Metachronous Sudden Sensorineural Hearing Loss: Patient Characteristics and Treatment Outcomes.

OBJECTIVES: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a distressing condition that can significantly affect quality of life. Unilateral ISSNHL, occurring first in 1 ear and then the contralateral ear at a separate and discrete time, is a rare presentation that we refer to as metachronous ISSNHL. Our objective was to characterize the presentation of metachronous ISSNHL and report on management and hearing outcomes. STUDY DESIGN: Retrospective case series. SETTING: Otology clinic at an academic tertiary referral center. SUBJECTS AND METHODS: Patients ≥18 years old presenting with metachronous ISSNHL between April 2008 to November 2017 were identified through review of the clinic electronic medical record. Metachronous ISSNHL was defined as unilateral ISSNHL occurring in temporally discrete episodes (>6 months apart) affecting both ears. Patients with identifiable causes for sudden hearing loss were excluded. Patient demographics, comorbidities, management, and audiologic outcomes were recorded. RESULTS: Eleven patients with metachronous ISSNHL were identified out of 558 patients with ISSNHL. In patients with metachronous ISSNHL, the mean ± standard deviation age at the time of ISSNHL in the second ear was 58.6 ± 15.2 years (range, 31-77 years). The mean interval between episodes was 9.6 ± 7.5 years (range, 1-22 years). Patients were treated with systemic and intratympanic steroids with variable hearing recovery; 5 patients with resultant bilateral severe to profound hearing loss underwent successful cochlear implantation. CONCLUSION: Metachronous ISSNHL is uncommon. Treatment is similar to ISSNHL, and cochlear implantation can successfully restore hearing in individuals who do not experience recovery.

[The correlation between plasma fibrinogen level and different types of sudden sensorineural hearing loss].

Objective: To investigate the correlation between plasma fibrinogen level and the incidence of sudden hearing loss. Method: A total of 225 patients (age ranging from 18 to 70 years) with sudden sensorineural hearing loss(SSNHL) were selected. The disease onset was within 2 weeks. No patient received previous medical intervention. Depending on the types of auditory threshold curve, SSNHL was divided into low frequency descending type, high frequency descending type, flat desending type and total deafness type. Two hundred and twenty-nine cases with normal hearing and no inflammatory diseases in the same period was selected as control group. Fibrinogen level and Blood Routine Indexes were detected for the purpose of retrospective cohort study.Result: The levels of fibrinogen in SSNHL group(2.98±0.59) g/L were significantly higher than that in control group(2.66±0.36) g/L (P<0.01). According to the types of auditory threshold curve, SSNHL groups were divided into group A(55 cases, 24.44%), Group B(36 cases, 16.00%), Group C(43 cases,19.11%) and Group D(91 cases, 40.44%). The average fibrinogen levels before treatment were at(2.75±0.46)g/L, (3.16±0.61) g/L, (3.02±0.63) g/L and(3.03±0.63) g/L respectively. There was no significant difference in fibrinogen level(P=0.286) between group A and the control group. Fibrinogen levels of group B, group C and group D were significantly elevated compared to control group (P<0.01). Conclusion: The level of fibrinogen is not significantly correlated with development of sudden deafness of low frequency descending type. The incidence of high frequency descending type, flat descending type and profound deafness type are all correlated with the level of high fibrinogen at the onset of sudden deafness. The classification of sudden deafness based on audiogram curves could be of great significance for analysis of possible causes and selection of treatment options.

[The reclassification of sudden deafness].

Objective:Reclassified the total deafness and flat type of sudden deafness,identified the relationship between new classification and hearing prognosis.Method:To analyze 192 cases of patients with sudden deafness,especially for 159 cases of flat type and total deafness patients for further curve type classification,classified as rise,decline and consistent,analysis the possible factors with hearing in multiple factors using regression analysis.Result:According to age group of 45 years old,P>0.05,the difference has not statistically significant;Course of the disease according to the 0-7 days and 14 days more,P<0.01,OR=4.291;8-14 days and 14 days,P<0.05,OR=2.983;According to the flat type and total deafness grouping,P<0.05,OR=0.409;According to the curve type of deafness,the difference between rise type and total deafness was significant,P<0.01,OR=9.692;Decline type,consistent type compared to total deafness type,there is no statistically significant difference,P>0.05.Conclusion:According to the pathogenesis of classification,sudden deafness can be divided into rise type,decline type and consistent type.The pathogenesis of rise type may be different degree of hydrops of inner ear.Decline type may be hair cell damage,and consistent type may be related to the damage of vascular stria and potential labyrinthitis,prognosis is poorer.

The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients.

OBJECTIVE: Recent reports have identified hypercholesterolaemia as a significant risk factor for idiopathic sudden sensorineural hearing loss (ISSNHL). Therefore, we investigated whether lipid profiles and lipoprotein ratios are correlated with the prognosis of hearing recovery in ISSNHL patients. DESIGN: A retrospective cohort study. MAIN OUTCOME MEASURES: Patients with ISSNHL were classified into four groups (complete, partial, slight and no recovery) according to their degree of hearing recovery using Siegel's criteria and the Sudden Deafness Research Group (SDRG) criteria developed by the Japanese Ministry of Welfare. All patients' lipid profiles were analysed, including total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol and triglycerides. We calculated the ratios of TC/HDL-C and LDL-C/HDL-C and used statistical methods to evaluate correlations between lipid profiles and lipoprotein ratios and ISSNHL prognosis. RESULTS: Hearing recovery was observed in 103 (62.0%) of 166 cases using Siegel's criteria and in 114 (68.7%) of 166 cases using SDRG's criteria. Among the three recovery groups (i.e. excluding the no recovery group), the ratio of LDL-C/HDL-C was found to be associated with recovery outcome by showing the ratio on an upward trend from complete recovery to slight recovery group, and the difference is statistically significant (P = 0.016 by Siegel's criteria, P = 0.041 by SDRG's criteria). Multiple linear regression analysis further revealed a significantly higher LDL-C/HDL-C ratio in slight hearing recovery group compared with complete recovery group (P = 0.007 by Siegel's criteria, P = 0.031 by SDRG's criteria). CONCLUSION: We suggested that lipoprotein ratio of LDL-C/HDL-C may be a prognostic factor for hearing recovery in ISSNHL patients. Further studies should be conducted to determine whether hearing outcomes in ISSNHL can be improved by changing patients' lipid profiles via antilipidemic treatment.

[Prospective clinical multi-center study on the treatment of sudden deafness with different typings in China].

OBJECTIVE: To investigate the necessity of subtyping for the treatment of sudden deafness. METHODS: The international standardized clinical research methods, the unified design and program were used in the study. The sudden deafness patients between 18 to 65 years old were recruited, whose duration was less than two weeks with no medication. The patients were divided into four types according to the hearing curve: type A was acute sensorineural hearing loss in low tone frequencies, type B was acute sensorineural hearing loss in high tone frequencies, type C was acute sensorineural hearing loss in all frequencies and type D was total deafness. Each type had four different treatment programs, based on the unified designed randomized table. RESULTS: Total of 1024 cases with single side sudden deafness were recruited in the study by 33 hospitals in China from August 2007 to October 2011, including 492 male cases (48.05%), and 532 females (51.95%). The average age was (41.2 ± 12.8) years old. By classification of audiogram, among the 1024 cases, 205 cases were type A (20.20%), 141 cases were type B (13.77%), 402 cases were type C (39.26%), 276 cases were type D (26.95%). The curative effects of different types were analyzed, type A had the highest rate of 90.73%, type C was 82.59%, type D was 70.29% and type B had the lowest rate of 65.96%. Significant difference of curative rate between different types was detected (χ(2) = 231.58, P = 0.000). Regarding the curative results of the 1024 cases, 378 cases were recovery (36.91%), 229 cases were excellent better (22.36%), 198 cases were better (19.34%) and 219 cases were poor (21.39%). Glucocorticoid was effective for each type and the combined treatment was better than any single medication. CONCLUSIONS: Different types of the hearing curves of sudden deafness have different curing effect, it indicates that different types should use different treatments. It'is important that sudden deafness should be treated according to the types of the hearing curve. The type in low tone frequencies has the best curative effect, followed by the type in all frequencies. The type in high tone frequencies and the total deafness type has poor curative results.

[Multi-center clinical study on the treatment of the low-middle frequency sudden hearing loss].

OBJECTIVE: To investigate and compare the short-term outcome of patients with low-middle frequency sudden deafness treated with alone or combination treatment. METHODS: From August 2007 to October 2011, 205 patients with the diagnosis of low-middle frequency sudden deafness who were from 33 different clinical centers were recruited. All patients were followed up for four weeks from the initial examination. Patients were treated with steroid , Ginaton, batroxobin respectively, or Ginaton and steroid combination treatment. RESULTS: The total effective rate was 90.73%. In Ginaton group, the total effective rate was 87.27%, 89.19% in steroid group, 87.80% in batroxobin group, and 95.83% in Ginaton and steroid group. Considering the total effective rate, there was no statistical difference between four groups (χ(2) = 7.98, P = 0.54). The clinical cure rate for steroid alone was 81.01%, Ginaton alone 76.36%, batroxobin alone 68.29%, and Ginaton and steroid combination treatment 80.56%. There were no clinically significant differences between the different treatments (P > 0.05). CONCLUSIONS: The low-middle frequency sudden deafness tends to have a relatively favorable prognosis. The steroid played a good effect in the treatment. But different treatments either improving the microcirculation of inner ear or alleviating edema blood has undifferentiated results. Therefore the combination therapy may be more effective.

Benign paroxysmal positional vertigo accompanied by sudden sensorineural hearing loss: a comparative study with idiopathic benign paroxysmal positional vertigo.

OBJECTIVES/HYPOTHESIS: To investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) associated with idiopathic sudden sensorineural hearing loss (ISSHL) and to compare them with the characteristics of idiopathic BPPV (i-BPPV). STUDY DESIGN: Retrospective case series. METHODS: We retrospectively analyzed 519 patients with ISSHL and 597 patients with i-BPPV. The ISSHL patients with recent vertigo history before or after admission were tested with video-nystagmography that included the caloric test. BPPV with same-side ISSHL was identified and categorized as secondary BPPV (s-BPPV) using the roll or Dix-Hallpike test. All members of the s-BPPV and i-BPPV groups underwent a daily canalith repositioning procedure (CRP) during the admission periods. We investigated the clinical characteristics, including the number of CRPs performed to achieve successful reposition, canal involvement type, and effect of canal paresis and made comparisons between the s-BPPV and i-BPPV groups. RESULTS: Of the 519 ISSHL patients, 63 (12.1%) were identified as having s-BPPV. Multicanal involvement was more frequent in s-BPPV than i-BPPV patients (P < .001). The mean number of CRPs needed to achieve successful reposition was 4.28 in s-BPPV and 1.34 in i-BPPV (P < .001). The presence of canal paresis was also associated with a greater number of CRPs required for s-BPPV (P < .02). CONCLUSIONS: In about 12% of ISSHL patients, s-BPPV was concurrent. More CRPs were required for successful repositioning in patients with s-BPPV than in patients with i-BPPV. Also, the presence of canal paresis in s-BPPV was associated with a greater number of required CRPs.

Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold.

Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80-89 dB (n = 18), 90-99 dB (n = 16), and ≥100 dB (n = 34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100 dB, significantly less complete and partial recoveries occurred compared to those in the 80-89 or 90-99 dB groups. Our results suggest that initial hearing threshold in excess of 100 dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.

[The revised version of the german guidelines "sudden idiopathic sensorineural hearing loss"]. / Die aktuell gefasste Leitlinie "Hörsturz" (Akuter idiopathischer sensorineuraler Hörverlust).

The new revised version (expires 2012) for sudden, unilateral, sensorineural hearing loss stresses the urgence but not the emergency of diagnostics and therapy in this inner ear disfunction with still increasing incidence. Minimum diagnostics should comprise ENT examination with earmicroscopy, pure tone and tuning fork hearing tests, tympano- and vestibulometry. Classification by frequency loss seems of interest in regard to different underlying pathology, which is still obscure. Therefore from experience glucocorticoids and rheological therapy are recommended in the light of some favoring recent studies. The intratympanic appliCation of glucokorticoids is considered as spare therapy.

[The analysis of concomitant vertigo in idiopathic sudden deafness].

OBJECTIVE: Analyzing different types of concomitant vertigo in sudden deafness (SD) patients with different hearing loss types, exploring different pathogenesis of SD and concomitant vertigo. METHOD: The clinical data of 121 SD cases during 2007. 12 - 2009. 4 were retrospectively analyzed. Detailed information including age, sex, history and hearing level were recorded. According to the standard of China Medical Association,all patients were classified into five sub-groups based on audiogram types: low frequency SD, high frequency SD, flat frequency SD and total SD. The proportion of vertigo in different SD types were calculated and analyzed by statistical method. RESULT: Among all 121 cases, 45 cases with concomitant vertigo, the proportion in different SD types was 42.9%, 47.1%, 23.6% and 51.4%, respectively. By chi-square test, P < 0.05, the proportion in the flat type was statistically lower than that of the other types. 23 patients were diagnosed as true vertigo. The vertigo incidence in different SD types had no statistical difference. CONCLUSION: Vaso factor and viral infection played different roles in different SD types. Discussing concomitant vertigo could help understand SD and otogenic vertigo.

[Analysis of sub-typing in full-frequency sudden deafness].

OBJECTIVE: To explore the relationship between the sub-typing of full-frequency sudden deafness and its effect in treatment. METHODS: A series of 87 cases that have full-frequency sudden deafness were studied from Aug, 2005 to Mar, 2008. All cases were treated with methylprednisolone, Batroxobin and Xueshuantong. RESULTS: Based on the frequency of hearing loss, the objectives were divided into sudden-drop-down type and slow-drop-down type. The effective percentage and significant effective percentage in sudden-drop-down type were 84.4% (27/32) and 68.8% (22/32), respectively. The effective percentage and significant effective percentage in slow-drop-down type were 52.7% (29/55) and 32.7% (18/55), respectively. Slow-drop-down type showed a higher effective and significant effective percentage respectively (P < 0.01). According to the degree of hearing loss, objectives were divided into flat-type and profound-type. The effective percentage and significant effective percentage in flat-type were 73.3 % (44/60) and 53.3 % (32/60) respectively. The effective percentage and significant effective percentage in flat-type were 44.4% (12/27) and 29.6% (8/27) respectively. The flat-type showed a higher effective (P < 0.01) and significant effective percentage (P < 0.05) for treatment. CONCLUSIONS: The sudden deafness needs a further classification. According to the frequency of hearing loss, it can be divided into sudden-drop-down and slow-drop-down type. According to the degree of hearing loss, it can be divided into flat-type and profound-type. It would be appropriate to using 90 dB(average hearing threshold) as a criteria for the classification of hearing loss.

Classification of otoneurological cases according to Bayesian probabilistic models.

We show that Bayesian methods can be efficiently applied to the classification of otoneurological diseases and to assess attribute dependencies. A set of 38 otoneurological attributes was employed in order to use a naive Bayesian probabilistic model and Bayesian networks with different scoring functions for the classification of cases from six otoneurological diseases. Tests were executed on the basis of tenfold crossvalidation. We obtained average sensitivities of 90%, positive predictive values of 92% and accuracies as high as 97%, which is better than our earlier tests with neural networks. Our assessments indicated that Bayesian methods have good power and potential to classify otoneurological patient cases correctly even if this is often a complicated task for the best specialists. Bayesian methods classified the current medical data and knowledge well.

[Acute hearing impairment by extremely high sound pressure levels]. / Akute Gehörschäden durch extrem hohe Schalldruckpegel.

The bulletin for occupational disease no. 2301 in the annex of the Occupational Disease Act, noise-induced hearing impairment, ("Merkblatt zu der Berufskrankheit Nr. 2301 der Anlage zur Berufskrankheiten-Verordnung: Lärmschwerhörigkeit") states that sound events with an intensity exceeding 137 dB (C) may cause immediate mechanical damage to the inner ear. Up to now a distinction has been made between prevention and actual damage potential for the risks caused by sounds with extremely high peak levels. In the field of prevention the unweighted sound pressure peak level of 140 dB, which is now 137 dB(C,peak) according to the LärmVibrationsArbSchV, was applied as the trigger threshold for measures; in contrast actual hearing impairment was not found until 150-160 dB. This article compiles the current state of knowledge and demonstrates that in the area of the reasons mentioned here for acute hearing impairment, no scientifically based new findings exist especially with reference to publications listed in the bulletin.

Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome.

CONCLUSION: Results from a database for sudden sensorineural hearing loss (SSNHL) demonstrate no correlation between laboratory findings, treatment, and outcome in 400 patients. The patients with pathological test results were not treated differently from those with normal test results. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. OBJECTIVES: To investigate diagnostic test batteries for SSNHL and evaluate their value in the management of idiopathic SSNHL. METHODS: A total of 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected about the patient's past medical history, potential precipitating events, trauma, medical history, hearing loss, current disease, diagnostic protocol, and treatment, using questionnaires as well as two audiograms, one at the first ENT clinic visit and another 3 months later. RESULTS: In all, 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT scan. Twenty-two of 160 MRI investigated had pathological findings including 5 acoustic neuromas. Also, 300 of these 400 patients were evaluated as having idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological test results. No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL.

On machine learning classification of otoneurological data.

A dataset including cases of six otoneurological diseases was analysed using machine learning methods to investigate the classification problem of these diseases and to compare the effectiveness of different methods for this data. Linear discriminant analysis was the best method and next multilayer perceptron neural networks provided that the data was input into a network in the form of principal components. Nearest neighbour searching, k-means clustering and Kohonen neural networks achieved almost as good results as the former, but decision trees slightly worse. Thus, these methods fared well, but Naïve Bayes rule could not be used since some data matrices were singular. Otoneurological cases subject to the six diseases given can be reliably distinguished.

Audiometric patterns and prognosis in sudden sensorineural hearing loss in southern Taiwan.

OBJECTIVES: To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7-pattern classification for audiometric pattern and prognosis analysis with Sheehy classification. RESULTS: We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7-pattern classification and with the low-tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis. CONCLUSIONS: SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome.

Idiopathic sudden sensorineural hearing loss is not an otologic emergency.

OBJECTIVE: To investigate whether delay in treatment has any influence on the audiometric outcome at Day 30 in idiopathic sudden sensorineural hearing loss. STUDY DESIGN: Prospective study. SETTING: Otorhinolaryngologic emergency center in Paris, France. PATIENTS: Three hundred forty-seven consecutive cases of sudden sensorineural hearing loss were examined. A neurologic or retrocochlear cause was revealed in 17 cases. Four additional cases were lost for follow-up. Three hundred twenty-six cases of "idiopathic" sensorineural hearing loss seen within 7 days of onset were enrolled and classified by type according to five audiogram shapes: low tone (Type A), flat (Type B), high tone (Type C), cup-shaped (Type D) or total or subtotal (Type E). Because of loss for follow-up, the hearing outcome at 1 month could be evaluated in only 249 cases. INTERVENTION: All 326 patients were given 1 mg/kg per day corticosteroids intravenously for 6 days and 500 ml mannitol 10% in the subgroup presenting ascending audiometric shape. MAIN OUTCOME MEASURES: The following parameters were used. The first parameter was hearing recovery (initial PTA-PTA at Day 6 or Day 30). It was considered as complete if final PTA was below 25 dB. The second parameter was incidence of hearing recovery based on the following formula: (initial PTA-PTA on a given test day)/(initial PTA) x 100%. Using regression analysis and ANOVA, the audiometric outcome was analyzed at Day 6 and Day 30 as a function of the day of onset of treatment and of the audiometric type. RESULTS: Whatever the audiometric type, there was no significant difference in final outcome whether the treatment was started within the first 24 hours or within the first week. CONCLUSIONS: Delay in initiating treatment does not appear to influence the final degree of hearing loss. Idiopathic sudden sensorineural hearing loss cannot be considered as an otologic emergency.

[Up to date: therapy of sudden hearing loss]. / Aktuelle Therapie bei Hörsturz.

Sudden sensorineural hearing loss is thought to be of different origin. Disturbances of microcirculation, autoimmune pathology and viral infection are among the most likely causes. The shape of the puretone audiogram can be a useful clue to its origin. Following is a description of five different forms of sudden hearing loss, its suspected pathogenesis and different therapeutic strategies recommended for the treatment of sudden hearing loss.

Hallazgos audiológicos en pacientes con hipoacusia súbita manejados con esteroides y extracto de ginkgo biloba / Audiologic findings in patients with sudden hearing loss treated with steroids and extract of ginkgo biloba

Propósito: Evaluar los resultados audiológicos en pacientes con hipoacusia súbita manejados con Ginkgo biliba y esteroides. Así mismo, evaluar el efecto de este tratamiento médico sobre el acúfeno que surge como secuela del padecimiento. Material y Métodos: Se realizó un estudio prospectivo, lineal y descriptivo, en el cual se revisó una muestra de 52 pacientes. Se administró tratamiento a base de esteroides y extracto de Ginkgo biloba. A todos los pacientes se les realizaron audiometrías seriadas cada 8 o 10 días hasta que se encontró estabilidad audiométrica. Resultados: En los umbrales de tonos puros, se observó mejoría de l a 30 dB HL en el 36.8 por ciento de los pacientes, de 31.60 dB HL en el 40.3 por ciento y de 61.90 dB HL en el 7.0 por ciento. La discriminación mejoró en el 61.66 por ciento. El acúfeno mostró mejoría importante en todos los casos. Conclusión: Aunque se ha reportado que en la hipoacusia súbita puede existir recuperación espontánea, la combinación de esteroides con extracto de Ginkgo biloba produjo recuperación en los umbrales de audiometría tonal y mejoría en la discriminación en la mayoría de los casos estudiados, incluso en pacientes que tenían de 1 a 2 meses de evolución y en los que no había existido mejoría espontánea. La recuperación no fue completa, pero si útil para obtener umbrales aceptables para la rehabilitación mediante una prótesis auditiva

[Acute and sudden sensorineural hearing loss]. / Ostraia i vnezapnaia neirosensornaia tugoukhost'.

Current views on neurosensory hypoacusis necessitate clear definitions and distinctions between acute and sudden hypoacusis as independent nosological entities of hearing defects. Sufficient data available make it possible to characterize the above forms clinically, etiologically and pathogenetically. Common views of many Russian ENT specialists on sudden and acute hypoacusis as the same entity complicate solving the problem of neurosensory hearing disorders. Orderly classification of acute and sudden hypoacusis variants and subgroups will encourage differentiated and sound approach to treatment of neurosensory hearing loss.