Effect of comorbid diabetes and hypercholesterolemia on the prognosis of idiopathic sudden sensorineural hearing loss.

OBJECTIVES: We tested the hypothesis that comorbid diseases significantly affect the prognosis of sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN: A retrospective cohort study. METHODS: The records of patients newly diagnosed with ISSNHL and treated with steroid prednisolone in a tertiary referral center between January 2003 and December 2013 were retrospectively reviewed. Pretreatment and posttreatment hearing levels were evaluated using pure-tone average (PTA) and word recognition score (WRS). The comorbidities of diabetes, hypertension, coronary artery disease, hypercholesterolemia, cerebrovascular disease, chronic kidney disease, and anemia were identified. We examined the effects of these comorbid diseases on the prognosis of ISSNHL 2 months posttreatment. RESULTS: Regression analyses adjusted for gender, age, pretreatment hearing, treatment delay time, and all the comorbidities showed that the probability of major improvement in the PTA was significantly higher in patients without diabetes compared to those with diabetes (univariate odds ratio [OR], 1.90; 95% confidence interval (CI), 1.25-2.90; multivariate OR, 1.69; 95% CI, 1.03-2.77). Major (≥ 90%) and moderate (50%-89% improvement of the PTA, but with a remaining hearing loss of > 10 dB) improvement in the PTA was significantly higher in patients without hypercholesterolemia compared to those with hypercholesterolemia (univariate OR, 1.78; 95% CI, 1.13-2.80; multivariate OR, 1.70; 95% CI, 1.02-2.84). There was, however, no significant difference in the distribution of major (≥ 90%), moderate (50%-89%), and minor (< 50%) improvement in the posttreatment WRS for these comorbid diseases. CONCLUSIONS: Comorbid diabetes or hypercholesterolemia may indicate a smaller probability of major or moderate PTA improvement for patients with ISSNHL.

Gallstone is correlated with an increased risk of idiopathic sudden sensorineural hearing loss: a retrospective cohort study.

OBJECTIVES: This study aims to test the hypothesis that gallstone disease (GSD) is a risk factor for the development of idiopathic sudden sensorineural hearing loss (ISSNHL). Research has shown risks of cardiovascular and cerebrovascular events in patients with GSD; however, well-conducted English studies on the association between GSD and the development of ISSNHL are lacking. DESIGN AND SETTING: Retrospective cohort study using the Taiwan Longitudinal Health Insurance Database. PARTICIPANTS: We compared 26,449 patients diagnosed with GSD between 1 January 2001 and 31 December 2007, with 52,898 age-matched, gender-matched and comorbidities propensity scores-matched controls. OUTCOME MEASURED: We followed each patient until the end of 2011 and evaluated the incidence of ISSNHL for at least 4 years after the initial GSD diagnosis. RESULTS: The incidence of ISSNHL was 1.42 times higher in the GS cohort than in the non-GS cohort (9.27 vs 6.52/10,000 person-years). Using Cox proportional hazard regressions, the adjusted HR was 1.44 (95% CI 1.19 to 1.74). In the cohort of patients with GSD who needed a cholecystectomy, 37 patients suffered from ISSNHL. Among those patients, 31 (83.7%) patients sustained ISSNHL before cholecystectomy and 6 (16.2%) patients sustained ISSNHL after cholecystectomy. CONCLUSIONS: A diagnosis of GSD may be an independent risk for ISSNHL. This finding suggests that an underlying vascular and inflammatory mechanism may contribute to the development of ISSNHL. Physicians may want to counsel patients with GSD to seek medical attention if they have hearing impairments, because patients may be at an increased risk of developing ISSNHL.

External auditory canal cholesteatoma in patients given radiotherapy for nasopharyngeal carcinoma.

BACKGROUND: Patients who undergo radiotherapy (RT) for nasopharyngeal carcinoma (NPC) may develop external auditory canal cholesteatoma (EACC). METHODS: The records of patients with newly diagnosed NPC who had received concomitant chemotherapy and RT in a tertiary referral center from 1997 January to 2012 July were retrospectively reviewed. RESULTS: RT-related external auditory canal cholesteatoma (RT-related EACC) was identified in 15 of 833 patients given RT for NPC. Three patients had EACC in both ears. The interval from completion of RT to the diagnosis of EACC ranged from 0.5 to 15.4 years (mean, 5.6 years). RT-related EACC commonly (75%) invaded the anterior and inferior parts of the external canal wall. Canaloplasty was used in 12 patients to surgically remove cholesteatoma. There was no recurrence of RT-related EACC during the study period. CONCLUSION: Patients with NPC might contract RT-related EACC a few years after RT. We hypothesize that a fraction dose of 200 cGy or more induces RT-related EACC.

Recurrence of idiopathic sudden sensorineural hearing loss: a retrospective cohort study.

OBJECTIVE: To explore the recurrence rate of idiopathic sudden sensorineural hearing loss (ISSNHL). DESIGN: Using the Taiwan Longitudinal Health Insurance Database, we compared in a retrospective cohort study 45,715 patients with ISSNHL between January 2001 and December 2006 with 45,715 age-, gender-, and comorbidity-matched controls without ISSNHL. We followed each patient from 180 days after the initial diagnosis until the end of 2009 and evaluated the incidence of ISSNHL for 3 years minimum. RESULTS: The cumulative incidence of ISSNHL recurrence was 4.99%. Cox proportional hazard regressions showed that the 50- to 64-year-old age group had a higher adjusted hazard ratio (1.59; 95% confidence interval: 1.40-1.81) than did the 0- to 34-year-old age group. Different comorbidities did not significantly affect the incidence of ISSNHL relapse. CONCLUSIONS: The risk of an ISSNHL relapse in patients with a history of ISSNHL was higher than was the risk of a first occurrence of ISSNHL in the Controls. We suggest that physicians counsel patients with a history of ISSNHL to seek medical attention if they have hearing impairments because they may also have a high risk of an ISSNHL relapse. EVIDENCE LEVEL: 2B.

The prevalence of chronic otitis media and its complication rates in teenagers and adult patients.

OBJECTIVE: To determine the annual complication rates of chronic otitis media (COM) and its management. STUDY DESIGN: Retrospective. SUBJECTS AND METHODS: Data were extracted from 3,223 adult patients, aged 15.1 years and older, under the diagnosis of COM from 1998 to 2007. Complications secondary to COM were identified in a total of 115 patients. RESULTS: The incidence of COM in adults decreased from 407 to 145 cases per year (R(2) = 0.845, P < 0.001) from 1998 to 2007. The mean age of patients with COM increased from 44.67 to 49.43 years (R(2) = 0.896, P < 0.001). The prevalence of COM decreased considerably during the study period. However, the annual extracranial complication rate (R(2) = 0.109, P = 0.352) and intracranial rate (R(2) = 0.382, P = 0.057) did not reduce during the past 10 years. CONCLUSION: The complication rate for COM remained steady in the past 10 years, regardless of the overall reduction in the prevalence of COM with use of antibiotics. A high index of suspicion and imaging studies for early identification are recommended. Pneumococcal vaccination is recommended, particularly for the elderly patients who are treated conservatively because of relatively poor general health conditions.