Sudden sensorineural hearing loss during oral anticoagulant therapy

This study investigated the role of sudden sensorineural hearing loss (SSNHL) as a symptom in oral anticoagulant therapy with vitamin K antagonists (Phenprocoumon; Marcumar, Falithrom). Vascular compromise of the cochlea due to thrombosis, embolus, reduced blood flow or vasospasm is one of the four possible pathways that can lead to SSNHL. Oral anticoagulant therapy should prevent thrombosis; if it does not the question arises as to whether the anticoagulation is working, or the wrong hypothesis of vascular compromise has been made. Patients with SSNHL during oral anticoagulant therapy who were admitted to the ENT Department of the University Hospital in Jena from 1998 to 2001 were included. The pure-tone audiograms and the prothrombin time (PT) values before and after the event of the SSNHL were evaluated. The study found 10 patients with SSNHL during oral anticoagulant therapy. Although the audiograms showed some improvement in the majority of cases, three cases showed almost no improvement in hearing. On admission, half of the patients showed a PT-value higher than 30 per cent and in nine cases a PT-value >30 per cent could be demonstrated at least once during testing. It was not possible to demonstrate a relationship between the SSNHL and oral anticoagulation. Vascular compromise cannot be excluded as a cause for sudden hearing loss in patients undergoing oral anticoagulant therapy. It is possible that oral anticoagulants influence the viscosity of the plasma leading to interference with the microcirculation in the inner ear. Further research into this area is currently being conducted.     

Sudden sensorineural hearing loss and hemodialysis

The etiology of sensorineural hearing loss (SNHL) associated with renal failure and hemodialysis is controversial. Possible mechanisms include a shared antigenicity between the kidney and the labyrinths, osmotic alteration caused by hemodialysis, and the ototoxic effect of diuretics. We present 2 cases of SNHL associated with renal failure and its treatment. One patient was a 35-year-old man who developed profound SNHL after 5 sessions of hemodialysis, and the other was a 36-year-old woman who developed severe to profound SNHL after 7 sessions. It is our impression that both hearing losses might have been attributable to osmotic disequilibrium in the labyrinth or to an acute labyrinthine injury caused by contamination of the blood by the degraded product of an old cellulose acetate hemodialyzer membrane; the hemodialyzer had been in use for 15 years.     

儿童突发性感音神经性聋发病特点分析

目的 :探讨儿童突发性感音神经性聋 (突发性聋 )的发病特点 ,以指导临床诊断与治疗。方法 :总结2 1例 14岁以下突发性聋患儿 (儿童组 )的临床表现及预后等 ,并与 6 7例成年突发性聋 (对照组 )进行对比分析。结果 :儿童组中 11例 (5 2 .4 % )查到可能的病因 ,其中腮腺炎 4例 (19% )、上呼吸道感染 3例 (14 .3% )、耳毒性药物中毒 2例 (9.5 % )、声损伤和代谢性脑病各 1例 ;对照组 19.4 %找到可疑的病因。入院时儿童组听力受损平均88.6dB ,对照组 80 .2dB ,两组差异有统计学意义 (P <0 .0 5 ) ;治疗后儿童组听力平均提高 14 .3dB ,对照组提高37.8dB ,两组差异有统计学意义 (P <0 .0 5 )。结论 :儿童突发性聋的特点多有明确病因 ,其中以病毒感染多见 ,其耳聋程度重 ,预后较成人差     

地震后突发性感音神经性听力损失发病情况调查

目的探讨地震后(Sudden sensorineural hearing loss,SSNHL)SSNHL的发病规律,及其与睡眠障碍(Sleep disorders,SD)之间的关系。方法从汶川及玉树两次地震后大坪医院收治的1328例伤病员中遴选1050例轻伤类伤病员作为研究对象,其中男性616例,女性434例。按照年龄分为5组,分别观察不同性别及年龄段伤病员SSNHL及SD的发病规律,以及SSNHL和SD的相关性。结果 1050例研究对象中,女性SSNHL发病率(12.9%)明显高于男性(6.66%)(P=0.001<0.01)。97例SSNHL患者中,低龄者(18~45岁)重度听力损失的发病率(21.67%)明显高于高龄者(5.41%)(P=0.031<0.05)。1050例伤病员中,男性和女性SD发病率分别为28.57%及24.65%,无显著性差异(P=0.159>0.05)。SD患者SSNHL的发病率(22.97%)明显高于非SD者(4.17%)(P=0.000<<0.01)。女性SSNHL患者SD的发病率(73.21%)明显高于男性(31.71%)(P=0.00<<0.01)。97例SSNHL病人中,第V组SD发病率(83.33%)明显高于其余各组(P=0.039<0.05)。结论地震后SSNHL发病率较高。老年人及女性高发。中青年发病率较低但病情重的趋势明显。SD可能与SSNHL的发生发展有关。     

Sudden sensorineural hearing loss: evidence from Taiwan

OBJECTIVE: This study uses 5-year population data to determine the incidence rate of sudden sensorineural hearing loss (SSNHL) in Taiwan, taking into consideration the age and gender of patients, as well as seasonal variations. STUDY DESIGN: A retrospective cross-sectional study. METHOD: The data used is from the Taiwan National Health Insurance Research Database covering the period from 1998 to 2002. A total of 9,267 sample patients were identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). The autoregressive integrated moving average (ARIMA) method was also carried out in order to identify any variations in the monthly incidence rates of SSNHL. RESULTS: We find that for the period under examination, gender-specific incidence rates per 100,000 of the population were 8.85 for males, and 7.79 for females, and that there was an increase in age-specific SSNHL incidence with age. The ARIMA test for seasonality was found to be significant for the whole sample. Of all the seasons in Taiwan, the highest SSNHL incidence rates were found in autumn. CONCLUSIONS: Our finding of significant variations in the monthly incidence of SSNHL provides valuable information for otolaryngologists and public health officials, creating an awareness of periods of a potential increased risk of SSNHL.     

Sudden sensorineural hearing loss: supporting the immunologic theory

Sudden deafness constitutes a diagnostic challenge. Classically, 2 causes, viral and vascular, are considered in the origin of idiopathic sudden hearing loss. More recently added to the list of possibilities are rupture of the membranous labyrinth and immune-mediated sensorineural hearing loss. The latter can be either primary and localized to the inner ear or, in perhaps fewer than one third of cases, secondary to generalized systemic autoimmune disease. The purpose of the present review is to define immune-mediated sudden sensorineural hearing loss as a distinctive entity, on the basis of clinical, immunologic, and pathological findings, and suggest a profile of the typical patient.     

听力损失与突发性聋预后的关系

目的：探索听力损失对突发性聋预后的影响。方法:对146例（167耳）突聋患者的临床资料进行回顾性分析,应用SAS 统计软件对纯音听阈情况与预后的关系进行统计学处理。结果:单因素分析显示,初诊时听力损失曲线为全聋型,纯音高频听阈（4?000?Hz及8?000?Hz）损失较重,高频听阈（4?000?Hz+8?000?Hz）大于低频(250?Hz+500?Hz)听阈的患者预后不佳;多因素分析显示,8?000?Hz的听阈水平与预后关系最为密切,其次为4?000?Hz听阈及听力损失类型。结论：从单、多因素分析的结果可以看出,对突聋应采用多因素逐步分析的方法进行研究,以使预后和疗效评估更具准确性和客观性;高频听力损失程度是突发性聋预后的一个可靠评估因素。     

Sudden sensorineural hearing loss after heroin injection

Sudden sensorineural hearing loss is a symptom of cochlear injury. Potential aetiologies are vascular diseases, viral infections, allergic reactions, autoimmune disorders, and traumatic rupture of the intralabyrinthe membrane. Unlike in unilateral cases bilateral sensorineural hearing loss is often associated with specific disease entities. We report a case of sudden bilateral deafness after intravenous heroin abuse. The putative pathophysiological mechanisms are discussed.     

Hyperbaric oxygen and steroid therapy for idiopathic sudden sensorineural hearing loss

In our controlled retrospective analysis of medical records in tertiary care academic medical center, we aimed to investigate the therapeutic effects of hyperbaric oxygen (HBO) therapy combined with steroid administration for idiopathic sudden sensorineural hearing loss (ISSNHL) in comparison with that of steroid administration alone. Our subjects were 130 consecutive inpatients with ISSNHL (hearing levels ≥40 dB; time from the onset of hearing loss to the start of treatment ≤30 days). Sixty-seven patients underwent HBO plus steroid therapy (HBO group), and 63 were given steroids alone (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to that in the unaffected contralateral ear. The cure rate and hearing improvement rate were not statistically different between the two groups; however, the recovery rate was significantly higher in the HBO group than in the steroid group (59.7% vs. 39.7%; P < 0.05). With regard to patients with initial hearing levels of ≥80 dB, the hearing improvement rate was significantly higher in the HBO group than in the steroid group (51.1 ± 7.0% vs. 27.1 ± 7.8%; P < 0.05), while in patients whose initial hearing levels were <80 dB, hearing outcomes were not statistically different between the two groups. In both the HBO and steroid groups, patients with initial hearing levels of <80 dB showed a better hearing improvement rate than those with initial hearing levels of ≥80 dB. In conclusion HBO therapy shows a significant additional effect in combination with steroid therapy for ISSNHL, particularly in patients with severe hearing loss.     

突发性聋与颈静脉球憩室关系初探

为探讨颈静脉憩室（ＪＢＤ）与突发性聋（突聋）的相关性，报告收治突聋１９例中，ＣＴ及磁共振血管造影显示右侧ＪＢＤ３例，共颈静脉孔和乙状窦均明显扩大。其产生内耳功能障碍的机理可能为：①ＪＢＤ压迫与阻塞耳蜗导水管和（或）前庭导水管，甚至内淋巴囊；②ＪＢＤ内的迂回血流对内耳的流体机械力学影响。提示：原因不明的内耳功能障碍病人，应作影像学检查，考虑有无ＪＢＤ的相关影响。     

Sudden sensorineural hearing loss: a treatment protocol including glucocorticoids and hyperbaric oxygen therapy

The aim of this study was to evaluate the efficacy of pharmacological treatment (corticosteroids, vasodilators, vitamins, Betaserc) combined with hyperbaric oxygen therapy (HBO) in the sudden sensorineural hearing loss (SSNHL). We reviewed 52 patients with SSNHL treated pharmacologically and with HBO (group A) between 1997 and 2000. All patients in this group received once daily, five days a week, 100% oxygen in a multiplace chamber under pressure of 2.5 ATA for 60 minutes (plus two 5 minutes air breaks). The other group (group B) consisted of 81 patients treated only pharmacologically between 1980 and 1997. Both groups were similar regarding age, season of the year in which deafness occurred, presence of vestibular symptoms and tinnitus, therapeutic delay from initial symptoms to start of treatment, and initial hearing loss, however there were significant differences in gender and shape of hearing loss. The improvement after treatment was measured by tonal audiometry. The retrospective analysis of audiometries performed in all patients was conducted. The improvement of hearing loss was statistically significantly better for group A (vasodilators, high-dose of corticosteroids, vitamins, Betaserc, HBO) than group B (vasodilators, lower-dose of corticosteroids, vitamins) in any single frequency (500-1000-2000-3000-4000-6000-8000 Hz) and in 4 ranges of frequencies (PTA, HTA, PMTA, OAA) both for relative and absolute values. We concluded that the combined therapy of high-dose corticosteroids and HBO improved the clinical results of treatment in the SSNHL, and therefore should be performed in such cases. We also observed that therapeutic delay and flat hearing loss are predictors of poor clinical outcome.     

Combination steroid and hyperbaric oxygenation therapy for sudden idiopathic sensorineural hearing loss

We retrospectively evaluated the efficacy of combination therapy with steroid and hyperbaric oxygenation for sudden idiopathic sensorineural hearing loss (SISNHL). Patients (n: 109; 111 ears) visited our clinic within 14 days from onset before receiving treatment between January 1999 and March 2003. Hearing loss was assessed based on criteria prepared by the Ministry of Health and Welfare Acute Severe Hearing Loss Study Group. Patients were distributed into Group I-95 patients who started treatment within 7 days from onset-, and Group II-14 patients who started treatment within 8-14 days from onset. We evaluated the outcome of therapy using grading established by The Research Committee on Acute Profound Deafness, Ministry of Health and Welfare, Japan. The complete recovery of hearing was worse in patients with severe hearing loss. It was 4.8% in grade 4a, 18.2% in grade 3a, 25% in grade 2a, 20.0% in grade 4b, 38.5% in grade 3b, and 66.7% in grade 2b. We studied the relationship between type of hearing loss and recovery after treatment. The complete recovery of hearing was most favorable in patients with low tone hearing loss, followed by those with middle tone hearing loss and those with horizontal hearing loss. These findings indicate that the type of hearing loss was the most significant determinant of SISNHL prognosis and course. Twenty patients with acute stage SISNHL had diabetes mellitus. The recovery of hearing was almost the same in those with and without diabetes mellitus. Recovery was complete in 32.4%, Niarked in 32.4%, and slight in 21.6%. In 13.5%, no change was observed. Our results and data from previous reports, involving more than 70 Japanese patients treated with steroids alone, suggest that combination therapy with steroid and hyperbaric oxygenation is effective for SISNHL.     

Sudden sensorineural hearing loss: literature survey on recent studies

Sudden sensorineural hearing loss (SSHL) is a symptom of cochlear injury. It is characterized by sudden onset, and, within a few hours, it reaches its maximum peak. It may be accompanied by vertigo and tinnitus. Many hypotheses have been advanced to explain its etiology: viral inflammation, vascular diseases, allergic reaction, rupture of intralabyrinthine membranes, and autoimmune diseases. The decrease in hearing may be unilateral or bilateral. To assess the histopathology of the labyrinth in cases of SSHL and to provide a better understanding of the etiopathogenesis, many studies have been carried out. Atrophy of the organ of Corti, loss of cochlear neurons, labyrinthine fibrosis, formation of new bone, and degeneration of the spiral ligament, vascular stria, hairy cells, dendrites, and apical spiral ganglion cells have been reported in temporal bone studies. In this article, new studies on the histopathologic and therapeutic bases of SSHL are reviewed.     

Sudden sensorineural hearing loss following manipulation of the cervical spine

Review of the otolaryngologic literature reveals no reports of sudden sensorineural hearing loss resulting from manipulation of the cervical spine. Indeed, in previously reported cases of vertebrobasilar artery injury following spinal manipulation, hearing loss has received little attention. Two patients with sudden sensorineural hearing loss following cervical spine manipulation are presented. The audiologic findings and cerebral arteriograms are reviewed and treatment is discussed. A review of the anatomy and pathophysiology is also included, and a possible mechanism of injury to the vertebral artery is proposed.     

A comparison between systemic and intratympanic steroid therapies as initial therapy for idiopathic sudden sensorineural hearing loss: a meta-analysis

Conclusions: Intratympanic steroid (ITS) treatment groups exhibited better outcomes in PTA improvement and recovery rate than systemic steroid therapy (SST) groups. Whether initial hearing loss severity would influence the PTA improvement and recovery rate still requires further research.

Objective: This article was aimed at evaluating whether intratympanic steroid (ITS) treatment would provide benefits over systemic steroid therapy (SST) as initial therapy in patients with idiopathic sudden sensorineural hearing loss (ISSHL). A meta-analysis was carried out based on published RCTs that included the hearing outcomes of ITS treatment and SST in ISSHL as initial therapy. Both PTA differences and recovery rate were analyzed.

Methods: The literature search was based on the online database including Pubmed, Embase, and Cochrane trails, which completed in July 2016. This study extracted the relevant data following the selection criteria. Mean difference (MD) of PTA differences and Odds ratio (OR) of recovery rate were calculated within 95% confidence intervals.

Results: Six eligible articles were reviewed. The pooled MDs of PTA differences was 3.42 (95% CI?=?0.17–6.67, p?=?.04) and the pooled ORs of recovery rate was 2.05 (95% CI?=?1.38–3.03, p?=?.0003), which indicated that ITS treatment yielded better PTA improvement than SST. Sub-group analyses based on the initial hearing loss were also conducted; however, the difference was insignificant according to our analysis results (p?=?.82 for PTA improvement and p?=?.26 for recovery rate).     

Sudden sensorineural hearing loss following intramuscular administration of penicillin

We report a case of sudden hearing loss in a patient with acute exudative tonsillitis, occurring 15 minutes after the intramuscular administration of penicillin. Audiological evaluation documented a profound sensorineural hearing loss of the cochlear type. The mechanism of the hearing loss was probably an immediate hypersensitivity (type I) allergic drug reaction. Penicillin is used frequently for the treatment of several infections. Allergic reactions to penicillin are well known and include urticaria, maculopapular exanthems, angio-oedema, bronchospasm and anaphylaxis, but sudden hearing loss has never been recorded.     

感音神经性聋的诊断和治疗

感音神经性聋概述 由于耳蜗毛细胞、听神经、听觉通路或各级听中枢神经元受损害,致声音的感受与神经冲动传递障碍者,称感音性聋或神经性聋.其中毛细胞病变引起者称感音性聋(耳蜗性聋或终器性聋),病变位于听神经及听觉通路者称神经性聋(蜗后性聋),病变发生于听觉中枢核团或大脑皮层听中枢者称中枢性聋.     

Defibrinogenation therapy for idiopathic sudden sensorineural hearing loss in comparison with high-dose steroid therapy

OBJECTIVE: The efficacy of defibrinogenation therapy for idiopathic sudden sensorineural hearing loss was studied in comparison with high-dose steroid therapy. MATERIAL AND METHODS: Eighty-eight consecutive patients with hearing levels > 40 dB and who had suffered hearing loss for < or = 30 days were enrolled: 40 patients for high-dose steroid therapy (PSL group) and 48 for defibrinogenation therapy (BX group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. RESULTS: The overall hearing outcomes of the two groups were roughly equivalent. However, with regard to patients with initial hearing levels < 80 dB, the hearing improvement rate of the BX group was significantly worse than that of the PSL group (61.2% +/- 7.3% vs 88.7% +/- 8.9%; p < 0.05), whereas in patients with initial hearing levels > or = 80 dB, the hearing outcomes did not differ between the 2 groups. Three patients in the PSL group manifested hyperglycemia while no serious side-effects were observed in the BX group. CONCLUSION: These results indicate that high-dose steroid therapy should be employed in preference to defibrinogenation therapy for patients with moderate hearing loss, whereas defibrinogenation therapy has an advantage for those with severe hearing loss, in view of its lower frequency of side-effects.