The prognostic value of peripheral blood parameters on all-frequency sudden sensorineural hearing loss

Abstract Objective: To determine whether peripheral blood parameters have any predictive value for all-frequency Sudden Sensorineural Hearing Loss (SSNHL). Methods: We chose 78 individuals with all-frequency SSNHL who had been admitted to our department. They were divided into two groups: the effective group and the ineffective group. In patients with all-frequency SSNHL, the prognostic variables, including peripheral blood tests and clinical traits, were examined by a logistic regression analysis. In addition, the predictive value was carried out. Results: The effective rate of all-frequency SSNHL was 61.5%. Pre-treatment hearing level and the proportion of patients with diabetes were both significantly lower in the effective group than in the ineffective group (p = 0.024 and 0.000, respectively). The levels of fibrinogen and C-reactive protein were also significantly different between the two groups (p = 0.001 and 0.025, respectively). Pre-treatment hearing level and fibrinogen level both significantly impacted the prognosis of all-frequency SSNHL (p = 0.032 and 0.002, respectively), according to a logistic regression analysis. Furthermore, the prognosis was significantly predicted by both fibrinogen level and pre-treatment hearing level (p = 0.001 and 0.0002, respectively). The receiver operating characteristic curve showed that the fibrinogen level had a sensitivity of 85.4% and a specificity of 60.0% for predicting the prognosis of all-frequency SSNHL. Conclusion: For the prognosis of all-frequency SSNHL, the fibrinogen level can be regarded as a useful predictor. The level of C-reactive protein, however, does not have a significant prognostic effect on predicting all-frequency SSNHL. Therefore, more attention should be devoted to the level of fibrinogen in the acute period of all-frequency SSNHL. Level of Evidence: 4.

Otosyphilis In An HIV-Infected Patient: The First Case in Vietnam

Syphilis has been re-emerging around the world, especially in MSM and people living with HIV. Because of the high number of infections, complications of the disease that were previously rare, now appear again. Otosyph-ilis is one of them. We reported a case of a 31-year-old MSM patient, HIV-positive, with sudden hearing loss of both ears and tinnitus due to syphilis. This is the first case of otosyphilis detected in Vietnam. The diagnosis of otosyphilis may be delayed because its symptoms are similar to those of other diseases. Therefore, there should be a highly suspected indicator of otosyphilis that can help clinicians orient the diagnosis and handle it in a timely manner.

Clinical characteristics of sudden sensorineural hearing loss with acute cerebral infarction / 中华内科杂志

Objective:To analyze the clinical and imaging features of patients with sudden sensorineural deafness and acute cerebral infarction in order to provide evidence for early recognition of such diseases.Methods:This was a case series reporting study. A retrospective analysis was performed on the clinical and imaging data of 29 patients with sudden hearing loss (SHL) who admitted to the Otolaryngology Head and Neck Surgery Department of Beijing Tiantan Hospital from January 2017 to December 2021 and diagnosed with acute cerebral infarction using MRI-DWI.Results:The patients were aged 31-71 years, with an average age of 56±12 years, and 82.8% (24/29) were men. In total, 82.8% (24/29) of the patients had three or more atherosclerotic risk factors, and 24.1% (7/29) had a history of SHL. The hearing types were flat and total deafness: 86.2% (25/29) of the patients had severe hearing loss, 27.6% (8/29) had bilateral SHL, 17.2% (5/29) had further hearing loss during hospitalization, and 82.8% (24/29) had dizziness or vertigo at the onset. The signs of central nervous system involvement mainly included speech impairment, diplopia, dysphagia, central facial paralysis, facial and limb hypoesthesia, ataxia, and decreased muscle strength. Imaging evaluation showed that 21 cases were located in the posterior circulation supply area and 8 cases in the anterior circulation supply area. Additionally, 82.8% (24/29) patients had vertebrobasilar artery stenosis, and 58.6% (17/29) patients had severe vertebrobasilar artery stenosis or occlusion.Conclusions:Patients with SHL who progress to cerebral infarction often have multiple atherosclerotic risk factors and SHL. Most of the patients are middle-aged and older men who often complain of dizziness or dizziness accompanied by severe flat and total deafness with unilateral or bilateral SHL. Imaging findings suggest that most patients have posterior circulation infarction, often accompanied by severe stenosis or occlusion of the vertebrobasilar artery.

Hipoacusia súbita asociada a depresión: síntoma inusual en adultos mayores infectados por Sars-CoV-2 / Sudden hearing loss associated with depression: an unusual symptom in older adults infected with Sars-CoV-2

Se comienza acumular información sobre las alteraciones en pacientes positivos a Covid-19, donde relacionan el virus con el daño del oído medio y oído interno, tanto en la porción vestibular como la auditiva en adultos mayores, generando episodios depresivos. Por tal razón, se propuso como objetivo evaluar la relación hipoacusia súbita asociada a depresión en adultos mayores infectados por Sars-CoV-2 atendidos en el Hospital Básico Pillaros, perteneciente al sector Ciudadela Ciudad Nueva, Ecuador 2020-2021. El estudio fue cuantitavo, descriptivo correlacional de corte transversal con una muestra de 87 pacientes >65 años positivos para Sars-CoV-2. Para la recolección de datos se aplicó el Test audiométrico y la escala de depresión geriátrica de Yesavage. El análisis de los datos fue con estadística descriptiva en base a frecuencias, porcentajes, IC 95% y X2 a través de SPSS. Como resultado 73,6% eran fememnino y 26,4% masculino, 54,0% tenían de 65-75 años, el tipo de presbiacusia más existente fue neural (31,2%) y coclear (31,0%). Así mismo, 81,6% presentaron signos de depresión, mientras que 18,4% no. En el test Vasayage 88,5% expresó no sentirse lleno de energía y 59,8% sienten temor a que algo malo suceda. Como conclusión, la presencia de trastornos auditivos constituye un problema para la comunicación de los adultos mayores que pudiese conllevar a estados depresivos, por ello, incentivar el desarrollo de investigaciones pudieran orientar hacia el desarrollo de alternativas de intervención temprana que favorezcan el mejoramiento de la calidad de vida de este grupo poblacional(AU)

Information is beginning to accumulate on the alterations in patients positive for Covid -19, where they relate the virus to damage to the middle ear and inner ear, both in the vestibular and auditory portions in older adults, generating depressive episodes. For this reason, the objective was to evaluate the relationship between sudden hearing loss associated with depression in older adults infected with Sars-CoV- treated at the Pillaros Basic Hospital, belonging to the Ciudadela Ciudad Nueva sector, Ecuador 2020-2021. The study was quantitative, descriptive correlational cross-sectional with a sample of 87 patients >65 years positive for Sars-CoV-2. For data collection, the audiometric test and the Yesavage geriatric depression scale were applied. The analysis of the data was with descriptive statistics based on frequencies, percentages, CI 95% and X2 through SPSS. As a result, 73.6% were female and 26.4% male, 54.0% were 65-75 years old, the most common type of presbycusis was neural (31.2%) and cochlear (31.0%). Likewise, 81.6% presented signs of depression, while 18.4% did not. In the Vasayage test, 88.5% expressed not feeling full of energy and 59.8% were afraid that something bad would happen. In conclusion, the presence of hearing disorders constitutes a problem for the communication of older adults that could lead to depressive states, therefore, encouraging the development of research could guide the development of early intervention alternatives that favor quality improvement. life of this population group(AU)

Vestibular function assessment in sudden hearing loss

Abstract Objectives: To perform vestibular assessment using cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing in patients with sudden hearing loss. Moreover, to evaluate the correlation of dizziness with vestibular tests and the correlation of vestibular tests with hearing prognosis. Methods: This is an observational, longitudinal and prospective study, including participants diagnosed with sudden hearing loss. The participants underwent cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing. The audiometric assessment was performed at the beginning and at the end of the follow-up. A value of p ≤ 0.05 was considered statistically significant. Results: Seventeen patients were included in the study sample, with a mean age of 45.4 ± 11.1 years. Five participants (29.41%) had dizziness and 15 (88.23%) had tinnitus. All participants underwent vestibular evaluation through cervical and ocular vestibular evoked myogenic potential and video head impulse test, and 13 of them were evaluated through caloric testing. The cervical vestibular evoked myogenic potential was considered altered in five (29.41%) participants, while 11 (64.71%) showed alterations at the ocular vestibular evoked myogenic potential. The video head impulse test and the caloric testing were considered altered in seven (41.18%) and five (38.46%) participants, respectively. There was no statistically significant correlation between the clinical data and the results of vestibular tests or hearing recovery, nor between the results of vestibular tests and hearing recovery. Conclusion: The assessment through vestibular evoked myogenic potential, video head impulse test and caloric testing showed vestibular involvement in some participants. However, it cannot be stated that the results of the vestibular tests are related to the hearing prognosis of sudden hearing loss.

Usos de cámara hiperbárica en otorrinolaringología / Uses for hyperbaric chambers in otolaryngology

Resumen En la terapia con oxígeno hiperbárico (HBO) se utiliza oxígeno al 100% de concentración en una cámara presurizada con presiones supraatmosféricas, que corresponden de 2 a 3 atmósferas. Los mecanismos por los cuales funciona esta terapia se relacionan con propiedades físicas de los gases y su comportamiento fisiológico en el organismo, lo que lleva finalmente a la hiperoxia, evento fisiológico que permite la obtención de diversos efectos beneficiosos. La evidencia en medicina ha demostrado su utilidad mayormente en la enfermedad por descompresión, infecciones cutáneas graves e intoxicación por monóxido de carbono. En el ámbito de la otorrinolaringología ha probado ser útil en algunas enfermedades como la hipoacusia súbita idiopática, tanto como terapia única como asociada al uso de corticosteroides, como en la osteomielitis refractaria del oído externo, la que en conjunto con antibioticoterapia y manejo quirúrgico presenta un evidente aumento en la tasa de mejoría. Cabe mencionar que la terapia con HBO ha demostrado también beneficios en los tratamientos y complicaciones posteriores a la radiación en pacientes con cáncer de cabeza y cuello. Es importante mencionar que la terapia con HBO no está exenta de riesgos y requiere que los pacientes cumplan con características específicas para su utilización, por lo que su indicación debe ser juiciosa y en casos seleccionados.

Abstract In hyperbaric oxygen therapy, 100% pure oxygen is used in a pressurized chamber with super atmospheric pressures which correspond to 2-3 atmospheres. The mechanism by which this treatment works is related to the physical properties of gases and their physiological behavior in the body, which leads to hyperoxia, the physiological event which allows for diverse beneficial health effects. The evidence in medicine has proven its utility mainly in decompression sickness, severe skin infections and carbon monoxide poisoning. In the otolaryngology field it has been proven useful in diseases like idiopathic sudden sensorineural hearing loss, both as the only treatment and as a concurrent treatment along with corticosteroids, in malignant otitis externa which in conjunction with antibiotic treatment and a surgical approach presents a clear increase in improvement rates. It must be mentioned that hyperbaric chamber treatment has also shown benefits in radiation treatment and post radiation complications in head and neck cancer patients. It is important to note that hyperbaric oxygen therapy is not without risks and patients must meet specific criteria for it to be applied, therefore it must be indicated using careful judgement and only in necessary cases.

The effect of hemodialysis on hearing in chronic kidney disease patients – A systematic review

Hemodialysis as a treatment modality for Stage V chronic kidney disease (CKD) has significantly decreased mortality. However, there have been several studies reporting sensorineural hearing loss (SNHL) in these patients which affects their quality of life. The role of hemodialysis in its etiology has been widely debated and the strength of available evidence has not yet been evaluated. A systematic literature review was conducted to identify a possible association of hemodialysis to hearing loss and guide in making informed decisions in the management of CKD patients. Relevant articles from PubMed, ScienceDirect, EBSCO Medline, SCOPUS, Google Scholar, and Clinical Key were identified using Preferred Reporting Items for Systematic Review and Meta-Analyses framework. Studies that were published since the inception of the database to May 2020 and written in the English language were analyzed. A total of 36 articles on hemodialysis and sudden or SNHL were retrieved. Many were observational (13 cohorts, 10 case-control, seven case series, and six cross-sectional) studies involving 99,020 participants with ages ranging from 1 to 80 years. This review elucidates the occurrence of SNHL in CKD patients on hemodialysis. Yet, the available literature fails to provide conclusive evidence on hemodialysis as a causative agent for SNHL. Audiological assessment of all CKD patients before hemodialysis and regular follow-up may help in early diagnosis and better management of hearing loss

Effect of different electroacupuncture stimulation parameters on sudden hearing loss / 中国针灸

OBJECTIVE@#To compare the efficacy of different electroacupuncture (EA) frequencies and wave patterns combined with medication and medication alone for sudden hearing loss (SHL), and to explore better electroacupuncture stimulation parameters.@*METHODS@#All of 118 patients with SHL were randomly divided into an acupuncture and medication group 1 (group 1, 30 cases, 1 case dropped off), an acupuncture and medication group 2 (group 2, 30 cases), an acupuncture and medication group 3 (group 3, 31 cases) and a medication group (27 cases, 1 case dropped off ). The patients in the medication group were treated with conventional medication. On the base of the medication group, the patients in the group 1, 2, and 3 were treated with acupuncture at Ermen (TE 21), Tinggong (SI 19), Tinghui (GB 2), Fengchi (GB 20), etc. on the affected side, and EA at Ermen (TE 21)-Yifeng (TE 17), Tinghui (GB 2)-Yifeng (TE 17) alternately. The 3 groups were given continuous wave with frequency of 2 Hz, continuous wave with frequency of 50 Hz, and disperse-dense wave with frequency of 2 Hz/50 Hz respectively. The treatment was given once a day, 10 days were as one course, with 2 courses in total. Before and after treatment, the pure tone hearing threshold test was performed, and the curative effect of pure tone hearing threshold test and the curative effect of tinnitus, ear fullness and dizziness were compared in the 3 groups.@*RESULTS@#After treatment, the pure tone hearing threshold test values of each group were lower than those before treatment (@*CONCLUSION@#On the basis of conventional medication treatment, the addition of electroacupuncture can effectively improve the hearing and ear stuffiness symptoms of patients with SHL, and the disperse-dense wave with frequency of 2 Hz/50 Hz is more effective.

Is the C-reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss? / A relação proteína C-reativa/albumina é um fator prognóstico e preditivo na surdez súbita?

Abstract Introduction: Sudden hearing loss is a significant otologic emergency. Previous studies have revealed a coexistence of sudden hearing loss with chronic inflammation. The predictive importance of C-reactive protein/albumin values as a prognostic factor has been shown in various inflammatory and tumoral conditions. Objectives: The aim of this study was to determine whether the C-reactive protein/albumin ratio in sudden hearing loss can be used for prognostic purposes and whether there is a relationship between the neutrophil/lymphocyte ratio and the C-reactive protein/albumin ratio. Methods: A retrospective examination was made of 40 patients diagnosed with idiopathic sudden hearing loss and a control group of 45 healthy subjects. The pure tone averages of all the patients were determined on first presentation and repeated at 3 months after the treatment. The patients were separated into 2 groups according to the response to treatment. The neutrophil/lynphocyte ratio and the C-reactive protein/albumin ratios were calculated from the laboratory tests. Results: The patients included 16 females and 24 males with a mean age of 44.1 ± 14.2 years and the control group was composed of 23 females and 22 males with a mean age of 42.2 ± 13.8 years. The mean C-reactive protein/albumin ratio was 0.95 ± 0.47 in the patient group and 0.74 ± 0.13 in the control group. The difference was statistically significant (p = 0.009). The mean C-reactive protein/albumin ratio was 0.79 ± 0.12 in the response to treatment group and 1.27 ± 0.72 in the non-response group, with no significant difference determined between the groups (p = 0.418). The mean neutrophil/lymphocyte ratio was 3.52 ± 3.00 in the response to treatment group and 4.90 ± 4.60 in the non-response group, with no statistically significant difference determined between the groups (p = 0.261). Conclusion: C-reactive/albumin ratio was significantly higher in patients with sudden hearing loss than in the control group. Although C-reactive protein/albumin ratio was found to be lower in sudden hearing loss patients who responded to treatment compared to those who did not, the difference between two groups was not statistically significant.

Resumo Introdução: A perda auditiva neurossensorial súbita ou surdez súbita é uma emergência otológica significativa. Estudos anteriores revelaram uma coexistência dessa condição com inflamação crônica. A importância preditiva dos valores da relação proteína C-reativa/albumina como fator prognóstico tem sido demonstrada em várias condições inflamatórias e tumorais. Objetivos: O objetivo deste estudo foi determinar se a relação proteína C-reativa/albumina na perda auditiva neurossensorial súbita pode ser usada para fins prognósticos e se existe uma associação entre as relações neutrófilo/linfócito e proteína C-reativa/albumina. Método: Foram avaliados retrospectivamente 40 pacientes com diagnóstico de perda auditiva neurossensorial súbita idiopática e um grupo controle de 45 indivíduos saudáveis. As médias de tons puros de todos os pacientes foram determinadas na primeira consulta e repetidas 3 meses após o tratamento. Os pacientes foram separados em 2 grupos de acordo com a resposta ao tratamento. As relações neutrófilo/linfócito e proteína C-reativa/albumina foram calculadas a partir de testes laboratoriais. Resultados: Os pacientes incluíam 16 mulheres e 24 homens, com média de 44,1 ± 14,2 anos, e o grupo controle por 23 mulheres e 22 homens, com média de 42,2 ± 13,8 anos. A média da relação proteína C-reativa/albumina foi de 0,95 ± 0,47 no grupo de pacientes e de 0,74 ± 0,13 no grupo controle e a diferença foi estatisticamente significante (p = 0,009). A média da relação proteína C-reativa/albumina foi de 0,79 ± 0,12 do grupo com resposta ao tratamento e de 1,27 ± 0,72 no grupo sem resposta, sem diferença significante entre os grupos (p = 0,418). A média da relação neutrófilo/linfócito foi de 3,52 ± 3,00 no grupo com resposta ao tratamento e de 4,90 ± 4,60 no grupo sem resposta, sem diferença estatisticamente significativa entre os grupos (p = 0,261). Conclusão: A relação proteína C-reativa/albumina foi significantemente maior nos pacientes com perda auditiva neurossensorial súbita do que no grupo controle. No entanto, embora a relação proteína C-reativa/albumina tenha sido menor nos pacientes com perda auditiva neurossensorial súbita que responderam ao tratamento em comparação a aqueles que não apresentaram resposta, a diferença entre os dois grupos não foi estatisticamente significante.

Vestibular evoked myogenic potentials in the prognosis of sudden hearing loss - a systematic review / O potencial evocado miogênico vestibular no prognóstico da surdez súbita - uma revisão sistemática

Abstract Introduction: Sudden hearing loss is an otorhinolaryngological emergency that often leads to severe damage to the auditory and vestibular function. The vestibular evoked myogenic potential is a test that allows a noninvasive evaluation of the otolithic system function and vestibulospinal and vestibulo-ocular pathways. Objective: To evaluate the importance of vestibular evoked myogenic potential in determining the prognosis of patients with sudden hearing loss. Methods: A search for articles published up to December 2018 was performed in the PubMed, Cochrane, VHL and LILACS databases using MeSH descriptors. Retrospective and prospective articles were included containing cervical or ocular vestibular evoked myogenic potential in sudden hearing loss patients and information on associated vertigo and/or dizziness. Results: Sixteen of 62 initially selected articles met the inclusion criteria and were analyzed. Regarding the methodology of the evaluated studies, 8 studies were prospective, six were retrospective, one contained part of the data from a retrospective analysis and another part from a prospective analysis, and one study was cross-sectional. A total of 872 patients were evaluated (50.22% males and 49.77% females) with a mean age of 51.26 years. Four hundred and twenty-six patients (50.35%) had vertigo and/or dizziness associated with sudden hearing loss. The cervical vestibular evoked myogenic potential was performed in all studies, but only seven assessed the ocular vestibular evoked myogenic potential. The cervical vestibular evoked myogenic potential showed alterations in 38.65% of 846 evaluated ears, whereas ocular vestibular evoked myogenic potential showed alterations in 47.88% of 368 evaluated ears. The hearing recovery rate was analyzed by 8 articles, with 63.4% of 410 evaluated ears showing hearing recovery. Conclusions: The studies suggest that the assessment of the vestibular system using vestibular evoked myogenic potential seems to be important in the prognosis of sudden hearing loss. For better follow-up of patients with sudden hearing loss, the emphasis should not be limited to the cochlea, but also include the diagnosis and treatment of vestibular abnormalities, regardless of the presence of vertigo.

Resumo Introdução: A surdez súbita é uma emergência otorrinolaringológica que frequentemente cursa com graves danos à função auditiva e vestibular. O potencial evocado miogênico vestibular é um exame que permite a avaliação não invasiva da função do sistema otolítico e das vias vestíbulo-espinhal e vestíbulo-ocular. Objetivo: Avaliar a importância do potencial evocado miogênico vestibular na determinação do prognóstico dos pacientes com surdez súbita. Método: Uma busca de trabalhos publicados até dezembro de 2018 foi realizada nos bancos de dados PubMed, Cochrane, BVS e Lilacs com descritores cadastrados no MeSH. Foram incluídos artigos retrospectivos e prospectivos que contivessem o potencial evocado miogênico vestibular cervical ou ocular em pacientes com surdez súbita e informações sobre vertigem e/ou tontura associados. Resultados: Dezesseis de 62 artigos selecionados inicialmente preencheram os critérios de inclusão e foram analisados. Quanto à metodologia dos trabalhos avaliados, 8 estudos foram prospectivos, seis retrospectivos, um continha parte dos dados oriunda de uma análise retrospectiva e outra parte de uma análise prospectiva e um estudo foi transversal. Foram avaliados 872 pacientes (50,22% do gênero masculino e 49,77% feminino) com média de 51,26 anos. Do total de pacientes, 426 (50,35%) apresentavam vertigem e/ou tontura associada à surdez súbita. O potencial evocado miogênico vestibular cervical foi realizado em todos os estudos, porém o potencial evocado miogênico vestibular ocular em apenas sete. O potencial evocado miogênico vestibular cervical apresentou alteração em 38,65% de 846 orelhas avaliadas, enquanto o potencial evocado miogênico vestibular ocular estava alterado em 47,88% das 368 orelhas avaliadas. A taxa de recuperação auditiva foi analisada por 8 artigos, 63,4% de 410 orelhas avaliadas apresentavam recuperação auditiva. Conclusões: Os estudos demonstram que a avaliação do sistema vestibular com o uso do potencial evocado miogênico vestibular parece ter importância no prognóstico da surdez súbita. Para melhor acompanhamento do paciente com surdez súbita a ênfase não deve se restringir à cóclea, mas também no diagnóstico e tratamento de alterações vestibulares, independentemente da presença de vertigem.

Investigation of neutrophil-to-lymphocyte ratio and red cell distribution width in sudden senseurineural hearing loss

Background: Sudden hearing loss (DHL) is a sudden sensorineural hearing loss effecting et least 3 or more frequencies more than 30 Decibel. The purpose of this study was to investigate the usefulness of the neutrophil to lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW) in the first diagnosis of sudden sensorineural hearing loss (SSHL).Methods: Total 24 patients diagnosed with SSHL and 24 control patients included in the study. Serum samples were analyzed retrospectively on the initial presentation.Results: On admission, the NLR was 2.1±1.1 The mean absolute neutrophil count was 7100±400/mm3, and the mean complete lymphocyte count was 3400±1100/mm3. RDW was 11.9±0.6. Eight patients had total healing, 12 patients had partial cure, and two patients had no healing in the study. Statistically significant changes in NLR determined in the measurements between SSHL and control group (p<0.05). Significant differences were not observed in hemoglobin and hematocrit values, lymphocyte counts, RDW measurements between SSHL and control group (p <0.05).Conclusions: In lights of this information we recommend to screen NLR levels in SSHL patients. This may help us follow up patients recovery and if the patients recover from the disease higher level of NLR may create doubt for recurrence of the disease in risky patients.

Hearing Outcome of Low-tone Compared to High-tone Sudden Sensorineural Hearing Loss

Abstract Introduction Low-tone sudden sensorineural hearing loss (SSHL) is a well-recognized disease, in which the hearing loss is restricted to low frequencies. In contrast to lowtone SSHL, high-tone SSHL is characterized by high-frequency (4,000, 8,000 Hz) hearing loss and preservation of low-, middle-frequency hearing. Objective The objective of this study is to compare the hearing recovery and longterm outcome of low-tone SSHL with those of patients affected by high-tone SSHL in a follow-up of ~ 3 years. Methods The low-tone SSHL and high-tone SSHL groups included 27 and 20 patients, respectively; the patients of both groups were treated with intravenous steroids. Predictive factors (gender, affected side, delay of treatment, follow-up time) were also examined. Results Overall, complete hearing recovery was observed in 77.7% of the patients in the low-tone SSHL group and in 15% of the patients in the high-tone SSHL group. In the high-tone SSHL group, a higher proportion of patients reported tinnitus compared with the low-tone SSHL group (13 cases [65%] versus 3 cases [11%]); however, recurrences were more common in the low-tone SSHL (22%, 6 patients) compared with the hightone SSHL (2 cases [10%]) group. No predictive factor was found to statistically impact on hearing outcome. Conclusion After initial therapy, the low-tone SSHL patients have more favorable hearing outcome than high-tone SSHL patients. However, recurrences occurred more frequently in the low-tone SSHL group, while the high-tone SSHL group was more often accompanied by residual symptoms, such as tinnitus. (AU)

Hearing Outcome of Patients with Acute Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although poor hearing outcomes have been associated with acute noise-induced hearing loss (ANIHL), only limited studies exist on this issue. This study evaluated the prognosis of ANIHL in comparison to idiopathic sudden sensorineural hearing loss (ISSNHL) and investigated the types of noise causing these disorders. SUBJECTS AND METHOD: Patients with sudden sensorineural hearing loss due to noise exposure were included in the ANIHL group if the threshold shift was more than 30 dB in three or more consecutive frequencies within the study period (from January 2010 to December 2016). The ANIHL group included 19 patients. As a matched-control group, treated patients with ISSNHL (n=95) were selected as a way of controlling the known prognostic factors that were evenly distributed between groups. Selected prognostic variables used for matching included age, sex, the degree of initial hearing loss, the number of days before the start of treatment, and treatment method. RESULTS: The overall hearing recovery rate of ANIHL was 11% and that of the control group was 80% (p<0.001). Noise exposure in military service (37%) and leisure activities (37%) was the most prominent cause of ANIHL. CONCLUSION: The hearing outcome of ANIHL was worse than that of ISSNHL. It is thus necessary to establish national guidelines for environmental noise regulations and to raise awareness of hazardous noise exposure.

Sudden bilateral sensorineural hearing loss in a patient immunocompromised by the human immunodeficiency virus

Abstract It is known that in less than a third of patients presenting sudden hearing loss, the disorder can be attributed to viral infection, trauma, neoplasms, and vascular and autoimmune diseases. However, the role of the HIV in the onset of this disease has not yet been well described. A 46-year-old female, in an immunosuppression state induced by HIV infection, presented with sudden bilateral hearing loss, with no improvement despite treatment. Several mechanisms were reported by which the virus could induce damage to the auditory pathway. However, little is known regarding the prevention and treatment of this morbidity.

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss

Abstract Introduction Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followedup for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week (p < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared (p > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome (p >0.05). Conclusion The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss / Injeção intratimpânica de corticoides e oxigenoterapia hiperbárica para o tratamento da perda auditiva súbita refratária

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

Resumo Introdução Há muita controvérsia sobre o uso de terapias de resgate para tratar a perda auditiva neurossensorial súbita (PANSS), sem consenso sobre as recomendações. Embora vários estudos tenham demonstrado a eficácia do uso de corticoides intratimpânicos (CIT) e o tratamento com oxigenoterapia hiperbárica (HBO), poucos têm comparado a eficácia da terapia ITS e HBO em pacientes com PANSS refratária. Objetivo Avaliamos a eficiência da terapia com CIT e HBO em pacientes com PANSS refratária. Método Pacientes que não se beneficiaram adequadamente do tratamento sistêmico foram avaliados retrospectivamente. Pacientes refratários foram definidos como aqueles que ganharam menos de 20 dB na audição após o tratamento inicial. Todos os pacientes refratários foram informados sobre as opções de terapia de resgate: terapia com CIT ou HBO, cujas vantagens e desvantagens foram explicadas brevemente. O CIT envolveu 4 mg/mL de dexametasona administrada através de uma agulha de calibre 25. Os pacientes foram submetidos à terapia HBO em uma câmara hiperbárica onde respiraram 100% de oxigênio por 120 min a 2,5 pressão atmosférica. Os níveis de audição de ambos os grupos foram avaliados antes da terapia de resgate e três meses após o tratamento. As melhorias na audição foram avaliadas de acordo com os critérios de Furahashi. Também comparamos as duas terapias em termos de Escores de Discriminação de Fala (EDF) e a recuperação de todas as frequências. Resultados As terapias de resgate demonstraram resultados semelhantes. As alterações nas médias de tons puros e nas EDF foram semelhantes para a terapia com CIT e HBO (p = 0,364 e p = 0,113). A comparação dos EDF e dos limiares de audição em todas as frequências mostrou níveis de melhoria semelhantes. Conclusão CIT e HBO produziram melhorias semelhantes nos pacientes com PANSS, mas o tamanho da amostra era muito pequeno para tirarmos conclusões definitivas. Estudos randomizados e controlados adicionais são necessários para identificar a melhor terapia para pacientes com perda auditiva repentina refratária.

Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment / Perda auditiva súbita bilateral idiopática simultânea - características e resposta ao tratamento

Abstract Introduction The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. Objective The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. Methods This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. Results The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p < 0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1 dB for unilateral sudden hearing loss and 63.3 dB for the left ears and 67.6 dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0 dB and 55.4 dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p < 0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p < 0.001). Tinnitus scores decreased significantly in both groups of patients (p < 0.001) in spite of there was no significant difference between the groups of patients. Conclusion Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Resumo Introdução A etiologia da perda auditiva súbita ainda não está bem definida; contudo, presume-se que as etiologias infecciosas, vasculares e neoplásicas sejam as responsáveis. Além disso, a etiologia da perda auditiva súbita bilateral também é desconhecida. Objetivo O objetivo desse estudo foi identificar as características e a resposta ao tratamento de perda auditiva súbita bilateral simultânea. Método Este é um estudo de caso-controle realizado em um centro de atenção terciária. Foram incluídos 132 pacientes com Perda Auditiva Neurossensorial Súbita (PANS) que foram tratados com esteroides sistêmicos e oxigênio hiperbárico. 26 pacientes tiveram PANS bilateral e 106 pacientes tiveram PANS unilateral. Os pacientes foram avaliados com exames clínicos, audiológicos, radiológicos e exames laboratoriais. Os achados e a resposta ao tratamento dos pacientes foram comparados. Resultados As idades médias dos pacientes com PANS unilateral e bilateral foram 42,0 anos e 24,5 anos, respectivamente, com diferença estatisticamente significante (p < 0,001). Os marcadores de resposta imune foram mais prevalentes na PANS bilateral. Os limiares audiológicos pré-tratamento foram 69,1 dB para PANS unilateral e 63,3 dB para a orelha esquerda e 67,6 dB para a orelha direita para PANS bilateral, sem diferença significativa. O limiar médio de audição pós-tratamento em PANS unilateral foi de 47,0 dB e 55,4 dB para a orelha esquerda e 59,0 para a orelha direita em PANS bilateral. A melhora auditiva média no grupo com PANS unilateral foi significativa (p < 0,001), apesar de não ser significativa no grupo com PANS bilateral para ambas as orelhas. Houve diferença significativa entre os grupos na melhora auditiva favorecendo a PANS unilateral (p < 0,001). Os escores de zumbido diminuíram significativamente em ambos os grupos de pacientes (p < 0,001), apesar de não ter havido diferença significativa entre os grupos de pacientes. Conclusão Os pacientes com PANS bilateral eram mais jovens, tinham pior prognóstico e maior taxa de marcadores de resposta imunológica positiva. Os fatores de risco cardiovasculares parecem ter um papel importante na etiologia dos casos unilaterais, ao passo que essa importância não estava presente nos casos bilaterais.

Can A Sudden Sensorineural Hearing Loss Occur Due to Miliary Tuberculosis?

Miliary tuberculosis is a severe form of tuberculosis resulting from dissemination of Mycobacterium tuberculosis bacilli. Since symptoms appearing in patients due to miliary TB are diverse and atypical, depending on the site of invasion, early diagnosis and treatment are important. A paradoxical response of tuberculosis is a rare phenomenon and it can be a clinical difficulty to treatment especially when involving the central nervous system. We present a case report with a review of related literature about the patient who developed sudden hearing loss due to tuberculosis infection in vestibulocochlear area.

A Case of Medullary Infarction Presented Initial Symptoms Similar to Meniere’s Disease

Fluctuating hearing loss and vertigo are the typical presentations of Meniere’s disease. However, it is unusual that fluctuating hearing loss and vertigo are caused by vertebral artery occlusion or cerebral infarction. Here, we described the case of a 54-year-old male patient with hypertension and diabetes mellitus who presented with fluctuating hearing loss in his left ear and severe whirling-type dizziness without associated neurological signs or symptoms. Temporal magnetic resonance imaging (MRI) was normal. He was diagnosed with a possible Meniere’s disease and started conservative treatment. Eight years later, the patient developed dysarthria and left-side weakness. Brain MRI revealed right anterior medullary infarction, and cerebral angiography showed occlusion of the right vertebral artery. In this case, we attempted to review the initial imaging study and reported the characteristics of the case.

Índice neutrófilo/linfocito y plaquetas/linfocito como marcador en la hipoacusia súbita / Neutrophil/lymphocyte and patelet/lymphocyte ratio marker in sudden hearing loss / Neutrófilos / linfócitos e plaquetas / índice de linfócitos como marcador na perda auditiva repentina

INTRODUCCIÓN: La hipoacusia neurosensorial de instalación súbita (HNSS), como la pérdida de 30 decibeles en tres frecuencias consecutivas en menos de 72 horas. El índice neutrófilo/linfocito (INL) se definió como un marcador potencial para medir los niveles de inflamación. La interacción entre los neutrófilos y el endotelio se ha descrito como la causante del incremento del daño endotelial y explicaría la adhesión plaquetaria. El índice plaquetas/linfocito (IPL) asociado a un mal pronóstico, cuando se encuentra elevado en pacientes con enfermedades oncológicas. MATERIAL Y MÉTODO: Se realizó un estudio prospectivo, observacional y analítico de casos y controles. Incluyó a pacientes con diagnóstico de hipoacusia súbita, a los cuales se les realizó estudios auditivos y un examen de laboratorio. Para el cálculo del INL e IPL se realizó una división aritmética de los mismos...

INTRODUCTION: The sudden installation sensorineural hearing loss (HNSS), as the loss of 30 decibels in three consecutive frequencies in less than 72 hours. The neutrophil / lymphocyte index (INL) was defined as a potential marker for measuring levels of inflammation. The interaction between neutrophils and the endothelium has been described as the cause of increased endothelial damage and would explain platelet adhesion. The platelet / lymphocyte index (IPL) associated with a poor prognosis, when it is elevated in patients with oncological diseases. MATERIAL AND METHOD: Prospective, observational and analytical study of cases and controls was carried out. It included patients with a diagnosis of sudden hearing loss, who underwent auditory studies and a laboratory examination. For the calculation of INL and IPL, an arithmetic division was made…

INTRODUÇÃO: A perda súbita da audição neurossensorial da instalação (HNSS), como a perda de 30 decibéis em três freqüências consecutivas em menos de 72 horas. O índice de neutrófilos / linfócitos (INL) foi definido como um marcador potencial para medir níveis de inflamação. A interação entre os neutrófilos e o endotélio foi descrita como a causa do aumento do dano endotelial e explicaria a adesão plaquetária. O índice de plaquetas / linfócitos (IPL) associado a um mau prognóstico, quando ele é elevado em pacientes com doenças oncológicas. MATERIAL E MÉTODO: Foi realizado um estudo prospectivo, observacional e analítico de casos e controles. Ele incluiu pacientes com diagnóstico de perda auditiva súbita, que foram submetidos a estudos auditivos e um exame laboratorial. Para o cálculo de INL e IPL, foi feita uma divisão aritmética...