Comparison of hearing recovery criteria in sudden sensorineural hearing loss

The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature.ObjectiveThis paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature.Materials and MethodsThis is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added.ResultsThere was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement.ConclusionsThere is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.     

Idiopathic sudden sensorineural hearing loss

Idiopathic sudden sensorineural hearing loss remains one of the major unsolved otologic emergencies. In this paper the most important recent clinical literature is reviewed, a new method of clinical staging is presented, and unexplored potential treatments are presented. The method of clinical staging presented here is based on four elements represented by the acronym HEAR. The individual elements of the staging are hearing threshold (H), elapsed time from onset (E), audiogram shape (A), and related vestibular symptoms (R). Insufficiently explored potential treatments of sudden hearing loss include antiviral drugs, rheologic agents, and free radical scavengers.     

Sudden sensorineural hearing loss and delayed complete sudden spontaneous recovery

This is a case report of a 53-yr-old female who experienced sudden sensorineural hearing loss (SSNHL) accompanied by roaring tinnitus in her right ear. The patient's hearing partially improved in the low frequencies in response to intratympanic injections. Given that her hearing loss did not improve further, the patient was fitted with a hearing aid to mask the tinnitus and restore a sense of balance between the two ears. Approximately 9 mo postonset of the SSNHL, a complete spontaneous recovery of hearing occurred. Such a delayed and complete recovery is highly unusual. This case highlights that the spontaneous recovery in hearing indicates that the pathological cause for the SSNHL involved a process that was capable of repair or regeneration, thus ruling out pathologies related to cochlear hair cell destruction or nerve fiber loss. This leaves a possibility that the event causing the onset of the SSNHL resulted in a disruption of the ion homeostatic properties of the cochlea via the production of the endocochlear potential.     

Prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss.

HYPOTHESIS: To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL). BACKGROUND: An important element of research on ISSHL is to identify prognostic factors for this disease. Many studies have described predictive indicators to identify patients with a good prognosis needing no or minimal treatment. Only a few of these studies have included a model for calculating the probability for patient recovery, which may be important for clinical work, but these prognostic tables have not achieved widespread use clinically. METHODS: Evaluation of an electronic patient data base of 541 patients with ISSHL. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 8 times per day in duration of 30 min) and prednisone orally (100 mg in 1 morning dose) for 7 days. Factors that were analyzed included the patient's age, the interval between the onset of symptoms and beginning of treatment, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the opposite ear. Hearing gain was expressed either as absolute hearing gain or as relative hearing gain. Significant recovery of hearing was defined as the final pure-tone audiometry of 30 dB or less (or the same as the pure-tone audiometry of the opposite ear). RESULTS: The absolute hearing gain was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had significant recovery of hearing, and 228 (43%) did not have significant recovery of hearing. Using step-wise multiple linear regression analysis, the most important factors for prognosis included severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape (beta coefficient was -0.216, -0.231, 0.211, 0.113, and -0.064, respectively; constant, 0.968). A recovery expectancy table was developed using the data from this study. CONCLUSION: Based on a retrospective analysis, prognostic indicators for hearing recovery in ISSHL were found to be severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape. We created a model for calculating the probability for hearing recovery based on the analysis of 529 patients with unilateral ISSHL.     

Migraine and sudden sensorineural hearing loss

A 62-year-old woman developed recurrent episodes of sudden sensorineural hearing loss, occurring with migraine headaches. This is an unusual complication of migraine, which probably arises from a reversible vasoconstriction of the cochlear blood vessels. Pathogenesis of migraine and its variants are reviewed herein, along with the rationale of the modalities in its treatment. In this case, the patient's hearing improved after administration of ergot alkaloids, carbon dioxide/oxygen inhalations, and stellate ganglion blocks; it is not known whether this improvement represented therapeutic effect or spontaneous recovery.     

Atresia and sudden sensorineural hearing loss

This case study summarizes findings in an adult male, aged 57, who presented to the Adult Audiology Clinic with aural atresia in the right ear resulting in a conductive hearing loss and a sudden sensorineural hearing loss in the left ear. Treatment options included reconstruction surgery in the right ear, bone anchored hearing aid in the right ear to overcome the conductive hearing loss, bone anchored hearing aid in the left ear for single sided deafness, and intratympanic steroid injections in the left ear to salvage hearing. This case study highlights that when a patient is educated on all available options the patient is then able to make a decision comfortable to him and to help improve his hearing.     

Spontaneous recovery of sudden sensorineural hearing loss: possible association with autoimmune disorders

A 46-year-old white male diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) was seen for audiological testing 15 minutes following a sudden onset hearing loss in the right ear. The test battery included pure-tone audiometry, word-recognition testing, speech-recognition threshold (SRT) testing, immittance testing, and distortion-product otoacoustic emissions (DPOAE) testing. Testing revealed a sensorineural hearing loss in the right ear. Shortly after testing, the patient indicated that his condition had improved. Testing was repeated, and the second round of tests revealed normal hearing in both ears. Four days later, a follow-up test again indicated normal hearing in both ears. Possible connections of this brief occurrence of idiopathic hearing loss with the patient's medical conditions are discussed. Specifically, symptoms were consistent with a transient ischemic attack (TIA) affecting his right cochlea in the stria vascularis region, resulting in a temporary, sensorineural hearing loss. No residual effects were observed clinically.     

以突聋为首发症状的颅内感染性疾病的临床特征分析

目的探讨以突发性耳聋为首发症状的颅内感染性疾病的临床特点、听力学及影像学表现,以减少误诊。方法对5例以突发性耳聋为首发症状的颅内感染性疾病患者的临床资料、诊断过程以及疾病转归进行分析。结果 5例患者中男4例,女1例,临床表现:听力下降5例,眩晕伴走路不稳3例,头痛伴恶心呕吐4例,发热3例。纯音测听5例均为感音神经性耳聋,双耳3例,单耳2例;声导抗测听鼓室曲线A型5例,声反射不能引出4例;DPOAE检查4例不能引出,前庭功能检查半规管功能低下3例。ABR检查2例为蜗后性改变,影像学检查CT无特殊表现;MRI检查未见明显异常1例,呈现炎症性改变4例。腰穿正常2例,脑脊液压力增高、细胞数高3例。最后确诊疾病:急性小脑炎1例,病毒性脑炎2例,结核性脑膜炎2例。结论临床上在诊治突发性耳聋的患者时应考虑到有颅内病变的可能,尤其对听力损失重度,且为双侧性以及有发热、头痛、眩晕等症状重者需进MRI、ABR、腰穿等检查明确诊断。     

Treatment of idiopathic sudden sensorineural hearing loss

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.     

双耳突聋与单耳突聋的临床比较

目的:对比双耳突发性聋与单耳突发性聋的临床特点及治疗效果的异同。方法:回顾性分析480例突发性聋患者,将其分为单耳组(440例)和双耳组(40例),对2组的临床特点及疗效进行比较。结果:与单耳突发性聋比较,双耳突发性聋更多见于糖尿病、高脂血症患者,并且年龄越大,发生双耳突发性聋的可能性越大。在双耳组中28耳治疗有效,有效率为35%;单耳组中228耳治疗有效,有效率为56.4%,两者差异有统计学意义。结论:双耳突发性聋和单耳突发性聋可能具有不同的病理生理机制和预后,从临床上认识两者间的异同,有助于治疗方案的制定和预后的评估。     

Nitrobid therapy in sudden sensorineural hearing loss

The efficacy of local application of Nitrobid oinment in the treatment of idiopathic sudden sensorineural hearing loss has been presented Overall good to fair recovery occured in 40% of the patients, important prognostic indicators were found to be severity of initial hearing loss, time from onset to initial visit, age of the patient and hearing status of the opposite ear.     

鼓室注射地塞米松治疗突发性聋

目的：报告鼓室注射地塞米松治疗突发性感音神经性聋（突聋）的疗效。方法：对1例双耳突聋患者行鼓室注射地塞米松治疗。结果：双耳纯音气导听阈下降40dB以上。结论：鼓室注射地塞米松是治疗突聋的有效方法。     

Chikungunya virus induced sudden sensorineural hearing loss

The aim of this study is to demonstrate the association of Chikungunya virus and sudden sensorineural hearing loss. In the case report described we had a case which developed sudden unilateral sensorineural hearing loss following chikungunya fever. A 15-year-old female presented to us with the complains of unilateral sudden onset of hearing loss following an episode of fever, arthralgia and rashes 1 month ago. At the time of these symptoms there were many cases of chikungunya fever in the city, three being in her locality. Clinically Chikungunya fever was suspected and a positive serological test further confirmed our diagnosis. The hearing loss could thus be attributed to Chikungunya virus. Viruses have always been implicated in causing sudden sensorineural hearing loss but Chikungunya virus as a cause has not been documented earlier making this case report a unique one.     

Pediatric sudden sensorineural hearing loss after diving

OBJECTIVE: Sensorineural hearing loss after diving from a low height has been rarely reported especially in children. METHODS: We present and discuss a new case of pediatric sudden sensorineural hearing loss after diving. RESULTS AND CONCLUSION: Medical and surgical approaches (indications and timing of explorative tympanotomy) to this occurrence are still controversial.     

突发性极重度聋与全聋的预后特点及差异

Objective To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss (SSNHL) and total SSNHL. Methods The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average (PTA) threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed.Results There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64. 9% (37/57) patient with total SSNHL group and 45.6% (67/147)patients with profound SSNHL, which had significant difference between the two groups (x2 = 5.72,P =0. 017). The PTA threshold improvement in total SSNHL group and profound SSNHL group was (36. 4 ±19.3) dB and (40. 2 ±21.3) dB respectively, which was no significant difference between the two groups (t = 1. 165 ,P =0. 245). The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2. 6% (1/38) patients in the total SSNHL group and 14. 3% (14/98) patients in the profound SSNHL group(P =0. 045). Furthermore, 3.5% (2/57) patients in total SSNHL group as well as 29. 9% (44/147) patients in profound SSNHL group obtained a good result with PTA threshold ≤50 dB after therapy(x2 = 15.92,P = 0. 001 ). In addition, the favorable prognosis was related with the onsettherapy time point( P = 0. 001 ), but not related to the patients' age. Conclusion Profound SSNHL and total SSNHL though both with PTA threshold > 90 dB had significant differences recovery rate and need to be studied separately.     

突发性极重度聋与全聋的预后特点及差异

Objective To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss (SSNHL) and total SSNHL. Methods The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average (PTA) threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed.Results There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64. 9% (37/57) patient with total SSNHL group and 45.6% (67/147)patients with profound SSNHL, which had significant difference between the two groups (x2 = 5.72,P =0. 017). The PTA threshold improvement in total SSNHL group and profound SSNHL group was (36. 4 ±19.3) dB and (40. 2 ±21.3) dB respectively, which was no significant difference between the two groups (t = 1. 165 ,P =0. 245). The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2. 6% (1/38) patients in the total SSNHL group and 14. 3% (14/98) patients in the profound SSNHL group(P =0. 045). Furthermore, 3.5% (2/57) patients in total SSNHL group as well as 29. 9% (44/147) patients in profound SSNHL group obtained a good result with PTA threshold ≤50 dB after therapy(x2 = 15.92,P = 0. 001 ). In addition, the favorable prognosis was related with the onsettherapy time point( P = 0. 001 ), but not related to the patients' age. Conclusion Profound SSNHL and total SSNHL though both with PTA threshold > 90 dB had significant differences recovery rate and need to be studied separately.     

Idiopathic sudden sensorineural hearing loss in children

OBJECTIVE: Although idiopathic sudden sensorineural hearing loss (ISSHL) is a frequent disease in adults, less is known about incidence and treatment of ISSHL in children. METHOD: A retrospective chart analysis was performed to evaluate the frequency of ISSHL in children aged under 18 years between 2000 and 2003, who were treated in our department. Children received prednisolone intravenously at an initial dose of 3mg/kg bodyweight. Prednisolone dose was reduced to half every second day. The medication was given for a maximum of 14 days or finished 2 days after the hearing normalized in pure-tone audiometry. The follow-up was continued between 3 and 14 months. RESULTS: The complete recovery rate was 57%, and the partial recovery was 36%. Initial hearing loss of 50dB and more was predictive for poor outcome in children (p=0.028). Presence of tinnitus was without relevance for the outcome. The incidence of ISSHL in the local area of about 250,000 inhabitants was 1/10,000 in children. CONCLUSION: ISSHL seems to be a less frequent disease in children than in adults. Severe initial hearing loss is coupled with poor outcome. Under treatment with prednisolone hearing improvement was found in 13 of 14 patients.     

Weather conditions and sudden sensorineural hearing loss

Background  

Climatic or meteorological condition changes have been implicated in the pathogenesis of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). We investigated the seasonal distribution of ISSHL and evaluated the influence of meteorological parameters (such as temperature, humidity, and atmospheric pressure), their variation and covariation on the incidence of the disease.     

突发性极重度聋与全聋的预后特点及差异

目的 研究突发性极重度聋和全聋的预后特点及差异.方法 回顾性研究复旦大学附属眼耳鼻喉科医院2007年6月至2008年9月收治的初始平均纯音听阈(pure tone average,PTA)>90 dB、随访完整的204例患者,分为全聋和极重度聋两组,对两组的预后进行比较,并对预后与年龄、并发症、发病-就诊时间进行相关性分析.结果 全聋组57例,极重度聋组147例,耳鸣、眩晕、耳闷三大伴随症状中,耳鸣的伴随率最高,两组均达90%以上,眩晕的伴随率全聋组为64.9%(37/57),极重度聋组为45.6%(67/147),两组间差异有统计学意义(x2=5.72,P=0.017).治疗后全聋组PTA下降(36.4±19.3)dB,极重度聋组下降(40.2±21. 3)dB,差异无统计学意义(t=1.165,P=0.245).两组痊愈者均为1周内接受治疗者,全聋组痊愈率为2.6%(1/38),极重度聋组为14.3%(14/98),两组间差异有统计学意义(Fisher确切概率法,P=0.045).全聋组治疗后PTA≤50 dB的患者占3.5%(2/57),极重度聋组达29.9%(44/147),两组间差异有统计学意义(x2=15.92,P=0.001).两组的预后与发病-就诊的时间有关(P值均为0.01),与年龄无关.结论 初始PTA>90 dB的突发性聋可分为极重度聋与全聋,两者预后有差异,需分开进行研究.