Sordera súbita: encuesta nacional en España / Sudden hearing loss: National survey in Spain

Introducción: El objetivo de nuestro estudio es identificar las actitudes diagnósticas y terapéuticas que se llevan a cabo en los diferentes servicios de otorrinolaringología (tanto del ámbito privado como público) en España con respecto a la sordera súbita. Esto permitirá establecer una base que ayude a generar un nuevo consenso a nivel nacional, unificando criterios para el tratamiento, diagnóstico y seguimiento de esta patología. Material y métodos: Se realizó una encuesta anónima por Internet, dirigida a otorrinolaringólogos españoles a nivel nacional (n = 2.029 especialistas afiliados a la SEORL), recopilando en 33 preguntas diferentes aspectos en relación a los criterios diagnósticos, pruebas complementarias, pautas de tratamiento y factores pronósticos en la sordera súbita, según los diferentes protocolos instaurados y experiencia de los participantes en la encuesta. Resultados: Participaron 293 otorrinolaringólogos españoles de forma anónima (14% del total). Respecto a criterios diagnósticos, destaca el requerimiento de confirmar una hipoacusia neurosensorial (91,1%), de inicio en menos de tres días (75%) y afectación de tres frecuencias consecutivas (76,4%). Más de la mitad de los participantes solicitan resonancia magnética de CAI/APC (68,7%), y el 88,2% utiliza contraste con gadolinio en esta prueba. El factor pronóstico que se consideró con mayor frecuencia en la encuesta fue la demora hasta inicio del tratamiento con un 84,8%. Respecto al tratamiento empleado en casos primarios, la gran mayoría de los encuestados (99,7%) coinciden en la administración de corticoides. La vía oral es la más utilizada (66%), seguida de la administración intravenosa (29,6%), e intratimpánica (1,4%). El 92% no han tenido complicaciones mayores con el tratamiento corticoide sistémico. La vía intratimpánica es empleada en un 70% como rescate en fracasos. Conclusiones: En España, existe actualmente una importante disparidad en el uso de los medios diagnósticos en la sordera súbita y un mayor acuerdo en el uso de corticoides como su tratamiento. Sería necesario implementar medidas que permitan un mejor abordaje, homogéneo y consensuado de esta patología (AU)

Introduction: The objective of our study was to identify the diagnostic and therapeutic approaches in the different ENT Departments of Spain with respect to sudden deafness. We wanted to establish a basis to help to create a new nation-wide consensus, unifying treatment, diagnostic and follow-up criteria for this disease. Methods: We carried out an anonymous Internet survey, addressing Spanish ENT doctors nation-wide (n = 2,029), gathering in 33 questions different aspects about diagnostic criteria, additional tests, treatment procedures and prognostic factors in sudden deafness, according to the different protocols and experience of the participants in the survey. Results: A total of 293 Spanish ENT doctors (14%) took part anonymously. In relation to diagnostic criteria, is the most noteworthy was the requisite of a confirmed neurosensorial loss (91.1%) followed by "initiated in less than three days" (75%) and 3 consecutive frequencies affected (76.4%). More than half of the participants requested an MRI of the IAC/CPA (68.7%) and 88.2% used gadolinium in this test. The prognostic factor most frequently considered was delay in commencement of treatment onset (84.8%). As far as treatment of primary cases, most of the responders agreed on the use of corticosteroids (99.7%). Oral administration was the most widely used (66%), followed by intravenous (29.6%) and intratympanic (1.4%) administration. Ninety-two percent had not had any major complications with systemic steroids. Intratympanic treatments were used by 70% of responders for rescue in failure. Conclusions: In Spain there is currently a significant disparity of concepts regarding the diagnosis of sudden deafness, and more agreement as to using steroids as their treatment. This highlights the need to implement measures to promote a better approach, which would be homogeneous and consensual, to this condition (AU)

Sudden hearing loss: National survey in Spain.

INTRODUCTION: The objective of our study was to identify the diagnostic and therapeutic approaches in the different ENT Departments of Spain with respect to sudden deafness. We wanted to establish a basis to help to create a new nation-wide consensus, unifying treatment, diagnostic and follow-up criteria for this disease. METHODS: We carried out an anonymous Internet survey, addressing Spanish ENT doctors nation-wide (n=2,029), gathering in 33 questions different aspects about diagnostic criteria, additional tests, treatment procedures and prognostic factors in sudden deafness, according to the different protocols and experience of the participants in the survey. RESULTS: A total of 293 Spanish ENT doctors (14%) took part anonymously. In relation to diagnostic criteria, is the most noteworthy was the requisite of a confirmed neurosensorial loss (91.1%) followed by "initiated in less than three days" (75%) and 3 consecutive frequencies affected (76.4%). More than half of the participants requested an MRI of the IAC/CPA (68.7%) and 88.2% used gadolinium in this test. The prognostic factor most frequently considered was delay in commencement of treatment onset (84.8%). As far as treatment of primary cases, most of the responders agreed on the use of corticosteroids (99.7%). Oral administration was the most widely used (66%), followed by intravenous (29.6%) and intratympanic (1.4%) administration. Ninety-two percent had not had any major complications with systemic steroids. Intratympanic treatments were used by 70% of responders for rescue in failure. CONCLUSIONS: In Spain there is currently a significant disparity of concepts regarding the diagnosis of sudden deafness, and more agreement as to using steroids as their treatment. This highlights the need to implement measures to promote a better approach, which would be homogeneous and consensual, to this condition.

Consenso sobre el diagnóstico y tratamiento de la sordera súbita / Consensus on diagnosis and treatment of sudden hearing loss

La sordera súbita idiopática es aquella hipoacusia neurosensorial de inicio súbito, en menos de 72 horas, sin otros antecedentes otológicos previos. Presentamos un consenso sobre el diagnóstico, tratamiento y seguimiento de la sordera súbita, surgido desde la Asociación Madrileña de ORL. Mediante revisión sistemática de la literatura sobre sordera súbita, desde 1966 hasta junio de 2010, sobre los términos MESH “(acute or sudden) hearing loss”, llegando a las siguientes sugerencias: en cuanto al diagnóstico, ante una sospecha clínica de sordera súbita, las pruebas diagnósticas que se consideran necesarias son: otoscopia, acumetría, audiometría tonal, audiometría verbal y timpanograma. Una vez hecho el diagnóstico clínico de sordera súbita, antes de comenzar el tratamiento, se solicitará una batería analítica, debiendo completarse más tarde el estudio con RM de oído interno. Se recomienda que el tratamiento de la sordera súbita esté basado fundamentalmente en los corticoides sistémicos, generalmente por vía oral, apoyados en los corticoides intratimpánicos como rescate. Respecto al seguimiento, se realizará un control a la semana del inicio del mismo, incluyendo audiometría tonal y verbal, y a los 15, 30 y 90 días del diagnóstico, y 12 meses después. Como consenso, el resultado de los tratamientos aplicados debería presentarse, tanto en cuanto a la cantidad de dBs recuperados en el umbral auditivo tonal, como siguiendo la tasa de recuperación en los casos unilaterales, así como con parámetros de audiometría verbal (AU)

Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry (AU)

[Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]. / Consenso sobre el diagnóstico y tratamiento de la sordera subita.

Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.