Intratympanic steroids as a salvage therapy for severe to profound idiopathic sudden sensorineural hearing loss

Abstract

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a decline in hearing affecting three or more frequencies by 30?dB

Objective: The aim of this study was to evaluate the results of intratympanic steroids as a salvage treatment for severe ISSNHL.

Materials and methods: A regimen of three IT steroid injections was offered to patients who failed a 7-days intravenous steroid treatment. Eighty-four patients underwent IT salvage treatment (IT group). Their outcomes were compared with those of 255 patients with severe ISSNHL who received the same intravenous steroid regimen without salvage IT steroid therapy (Control group).

Results: 56% of the patients in the IT group had a hearing improvement of >15?dB after one month. The average hearing improvements were 26.5?±?28?dB and 27.9?±?24?dB in the IT group and the Control group, respectively (p?=?.67). However, patients with a type E audiogram pattern (total deafness), displayed a substantial hearing gain.

Conclusion: Intratympanic steroids failed to show a global auditory benefit as a salvage treatment in patients with severe ISSNHL.

Significance: Our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed.     

Intratympanic steroid injection for sudden sensorineural hearing loss: Impact of injection interval on therapeutic efficacy

ObjectiveTo compare the effect of injection time intervals of intratympanic (IT) dexamethasone (DEX) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsSeventy-five adults with ISSNHL were grouped into four groups according to the IT DEX interval. In addition to concurrent oral steroid medication for two weeks, patients received IT DEX injections every 1, 2, 3, and four days, respectively. (Group 1, Group 2, Group 3, and Group 4). We evaluated the treatment outcomes according to modified criteria from “Clinical Practice Guideline: Sudden Hearing Loss” of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) to justify treatment success.ResultsThere were no significant differences in demographic and baseline audiometric data. The mean of pure tone audiometry (PTA) and speech discrimination score (SDSs) were significantly improved after oral steroid and IT DEX treatment in all four groups. Group 1 showed significantly higher improvement than Group 4 in PTA after treatment. There was a significantly higher complete recovery (CR) rate in Group 1 than Group 4.ConclusionWe found a statistically significant difference in the complete hearing recovery rate and audiometric results (PTA) between the group with a daily interval of injections and the group with a four-day time interval. Therefore, daily time intervals in intratympanic steroid injection may be considered as an option for better improvement of hearing in patients with ISSNHL.     

Prostaglandin E1 versus steroid in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss

OBJECTIVE: We conducted a controlled retrospective analysis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in order to investigate the effect of prostaglandin E1 (PGE1) plus hyperbaric oxygen (HBO) therapy in comparison with that of steroid plus HBO therapy. METHODS: One hundred and ninety-six consecutive patients with ISSNHL (hearing levels > or ==40dB; time from the onset of hearing loss to the start of treatment < or ==30 days) were enrolled. Ninety-five patients underwent PGE1 plus HBO therapy (PG group) and 101 underwent steroid administration plus HBO therapy (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. RESULTS: The hearing levels after treatment were 52.2+/-3.0 and 47.5+/-2.8dB, the hearing gains were 31.3+/-2.2 and 27.2+/-2.3dB, the cure rates were 28.4% and 28.7%, the recovery rates were 54.7% and 53.5%, and the hearing improvement rates were 48.4+/-5.1% and 53.9+/-4.2% in the PG and steroid groups, respectively. There were no significant differences between the two groups. CONCLUSION: We concluded that PGE1 and a steroid are equally effective in the treatment of ISSNHL when used together with HBO therapy. PGE1 plus HBO therapy can be one of the potential alternative treatments for ISSNHL, particularly in steroid-intolerant patients such as those with severe diabetes mellitus, an active peptic ulcer, or viral hepatitis.     

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.     

Intratympanic methylprednisolone administration promotes the recovery of idiopathic sudden sensorineural hearing loss: a retrospective case-control study

Abstract

Background: Efficacy of current treatment methods in idiopathic sudden sensorineural hearing loss (ISSNHL) is still unsatisfactory.

Objective: This study aimed to discover in differences in effect between steroid applications responsible for promoting the prognosis in ISSNHL.

Materials and methods: A study was conducted to diagnose ISSNHL patients in our hospital from January 2014 to September 2016. All patients accepted treatments including intravenous injection (intravenous dexamethasone, [IV DXM]), intratympanic injection (intratympanic methylprednisolone [IT MP], intratympanic dexamethasone [IT DXM]) or combined injections with steroids (IV?+?IT DXM). Patients were divided into groups according to treatment outcomes and clinical characteristics of each group were compared for univariate comparison. Logistic regression was utilized to verify screening factors from univariate comparison for exclude biases.

Results: There were 313 patients with ISSNHL enrolled in the study. Logistic regression verified that vertigo (p?=?.023), severity of hearing loss (p=.969), pattern of hearing loss (p?=?.03), and the treatment method (p?<?.001) were statistically related to the patients’ prognosis based on the condition all biases had been excluded as possible. IT MP showed a better prognosis of hearing improvement compared to treatment with IT DXM (OR?=?0.5), IV DXM (OR =0.226), and IV DXM?+?IV DXM (OR?=?0.320).

Conclusions and significance: IT MP treatment could be utilized as initial treatment in ISSNHL and might promote outcomes.     

Hyperbaric oxygen for idiopathic sudden hearing loss: is the routine application helpful?

Conclusion: We recommend the routine application of hyperbaric oxygen (HBO) in conjunction with intravenous steroid (IVS) for all patients with idiopathic sudden sensorineural hearing loss (ISSNHL). For best results, this therapy must be started within 14 days. Objective: To investigate the necessity of routine application of HBO therapy for ISSNHL. Methods: This was a retrospective cohort study. A total of 300 patients (300 diseased ears) were divided into 3 groups according to the therapy received: IVS (group A), HBO (group B), or IVS + HBO (group C). Patients in each treatment group were subdivided into subgroups according to the time of therapy initiation. The outcomes of their hearing recovery were classi?ed into three recovery grades: good, fair, and poor. Results: The proportion of patients responding to therapy and those with complete recovery was the highest in the combined treatment group, 84% and 58%, respectively, regardless of the initial hearing levels. In all the groups, mean gains of cases in whom therapy was started in the first 2 weeks were significantly higher (p < 0.05) and hypercholesterolemia (>240 mg/dl) caused significantly worse responses (p < 0.05).     

Efficacy comparison of oral steroid,intratympanic steroid,hyperbaric oxygen and oral steroid + hyperbaric oxygen treatments in idiopathic sudden sensorineural hearing loss cases

Idiopathic sudden sensorineural hearing loss is a rare disorder of unknown pathogenesis in which hearing is lost partially or totally. About 60 treatment modalities have been described. We aimed to compare the efficacy of hyperbaric oxygen, oral steroid, intratympanic steroid therapy and their combinations in idiopathic sudden sensorineural hearing loss patients. Files of patients who were followed up between 2004 and 2010 in our clinic were examined retrospectively. Patients were divided into four groups according to the therapy received: Oral steroid, oral steroid + hyperbaric oxygen, intratympanic steroid and hyperbaric oxygen. Treatment success was assessed by Siegel criteria and mean gains using pre-treatment and post-treatment audiograms. 217 patients and 219 ears were examined. The proportion of patients responding to therapy was the highest in the oral steroid + hyperbaric oxygen group with 86.88% (53/61) followed by the oral steroid group with 63.79% (37/58), the intratympanic steroid group with 46,51% (20/43) and the hyperbaric oxygen group with 43.85% (25/57). The proportion of patients who had complete recovery was the highest in the oral steroid + hyperbaric oxygen group with 42.6% (26/61) followed by the oral steroid group with 19.0% (11/58), the hyperbaric oxygen group with 17.5% (10/57) and the intratympanic steroid group with 11.6% (5/43). The oral steroid + hyperbaric oxygen group has the highest mean hearing gain among all groups (p < 0.05). Idiopathic sudden sensorineural hearing loss patients receiving oral steroid + hyperbaric oxygen combination therapy have a higher likelihood of recovery than patients receiving oral steroids, hyperbaric oxygen or intratympanic steroids alone.     

Efficacy of the additional effect of hyperbaric oxygen therapy in combination of systemic steroid and prostaglandin E1 for idiopathic sudden sensorineural hearing loss

PurposeThe efficacies of hyperbaric oxygen therapy (HBO), systemic steroid, prostaglandin E₁, or the combination of any two modalities have been reported in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). However, little is known about the combined efficacy of HBO, systemic steroid, and prostaglandin E₁ for this disorder. We aimed to investigate the efficacy of HBO combined with systemic steroids and prostaglandin E₁ as triple therapy in patients with ISSNHL.Materials and methodsWe retrospectively evaluated the records of 67 patients with ISSNHL who were treated with systemic steroid and prostaglandin E₁, with (n = 38) or without (n = 29) HBO. The inclusion criteria included a diagnosis of ISSNHL within 14 days of symptom onset, age ≥15 years, treatment according to the protocol, and clinical follow-up of at least 1 month. The patients' hearing levels were evaluated 1 month after hearing loss onset. The primary outcome was hearing improvement on pure tone audiometry. We also evaluated the demographic profiles of patients.ResultsPatients treated with triple therapy showed significantly greater hearing improvement (p < 0.01) than those treated without HBO, despite some differences between the two treatment groups. Multivariate logistic regression analysis revealed a significant positive correlation between pure tone audiometry improvement and hyperbaric oxygen therapy, after adjustment for confounding factors (odds ratio = 7.42; 95% and confidence interval = 2.37–23.3; p = 0.001).ConclusionHBO with systemic steroid and prostaglandin E₁ administration conferred significant therapeutic benefits for ISSNHL. Therefore, routine use of triple therapy is recommended for patients with ISSNHL.     

Prostaglandin E1 in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss

CONCLUSIONS: Prostaglandin E1 (PGE1) is less effective than stellate ganglion block (SGB) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with severe hearing losses when used together with hyperbaric oxygen (HBO) therapy. In contrast with the systemic action of intravenous PGE1, SGB's localized vasodilating action may explain its advantage over intravenous PGE1. OBJECTIVES: To investigate the effect of PGE1 plus HBO therapy on ISSNHL in comparison with that of SGB plus HBO therapy. PATIENTS AND METHODS: We retrospectively analyzed 205 consecutive patients with ISSNHL (hearing levels > or = 40 dB; time from the onset of hearing loss to the start of treatment < or = 30 days). Ninety-five patients underwent intravenous PGE1 plus HBO therapy (PG group) and 110 underwent SGB plus HBO therapy (SGB group). Hearing recovery was evaluated by grade assessment and by hearing improvement compared to that in the unaffected contralateral ear. RESULTS: The overall hearing outcome was not statistically different between the two groups. For patients with initial hearing levels <80 dB, the groups had roughly equivalent hearing outcomes, whereas in patients with initial hearing levels > or = 80 dB, the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0 +/- 5.0% vs 35.3 +/- 6.8%; p <0.05).     

Necessity of admission to improve the hearing-recovery rate in idiopathic sudden sensorineural hearing loss

Objectives: The purpose of this study was to determine the prognostic potential of admission of a patient for idiopathic sudden sensorineural hearing loss (ISSNHL).

Study design: Retrospective clinical study.

Methods: We conducted a retrospective study of 301 patients with ISSNHL. The patients were divided into a study (57 patients at out-patients department (OPD) based treatment, using systemic steroids and intra-tympanic (IT) steroid injection) and a control groups (301 patients at admission, using systemic steroids and IT steroid injection). We compared the success rate (15?dB cut off), Siegel’s criteria and hearing gain decibels between two groups.

Results: The overall recovery rate of the OPD based treatment group (29.8%) was poor than that of the admission group (52.9%) (p?=?.002). The odd ratio of OPD based treatment factor was 2.035 when the OPD based treatment and poor prognostic factors were analyzed at logistic regression test (Duration of delayed treatment, 1.073; average hearing loss level, 0.972) (p?=?.041).

Conclusion: Admission must be strongly recommended when the patients with ISSNHL asked about the necessity of admission. We hypothesized that resting, getting out of their social stress, and relief of anxiety might be helpful to their hearing recoveries.     

Intratympanic steroids for combined treatment of idiopathic sudden hearing loss: when is it too late?

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) requires early treatment.

Objective: To describe our experience on intratympanic steroid treatment (ITS) of ISSNHL analyzing the delay to start therapy as prognostic factor.

Material and methods: We perform a retrospective study on ISSNHL treated with systemic steroids without full recovery on PTA (pure tone average) according to Siegel criteria. They were divided into two different groups: one group that additionally received ITS as combined therapy (treatment group), and another without it (control group). We analyzed the hearing recovery at 6 months and 2 years, and the influence of the delay to start ITS in the recovery.

Results: After ITS was added, further complete recovery was achieved in 10 patients of the treatment group. After 6 months, PTA improvement in the treatment group was 10.84?dB, compared to 1.13?dB in the control group (p<.0001). Nevertheless, patients starting such combination of oral steroids and ITS within 8 days of diagnosis had an additional gain of 15?dB in the first 6 months, that increased to 19.17?dB after 24 months (p<.022).

Conclusions: When ITS was added within the first 8 days, a significantly better and more stable response was obtained.     

Idiopathic sudden sensorineural hearing loss: Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.     

Contribution of intratympanic steroids in the primary treatment of sudden hearing loss*

Objective: The primary objective is to investigate the contribution of intratympanic steroids in the primary treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The secondary objective is to compare methylprednisolone (MP) and dexamethasone in terms of their effectiveness and injection-site pain.

Methods: Two hundred and four patients with ISSNHL, 144 patients underwent systemic steroid therapy (SST) alone and 60 patients underwent combined therapy (CT). The effectiveness of the treatment was assessed according to the Furuhashi criteria. Injection-site pain after the procedure was assessed at 5 and 60 min on a visual analog scale (VAS).

Results: Successful recovery was 55% in the CT group and 34% in the SST alone group (p?=?.004). Patients whose initial hearing level is severe, the success rate was statistically significantly higher with CT (p?=?.0001). Hearing improvement differed significantly between the MP and dexamethasone (p?=?.015). Injection-site pain at 5 min after the procedure, higher VAS scores were obtained with MP (p?=?.002).

Conclusion: In the primary treatment of sudden hearing loss, in which the level of hearing loss is 70–89 dB HL, the addition of ITS to the treatment significantly increased the success rate. The pain occurring in the middle ear was high but tolerable in the first few minutes by MP.     

Should air travel be avoided shortly after an idiopathic sudden sensorineural hearing loss?

Abstract

Introduction: The effect of air travel on the recovery rate after idiopathic sudden sensorineural hearing loss (ISSNHL) has not been established. The advice to avoid flights is essentially based upon conjecture.

Objectives: To analyze the recovery rate of patients who traveled by air shortly after they were treated for ISSNHL.

Materials and methods: The hospital records of 115 newly diagnosed adult patients with unilateral ISSNHL were retrospectively collected. Included were patients who traveled by air within 90?days since the ISSNHL occurrence. The treatment protocol included oral prednisone and intratympanic dexamethasone injection when indicated. Audiograms performed upon presentation and 90?days later were compared.

Results: Twelve patients were included (median age 45.5?years). The median treatment delay was 3?days. The average time from the ISSNHL to air-travel was 37?days, and the average air-travel distance was 13,362?km. The degree of HL was moderate, moderately severe, and severe (4 patients each). Seven patients (58%) underwent full recovery. No patients experienced further deterioration of their audiometric results after air-travel.

Conclusions: This study does not support the avoidance of air-travel after ISSNHL.

Significance: This study is the first to investigate the effect of air-travel on ISSNHL recovery rates, a clinical question that rises commonly.     

Clinical characteristics and correlation between hearing outcomes after different episodes of recurrent idiopathic sudden sensorineural hearing loss

ObjectivesRecurrent idiopathic sudden sensorineural hearing loss (ISSNHL) is a rare disease. In this study, we evaluated the correlations between hearing recovery after the first and recurrent episodes of ISSNHL and characterized the clinical features of different episodes of ISSNHL.MethodsThis retrospective study was conducted by reviewing medical records pertaining to the period 2008–2018. A total of 30 patients (16 male, 14 female) who had experienced at least two episodes of ISSNHL were included. All patients were had received steroid therapy (including systemic and IT) and/or hyperbaric oxygen therapy within 2 weeks after the onset of disease. The SDRG's criteria was used for the grading of hearing recovery.ResultsThe median age at the first and second episode of ISSNHL was 48 and 53.5 years, respectively; a total of 30% of patients presented with vertigo in the first episode and 40% presented with vertigo in the second episode. The hearing outcomes of both episodes showed significant improvement after treatment. The rate of complete recovery after the first and second episodes was 46.67% and 33.33%, respectively. A significant positive correlation was observed between the treatment outcomes of the first and second episodes (r = 0.721, p < 0.001).ConclusionIn ISSNHL, hearing recovery after a recurrent episode is significantly correlated with the hearing outcome after the initial episode (p = 0.042). The treatment outcome of the first episode is a prognostic factor for the outcomes of recurrent episodes.     

Vitamins A,C, and E and selenium in the treatment of idiopathic sudden sensorineural hearing loss

This study evaluated the effectiveness of vitamins A, C, and E, with selenium, in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). This was a prospective, controlled study performed at a tertiary teaching and research hospital. Over a 32-month period, patients were treated with either our standard ISSNHL treatment regimen plus vitamins A, C, and E and selenium (ACE+ group) or with only our standard ISSNHL treatment regimen (ACE? group). The demographics, additional symptoms, mean initial and final hearing levels, mean hearing gain, and recovery data were compared between the two groups. The ACE+ group, consisting of 70 (55.5 %) patients, received vitamin A (natural beta-carotene, 26,000 IU), vitamin C (ascorbic acid, 200 mg), vitamin E (d-alpha-tocopherol, 200 IU), and selenium (50 μg) twice daily for 30 days in addition to our ISSNHL treatment regimen: methylprednisolone at an initial dose of 1 mg/kg body weight per day, tapered over 14 days; Rheomacrodex^® [(10 g of dextran and 0.9 g of NaCl)/100 ml] 500 ml daily for 5 days; Vastarel^® 20-mg tablet (20 mg of trimetazidine dihydrochloride) three times daily for 30 days; and ten 60-min hyperbaric oxygen (HBO) sessions (2.5 absolute atmospheres of 100 % O₂), once daily, starting the day of hospitalization. The ACE? group comprised 56 (44.4 %) patients, who received only our ISSNHL treatment regimen. The mean hearing gains were 36.2 ± 20.3 dB in the ACE+ group and 27.1 ± 20.6 dB in the ACE? group. The mean hearing gain rates were significantly higher in the ACE+ group than in the ACE? group (p = 0.014). Treatment with vitamins A, C, and E and selenium was effective in ISSNHL patients undergoing treatment with methylprednisolone, dextran, trimetazidine dihydrochloride, and HBO, and might be more effective when the initial hearing level is below 46 dB.     

Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss

Objective

This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy.

Prediction of hearing outcomes by distortion product otoacoustic emissions in patients with idiopathic sudden sensorineural hearing loss

Objective

To investigate whether distortion product otoacoustic emissions (DPOAEs) can be a prognostic indicator of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Methods

Seventy-eight consecutive patients with ISSNHL were enrolled. DPOAEs were measured at the first hospital visit. Two primary pure tones with a frequency ratio (f2/f1) of 1.2 were used at non-equal sound pressure levels (L1/L2 = 80/70 dB SPL). The DPOAE amplitude was measured at the 11 frequencies of 2f1-f2 with f2 varying from 593 to 6031 Hz. All the patients received steroid administration in combination with hyperbaric oxygen (HBO) therapy. Hearing recovery was evaluated by the improvement in hearing compared to the unaffected contralateral ear. Correlations between the hearing improvement rate and five potential prognostic factors (the DPOAE amplitude, patient's age, days from onset to the start of treatment, initial hearing level, and presence of vertigo) were examined by simple and multiple regression analyses.

Results

The net DPOAE amplitude in patients with hearing improvement rate ≥50% was significantly larger than that with hearing improvement rate <50% at f2 frequencies of 3031 and 4812 Hz (unpaired Student's t-test, p < 0.05). A simple regression analysis showed that the hearing improvement rate significantly correlated with the net DPOAE amplitude at f2 frequencies of 3031 and 4812 Hz, but not with that at the other f2 frequencies tested. The correlation coefficients were 0.528 and 0.522 for 3031 and 4812 Hz, respectively, with p values <1 × 10⁻⁶. In a multiple regression analysis, the partial correlation coefficients of the net DPOAE amplitude were 0.308 and 0.246 with p values of 0.008 and 0.036 for 3031 and 4812 Hz, respectively.

Conclusion

The significant correlation between hearing recovery and DPOAEs measured before treatment indicates that DPOAEs are a potentially useful means of predicting hearing prognosis in ISSNHL.     

Sudden sensorineural hearing loss during pregnancy: clinical characteristics,management and outcome

Background: Sudden sensorineural hearing loss (SSNHL) may occur during pregnancy with a rare prevalence, and little is known about it.

Aims: To retrospectively analyze cases of SSNHL during pregnancy and investigate their clinical characteristics, management and outcome.

Material and methods: Records of 30 SSNHL patients during pregnancy were reviewed, including age, localization, duration from onset to treatment, gestation period, accompanying symptoms, initial hearing threshold, final hearing threshold, audiogram, treatment and outcome.

Results: Twenty-four patients (80.0%) suffered SSNHL in the second trimester or the last trimester with a high rate of tinnitus (70.0%). The initial hearing threshold was 63.4?±?25.1?dB, and most audiograms were flat and profound. The overall recovery rate was 60.0%, including complete recovery (33.3%) and partial recovery (26.7%). Further, 16 patients received adjuvant intratympanic steroid showed a better audiologic outcome (improvement 27.1?±?16.4 vs. 15.7?±?12.0?dB, p?=?.042) than those who had not.

Conclusions and significance: SSNHL during pregnancy often occurred in the second trimester or the last trimester with a severe hearing loss, the most audiogram configurations are flat and profound. Dextran-40 is a safe and beneficial therapy for SSNHL patients during pregnancy and adjuvant intratympanic steroid increase the probability of hearing recovery.     

The value of having an initial word recognition score for a precise prognosis of idiopathic sudden sensorineural hearing loss

ObjectiveAlthough the hearing thresholds of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) closely relate to the prognosis that results in progressive floor effects, many studies have usually used hearing thresholds as the main outcome of the measurement of prognostic factors. The present study aimed to identify the prognostic factors related to initial hearing tests and speculates the effects of word recognition score (WRS) on the prognoses for patients with ISSNHL.MethodsBetween March 2011 and November 2020, we retrospectively reviewed chart profiles of 2,636 ISSNHL patients. The 180 patients who met the inclusion criteria were asked to participate in the present study. Based on their initial WRS, all these patients were divided into good WRS (GW) and poor WRS (PW) groups with 52% as the cut-off points. Demographic, clinical, and audiological variables, such as age, onset time, duration of treatment, gender, ear side, comorbidities (i.e., hypertension, diabetes mellitus, tinnitus, dizziness), hearing configuration (i.e., ascending, descending, flat, irregular, and profound), treatment options (i.e., systemic corticosteroid therapy per oral, intratympanic steroid injection, and hyperbaric oxygen therapy), and WRS were analyzed as being underlying prognostic factors.ResultsBoth groups showed significantly different distributions for hearing thresholds and hyperbaric oxygen therapy (HBOT) as general characteristics. The results of a multivariate logistic regression analysis showed that the odds ratio (OR) of age (OR: 0.96, 95% CI: 0.59 – 24.25), duration of treatment (OR: 0.98, 95% CI: 0.96 – 1.00), ascending configuration (OR: 4.97, 95% CI: 1.64 – 16.62), irregular configuration (OR: 4.58, 95% CI: 1.62 – 13.79), and WRS (OR: 1.01, 95% CI: 1.00 – 1.02) were the significant prognostic factors for all the patients. Further analysis of those patients with WRS under 52% cut-off points showed that an ascending configuration (OR: 5.87, 95% CI: 1.18 – 35.99), irregular configuration (OR: 8.03, 95% CI: 1.69 – 46.30), and WRS (OR: 1.05, 95% CI: 1.01 – 1.10) significantly affected the prognosis. As the initial WRS of ISSNHL patients decreased, the OR of the WRS itself increased. These results suggested that the importance of WRS as the prognostic factor was stressed for PW patients.ConclusionThe age, duration of treatment, initial hearing configuration (ascending and irregular types), and WRS were the significant prognostic factors for patients with ISSNHL. It was learned that WRS could be a remarkable prognostic factor to consider, especially for ISSNHL patients with poor WRS.