportive tool to stratify patients with progressive hearing loss. A retrospective longitudinal analysis of 141 adult patients presenting with hearing loss was performed. Hearing threshold was measured at least twice 18 months or more apart. Based on the baseline audiogram, hearing thresholds and age were uploaded to AudioGene v4® (Center for Bioinformatics and Computational Biology at The University of Iowa City, IA, USA) to predict the underlying genetic cause of hearing loss and the likely progression of hearing loss. The progression of hearing loss was validated by comparison with the most recent audiogram data of the patients. The most frequently predicted loci were DFNA2B, DFNA9 and DFNA2A. The frequency of loci/genes predicted by AudioGene remains consistent when using the initial or the final audiogram of the patients. In conclusion, machine learning-based software analysis of clinical data might be a useful tool to identify patients at risk for having autosomal dominant hearing loss. With this approach, patients with suspected progressive hearing loss could be subjected to close audiological followup, genetic testing and improved patient counselling.
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Affiliation(s)
- Oren Weininger
- Department of Otolaryngology, Hannover Medical School, Hannover
| | - Athanasia Warnecke
- Department of Otolaryngology, Hannover Medical School, Hannover.,Cluster of Excellence, Hearing4all German Research Foundation, Hannover, Germany
| | | | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover.,Cluster of Excellence, Hearing4all German Research Foundation, Hannover, Germany
| | - Stefan Stolle
- Department of Otolaryngology, Hannover Medical School, Hannover
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