Clinical observations of acute low-tone sensorineural hearing loss considered as cochlear hydrops

Acute low-tone sensorineural hearing loss (ALHL) has the following three criteria; obscure origin, acute onset and sensorineural hearing loss limited to low frequencies. Sixteen cases of ALHL which were considered as cochlear hydrops using glycerol test and electrocochleogram were studied. All patients visited our department within two weeks after onset and were followed up for one year or more after initial examination. The subjective symptoms, the character of vestibular and hearing impairment and prognosis of 16 cases with ALHL were also investigated. The results were as follows. 1. Patients complained of ear fullness rather than hearing impairment. Four patients were unaware of hearing loss. 2. Recruitment phenomenon was found in all of 15 cases examined. Vestibular findings were mostly normal, except that spontaneous nystagmus was found in two cases and head-shaking nystagmus in one. 3. Recurrence and fluctuation of hearing impairment occurred in 14 cases. Three cases had an attack of rotatory vertigo once and two has diagnosed as Meniere's disease later. 4. During three months prior to last examination, hearing was stabilized in nine cases and continued to fluctuate in seven cases. In the former, hearing was improved in four cases, unchanged in three, and worsened in two. 5. Two patients underwent an endolymphatic sac operation and have had a good prognosis. 6. The authors suggest that most of ALHL should be considered as transient cochlear hydrops because the subjective symptom and audiological and vestibular findings of our cases are similar to those of cases which were reported as ALHL by other investigators. According to the findings of glycerol test and electrocochleogram, endolymphatic hydrops in ALHL is considered to exist in all turns of cochlea.     

Clinical statistics of recurrent acute low-tone senseorineural hearing loss

Recently, acute low-tone senseorineural hearing loss (ALHL) has become common, and its good prognosis is known well. On the other hand, several reports have suggested that ALHL is frequently associated with Meniere's disease. We retrospectively examined the clinical course of 357 cases that were diagnosed and treated as ALHL at our hospitals. Forty-four of these cases that showed high-tone hearing loss in association with age-related changes were classified as atypical cases. The clinical futures of 49 "poor prognosis cases", who experienced recurrent hearing loss and/or profound hearing loss, are reported. Eight of the 49 cases who experienced recurrences had progressive hearing loss upto middle or high tones. Seventeen cases complained of vertiginous sensation, and 8 of these cases experienced recurrent attacks of vertigo and were diagnosed as having Meniere's disease. The former seventeen cases accounted for 34.7% of the "poor prognosis cases", and the latter eight accounted for 16.3% of these cases. Our results suggest that the hearing loss is more frequently associated with Meniere's disease in cases who experience recurrent hearing loss. Thus, cases initially diagnosed as ALHL may include some cases of progressive hearing loss and Meniere's disease. Even in cases in which hearing improvement is obtained, careful clinical observation is necessary, especially in older patients with bilateral affliction and atypical presentation. ALHL has been generally considered to have a good prognosis, however our examination revealed a relatively high frequency of recurrences, progressive hearing loss and complication by vertigo. We recommend, based on this evidence, that careful explanation of this disease is necessary at time of initial informed consent.     

Vestibular evoked myogenic potentials in acute low-tone sensorineural hearing loss

OBJECTIVE/HYPOTHESIS: It was the authors' premise that the vestibular evoked myogenic potential (VEMP) test may be used to differentiate acute low-tone hearing loss (ALHL) from Meniere's disease with low-tone HL. STUDY DESIGN: Prospective study. METHODS: From January 2000 to December 2002, consecutive 12 patients with ALHL and another 12 patients with definite Meniere's disease with low-tone HL were enrolled in this study. All patients underwent audiometry and VEMP test, before and after treatment with isosorbide for 3 consecutive months. RESULTS: Before treatment, 12 patients with ALHL revealed normal VEMPs (11, 92%) and augmented VEMPs (1). After treatment, 11 (92%) patients had resolved to normal hearing within 3 days. One year later, two (17%) patients progressed to Meniere's disease. In comparison with Meniere's disease, 6 (50%) of 12 patients showed normal VEMPs before treatment, and 7 (58%) patients had their hearing improved 3 months after treatment. Comparison of VEMP responses or hearing outcome between both groups exhibited significant differences. CONCLUSION: Most patients with ALHL reveal normal VEMPs throughout the episode, indicating that the saccule is spared. In contrast, 50% of Meniere's disease patients with low-tone HL demonstrate abnormal VEMPs, showing a significant difference. Therefore, the VEMP test can be used to differentiate ALHL from Meniere's disease with low-tone HL.     

Bilaterality in acute low-tone sensorineural hearing loss

Bilaterality in acute low-tone sensorineural hearing loss (ALHL) is more generally recognized than that in idiopathic sudden sensorineural hearing loss. Subjects were 274 patients diagnosed with ALHL based on criteria of a study group of the Ministry of Health, Labor and Welfare of Japan, i.e., total of 3 low tone hearing of 70dB or more and, a total of 3 high-tone hearing of 60dB or less, and treated at the departments of otolaryngology at Yamanashi University and Suwa Central Hospital. ALHL involving bilateral ears symptoms and/or bilateral hearing impairment conforming to diagnostic criteria was selected and summarized. Clinical ear symptoms, clinical test results, and hearing levels (total 3 low tone hearing, 1kHz, and total of 3 high-tone hearing) were statistically analyzed. We also reviewed Japanese clinical reports of ALHL that include bilateral cases. In 32 cases (11.7%) of 274 cases, both ear symptoms and hearing impairment were bilateral. In 22 (8.0%) of the 274, bilateral ear symptoms were present, but showed unilateral hearing loss conforming to diagnostic criteria. Another 22 (8.0%) out the 274 reported unilateral ear symptoms, but hearing tests indicated bilateral ALHL. A total of 76 cases (27.7%) of the 274 had bilaterality in either ear symptoms or hearing loss. Our review indicated that 9.0% (162 of 1803) ALHL patients were bilaterally affected, possibly indicating that AIHL includes a larger number of bilateral cases than currently assumed, if the opposite side were given a especially detailed clinical interview. Statistical analysis (Mann Whitney test, P<0.01) of hearing of unilateral cases indicated that 3 low tone hearing was more affected than 3 high-tone hearing, even on the normal side. These results indicate that ALHL tends to be bilateral, possibly due to the mechanism of pathogenesis, and also that the mechanism may include both local and general conditions. This more closely resembles Meniere's disease than idiopathic sudden sensorineural hearing loss. Both sides of bilateral cases were not usually the same in hearing patterns, glycerol test results, or prognosis. A statistically significant difference (Mann Whitney test, P<0.01) in total of 3 low tone hearing was seen between worse and better sides in bilateral cases. The degree of disease on both sides in bilateral cases thus was not always the same. Bilateral cases may result from both the influence of general conditions such as fatigue, stress, and lack of sleep and local conditions such as pathogenesis of endolymphatic hydrops that may cause differences in both ears. No clear difference was seen in clinical symptoms, hearing levels, and clinical examination, e.g., Schellong and glyceol tests, between unilateral and bilateral cases. Bilateral cases had a poorer prognosis (lower complete recovery ratio; chi2 test P<0.01) than unilateral cases. Our results indicated that cautious evaluation of opposite ear is necessary in diagnosis, treatment, and prognostication of ALHL.     

Analysis of audio-vestibular assessment in acute low-tone hearing loss

Conclusion This study demonstrated excellent hearing recovery following the combined treatment of diuretic and oral steroid, and electrocochleography (ECoG) was significantly higher than normal side. This study reports characteristics of acute low-tone hearing loss (ALHL) that show the greater low-tone hearing loss, the higher ECoG, and excellent recovery, even-though low-tone hearing loss is worse, which can be different compared with sudden deafness. Objective To analyze ALHL without vertigo, this study compared the ALHL group with all patients exhibiting low-tone hearing loss and ear fullness. Hearing changes and vestibular functions were analyzed. Materials and methods ALHL was defined as a mean hearing loss of?≥?30?dB at 125, 250, and 500?Hz, and?≤?20?dB at 2, 4, and 8?kHz. From 156 cases of low-tone hearing loss of more than 10?dB without vertigo, 31 met the ALHL criteria and were subjected to audio-vestibular assessments including PTA, ECoG, vestibular evoked myogenic potential (VEMP) testing, and caloric testing. Results In ALHL, low-tone hearing loss was 42.7?±?9.5?dB, and 83.9% of ALHL significantly recovered by more than 10?dB. The ECoG in ALHL was 0.334?±?0.11 (higher than 0.25?±?0.08 on the normal side) and ECoG abnormality was 35.5% (the greater low-tone hearing loss, the higher ECoG value).     

急性低频感音神经性耳聋的临床观察

目的探讨急性低频感音神经性耳聋(acute low-tone sensorineural hearing loss,ALHL)的临床特点和疗效,提高对该疾病的诊断和认识。方法回顾性分析62例ALHL患者的临床表现、听力学检查和治疗情况,总结其临床发展规律。结果发病年龄以青中年为主,女性明显多于男性,多为单耳发病,表现为耳闷或伴耳鸣,听力下降,不伴眩晕,所有患者纯音听阈均表现为轻中度低频感音神经性耳聋,治疗前后分别为(38.71±6.82)dB和(20.56±9.44)dB,两者比较差异具有统计学意义(P<0.05)。鼓室图"A"型,49例(80.9%)镫骨肌反射引出,40例(64.5%)Metz试验阳性,62例ABR均正常。62例患者治疗前DPOAE在0.5～1 kHz的引出率仅为18.7%,反应幅值明显降低,治疗后DPOAE在0.5～1 kHz的引出率提高至43.8%,幅值亦有所提高。结论 ALHL以突发的耳闷和(或)伴耳鸣为主要表现,常单耳发病,青中年女性为主,听力学定位诊断为蜗性聋,仅累及低频区,皮质类固醇激素治疗有较好的疗效。     

急性低频感音神经性聋的临床研究

目的探讨急性低频感音神经性聋（acute low-frequency sensorineural hearing loss,ALHL）的临床特征和疗效,提高对该疾病的认识和鉴别能力。方法回顾性分析42例（42耳）ALHL的临床表现、听力学检测结果和2～5年的随访情况,总结ALHL的临床发病特征。结果本组42例（42耳）ALHL呈急性发病,年龄27～44岁。男16例（38.10%）,女26例（61.90%）。20例（20耳）伴低调耳鸣,17例（17耳）伴耳部堵闷,11例（11耳）伴听觉过敏现象,6例（6耳）伴有头昏。0.125～1kHz平均听阈为（38.74&#177;4.62）dBHL,2～8kHz平均听阈为（13.52&#177;3.86）dBHL,治疗后上述平均听阈分别为（21.05&#177;9.74）dBHL和（19.85&#177;9.44）dBHL。所有病人的听性脑干反应（auditory brainstem response,ABR）各波潜伏期及波间期正常。畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）在低频区引出率为16.67%,高频区引出率为85.71%。结论ALHL以单侧发病为主,常伴低调耳鸣、耳部堵闷及胀满感。该病多见于青年女性。纯音听阈以低频听阈升高为特征,ABR正常。病变可能位于耳蜗顶周。     

Evolution of audiometric pattern in Meniere's disease: long-term survey of 380 cases evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery

OBJECTIVES: Hearing loss in the early stages of Meniere's disease is characterized by a fluctuation in the audiometric pattern limited to the low frequencies, and then, during the disease's evolution, the hearing loss involves the medium and high frequencies. As far as the prevalence of different types of audiometric curves is concerned, there is no agreement among the various studies. The study of audiometric evolution in the course of the disease has been limited owing to the difficulties in following a relevant number of patients for a long period of time. The aim of the present study was to compare the auditory level and audiometric pattern evolution in a significant number of patients suffering from Meniere's disease who had undergone long-term follow-up (at least 10 years). METHODS: The study considered 380 patients with a confirmed diagnosis of Meniere's disease. The audiometric data were collected at the onset of the disease and after 5 and 10 years. Four patterns were considered: peak, rising, falling, and flat. Audiometric evolution analysis in four stages, defined by the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery, was evaluated. RESULTS: At the onset, in 190 cases, the audiometric pattern was a peak curve, with fluctuation of the threshold in 68% of cases. The mean threshold shift for the 500 to 3000 Hz range was between 26 and 40 dB. After 5 years, a peak type (41.9%) or a flat type (42.9%) was observed; the pure-tone average (PTA) ranged between 26 and 40 dB in 47.9% and between 41 and 70 dB in 51.8% of cases. After 10 years, in most cases (57.9%), a flat curve was observed, and the PTA in 100% ranged between 41 and 70 dB. CONCLUSION: The most common audiometric pattern at the onset of the disease is the peak type; long-term transformation of the initial audiometric pattern into a flat curve has been confirmed. High-frequency involvement seemed to be related more to Meniere's disease duration than to the influence of aging on hearing loss.     

Acute sensorineural hearing loss in 277 outpatient cases]

Subjects were 227 patients with acute sensorineural hearing loss of 17,146 patients seen at our ear, nose, and throat (E.N.T.) outpatient clinic from October 1994 through September 2000. Of these, 45 suffered from profound and moderate idiopathic sudden hearing loss diagnosed when the arithmetical mean of hearing thresholds at 0.25, 0.5, 1, 2, and 4 KHz was 40 dB or worse. Of the 30 patients whose medical treatment was started within 7 days of onset, 18 (60%) showed excellent or complete recovery of hearing, whereas none of the 15 whose treatment was started 8 days or late after onset showed satisfactory improvement. In general, the sooner treatment was started, the better hearing recovered. Idiopathic acute low-tone sensorineural hearing loss was found in 111 (49%) patients with a female preponderance at a M:F ratio of 1:2.3, but no gender difference was seen in other diseases. The most common symptom was a feeling of pressure or fullness in the affected ear. Only 16% of patients were aware of their hearing disturbance. Some 73 (66%) showed complete recovery. Meniere's disease was diagnosed in 13, in whom hearing improved in only 2 (15%). Probable Meniere's disease was diagnosed in 9 patients who had 1 definitive episode of vertigo with low-tone sensorineural hearing loss, and their prognosis was good. The prognosis in 7 patients with hearing loss due to acoustic trauma and 1 with psychogenic hearing loss was good, but normal hearing was not restored in 1 with mumps or 1 with acoustic neurinoma. A patient with diabetic nephropathy had low-tone hearing loss and nystagmus toward the affected ear. Attacks of vertigo were controlled by diuretic therapy, but hearing recovery occurred by a little less than 10 dB. Some 35 patients had mild idiopathic hearing loss and prognosis was relatively good. Hearing was disturbed after head injury in 2 and after nose blowing in 1, probably attributable to concussion of the labyrinth or the formation of a perilymphatic fistula. The diagnosis of this condition could not be made with certainty by surgical exploration of the ear.     

An electrocochleographic study of acute low-tone sensorineural hearing loss

Summary Twenty-four patients with acute low-tone sensorineural hearing loss (ALHL) were examined using electrocochleography. The negative summating potential (SP) amplitude and the summating potential/action potential (AP) ratio were significantly greater in the ALHL patients than in normals. The SP/AP ratio was smaller in the ALHL patients than in patients with known Meniere's disease and moderate hearing loss, although the SP amplitude was somewhat greater in the former. An abnormal increase in the SP amplitude following click stimuli was found in 54% of the ALHL patients, while the SP/AP ratio was increased abnormally in 63% of these patients. These findings suggest that the pathophysiology of ALHL may be similar to that for endolymphatic hydrops.     

急性低频感音神经性听力损失的临床研究

目的　探讨急性低频感音神经性听力损失(acutelow tonesensorineuralhearingloss,ALHL)的病因病理、临床特点和诊治方法。方法　选择30例ALHL患者为研究对象,在详细采集病史和耳科检查的基础上,行系统的听力学检测,包括纯音测听、声导抗测试、听性脑干反应(auditorybrainstemresponse, ABR)和耳声发射(otoacousticemissions,OAE)。所有患者接受为期15天的皮质类固醇激素试验性治疗,疗程结束后随访6~14个月(平均10 2个月)。结果　本组患者以青年为主,临床主诉多为低音调耳鸣、耳闷和听力下降,耳科检查未见异常。所有患者(30例31耳)纯音测听显示轻到中度的低频感音神经性听力损失;鼓室图呈“A”型, 26耳引出镫骨肌声反射,其中14耳Metz试验阳性。受检的20耳中,ABR均正常;初诊时14耳瞬态诱发性耳声发射未通过,畸变产物耳声发射听力图表现为0 .5及0 .75kHz两个频率点上异常。经激素治疗后, 24耳听力完全恢复, 4耳部分恢复, 3耳无变化,总有效率90. 3%。结论　ALHL以突发的低音调耳鸣、听力下降和耳闷为主要表现,常单耳发病,听力学定位诊断提示为蜗性病变,仅累及低频区。本病尚无特效疗法,皮质类固醇激素可能是一种有希望的治疗药物。     

Short-term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid

Acute low-tone hearing loss (ALHL) is a typical type of hearing loss in Ménière's disease and thought to be caused by endolymphatic hydrops in the inner ear. We treated 40 patients with ALHL by administration of the steroid and the early outcome and prognosis of the hearing level was retrospectively evaluated. The prognosis was generally determined within 7-10 days after administration of steroid. High-dose steroid cured some patients who failed to recover with low-dose steroid therapy. Our results showed that steroid is one of the effective therapies for ALHL and supported that etiology of ALHL involves an immune response.     

Epidemiological survey of acute low-tone sensorineural hearing loss

Abstract

Objectives: A nationwide epidemiological survey involving 23 hospitals in Japan was conducted and the predictive values of demographic data were examined statistically.

Methods: A total of 642 patients from 23 hospitals, including 20 university hospitals, in Japan were enrolled in the study. Age ranged from 8 to 87 years, and all were diagnosed with acute low-tone sensorineural hearing loss (ALHL) between 1994 and 2016. Demographic data for the patients, such as symptoms, gender, mean age, and distribution of ALHL grading, were collected and analyzed in relation to prognosis using Student’s t-test, χ² test and logistic regression.

Results: Female gender (p?<?.013), younger age (p?<?.001), low-grade hearing loss (p?<?.001), and shorter interval between onset and initial visit (p?<?.004) were significantly predictive of a good prognosis. The prognosis for definite ALHL was significantly better than that for probable ALHL (p?<?.007).

Conclusions: The severity of initial hearing loss, interval between onset and initial visit and age were important prognostic indicators for ALHL, while female gender was an important prognostic indicator peculiar to ALHL.     

Audiometric findings of patients with migraine-associated dizziness.

OBJECTIVE: The objective of this study was to determine whether the audiometric findings of migraine-associated dizziness could be used to better distinguish migraine-associated dizziness from Meniere's disease. STUDY DESIGN: A retrospective chart review. SETTING: Tertiary, otology/neurotology practice. PATIENTS: Two groups of patients were studied, a migraine-associated dizziness and a Meniere's disease group. There were 76 and 34 patients in the migraine-associated dizziness and Meniere's disease groups, respectively. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Initial and follow-up pure-tone average and low-frequency pure-tone average were recorded for both groups. Independent samples t tests were used to test for mean differences in pure-tone average and low-frequency pure-tone average. RESULTS: Pure-tone average and low-frequency pure-tone average were significantly worse for patients in the Meniere's disease group at both the initial and follow-up assessments. Three patients in the migraine-associated dizziness group had an elevated pure-tone average (>/=26 dB) and/or low-frequency pure-tone average at initial and/or follow-up assessment. The remaining 73 migraine-associated dizziness patients had normal hearing. In the Meniere's disease group, only two patients had a normal pure-tone average and low-frequency pure-tone average at both initial and follow-up evaluations. The hearing difference between the two groups was significant even when controlling for age and duration of dizziness symptoms. CONCLUSION: Audiometric findings of patients with migraine-associated dizziness are most often normal. Unlike Meniere's disease, the sensorineural hearing loss in migraine-associated dizziness rarely progresses. These audiometric findings may help to distinguish migraine-associated dizziness from Meniere's disease when diagnostic ambiguity exists between these two diagnoses.     

Long-term assessment of auditory changes resulting from a single noise exposure associated with non-occupational activities

We examined the long-term sequelae in both ears of 42 patients who reported the occurrence of auditory changes resulting from a single exposure to intense sound levels during non-occupational activities. We divided these patients into two groups, based upon noise exposures of either continuous duration or single high-energy impulse. Audiometric data were available for each of these subjects shortly after their noise-exposure events and follow-up examinations took place more than one year after the noise occurrence (range: 1-16 years). The initial median hearing loss for the continuous-type noise exposure group at 3-8 kHz was found to be 9 dB, relative to the age-appropriate norms, in the more affected ears, and hearing function was found to have returned to normal levels at follow-up. The same initial hearing loss was measured for the impulse-type noise group, but a residual hearing loss of 4 dB was measured at follow-up. Furthermore, the majority of the subjects from both groups reported tinnitus and hypersensitivity to sound at follow-up, but with minimal impact on their lives.     

Stapedectomy versus stapedotomy: comparison of results with long-term follow-up

OBJECTIVE/HYPOTHESIS: To compare the effectiveness and long-term stability of hearing results between stapedectomy and small fenestra stapedotomy in patients with conductive hearing loss due to otosclerosis. STUDY DESIGN: Retrospective review of prospectively collected audiometric data. METHODS: The hearing results and complication rates of 209 ears with long-term follow-up that underwent either stapedectomy or stapedotomy by the senior author (h.p.h.) between 1961 and 1989 were compared. Forty-two patients underwent stapedectomy in one ear and stapedotomy in the opposite ear, permitting a paired case review of the results in these patients. The techniques were compared with respect to initial and late hearing results and change of the results over time. RESULTS: Patients undergoing stapedectomy and stapedotomy were followed for an average of 11.5 and 6.0 years, respectively. There were no statistically significant differences in initial or late postoperative pure-tone average (PTA), PTA air-bone gap, speech discrimination scores, or incidence of sensorineural hearing loss between the two groups. Ears treated by stapedotomy showed statistically better initial and late postoperative 4-kHz air-conduction threshold and initial 4-kHz air-bone gap, but the gap difference was not significant with late follow-up. There was no significant difference in the percentage of patients with air-bone gap closure within 10 dB for any frequency other than 4 kHz at the initial postoperative test. Importantly, the successful outcomes in both groups were stable over long-term follow-up. Results were the same when comparing the two procedures in patients having undergone both. CONCLUSION: These results show that, in the hands of an experienced surgeon, either technique provides satisfactory and stable long-term results.     

Is recurrent loss of low frequency tone perception--without vertigo--a precursor of Meniere disease?

PURPOSE: Recurrent low-frequency sensory hearing loss is one characteristic sign of Meniere's disease. It is therefore often assumed to be a prodromal sign of Meniere's disease. METHODS: We report on 81 patients with recurrent low-frequency sensory hearing loss who did not previously suffer from vertigo. All patients underwent a follow-up examination after at least 1 year up to more than 10 years after the onset of the disease [average: 64.65 months (SD 56.33)]. CONCLUSIONS: Only 3.7% of these patients developed the typical signs of Meniere's disease with labyrinthine vertigo, whereas 25.9% suffered from recurrent hearing loss and an unspecific vertigo, which could be diagnosed and treated as psychogenic vertigo; 3.7% showed a typical benign positional vertigo. We can thus conclude that although almost every patient with Meniere's disease suffers from recurrent hearing loss, only a few patients with recurrent hearing loss will develop Meniere's disease. However, many patients with low-frequency sensory hearing loss develop anxiety and psychogenic dizziness in expectation of "imminent" Meniere's disease. Therefore, it is important to counsel the patients carefully that the probability of this occurring is not very high.     

Prognosis of low-tone sudden deafness - does it inevitably progress to Meniere's disease?

CONCLUSION: We conclude that not all low-tone sudden deafness (SD) patients suffered from endolymphatic hydrops even if they had vertigo attack at the onset and that electrocochleography (ECochG) was a useful prognostic tool. OBJECTIVES: To investigate whether low-tone SD was a precursor of Meniere's disease and whether patients with low-tone SD suffered from endolymphatic hydrops. PATIENTS AND METHODS: This was a retrospective case review in the university hospital. A total of 184 patients with low-tone SD were divided into two groups with single and recurrent episodes. The progress, follow-up audiograms, and ECochG results of the patients were reviewed and compared with those of patients with high-tone SD and Meniere's disease. RESULTS: In all, 83 of 177 patients with low-tone SD unaccompanied by vertigo had recurrent hearing loss; 15 of the 83 developed vertiginous attacks. The remaining 94 patients had a single episode. Three of the seven patients with low-tone SD accompanied by vertigo had recurrent hearing loss; two of the three were subsequently confirmed to have Meniere's disease. The other four had a single episode. No difference in rate of progress from SD to Meniere's disease was observed among the low-tone and the high-tone SD groups. The average -SP/AP of each group with a single episode is smaller than that of other groups with recurrent episodes and Meniere's disease.     

Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan

Abstract

Objectives: The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis.

Methods: Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis.

Results: Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent.

Conclusion: The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.     

Hearing loss in the 4-8 kHz range following tympanic membrane perforation from minor trauma

This study looked at the incidence of sensorineural hearing loss in the 4-8 kHz range in patients with unilateral tympanic membrane perforations from minor trauma who presented to the department in the past year. Eleven patients conformed to our inclusion criteria, one was lost to follow-up. Perforation was present in all patients in the pars tensa and no treatment was required in nine patients. The mean sensorineural hearing loss at 4,6 and 8 kHz was 28.2 dB on initial examination and 14.6 dB by Day 30. All 11 patients had normal hearing in the contra-lateral ear (mean 13.5 dB). In this group of patients with a tympanic membrane perforation from minor trauma the conductive hearing loss was accompanied by a significant (P= 0.001) but reversible high frequency sensorineural deafness.