Is Idiopathic Sudden Sensorineural Hearing Loss Seasonal?

OBJECTIVE: To investigate the circannual rhythm (seasonal incidence) of idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Data were retrieved from the medical files of an original cohort of all consecutive patients with ISSNHL in a tertiary medical center between 2012 and 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed. A Google Trends analysis of the term [sudden hearing loss] and related terms between 2014 and 2020 was also performed. RESULTS: Most of the published series (9/12) reported the highest ISSNHL incidence in the spring and the lowest in the winter (8/12). In our local series, the incidence during the winter was significantly lower than that for the other seasons by a factor of 0.69 (95% confidence interval, 0.65-0.77; p = 0.041; r = 0.36). Google Trends data showed no significant correlation between the calendric month and the incidence of ISSNHL in any of the analyzed countries ( p = 0.873, r2 = 0.029). CONCLUSION: The ISSNHL incidence was lowest during the winter season in our cohort and reported for other cohorts worldwide. Google Trends-based model analysis did not determine any circannual rhythm.

Evaluation of the Quality of Online Information on Sudden Sensorineural Hearing Loss.

OBJECTIVE: To evaluate the quality of leading Internet resources of information on sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Cross-sectional descriptive design. SETTINGS: An online search by means of the Google search engine. METHODS: An online search was conducted using terms related to SSNHL. We defined "quality" according to scaled readability measures (Flesch Reading Ease [FRE] and Flesch-Kincaid Grade-Level [FKGL]), as well as "understandability" and "actionability" (Patient Education Materials Assessment Tool), and Clinical Practice Guideline (CPG) adherence. Scoring was performed by two independent physicians. RESULTS: The 10 most frequently encountered patient education websites were analyzed. The average FRE score was "fairly difficult" (mean 57.28, median 55.55, range 46.4-71.8) and the average FKGL score was "standard" (mean 9th grade, median 9th grade, range 5th-10th grade). Nine websites were understandable (mean 83%, median 84%, range 69-100%), and seven had good actionability scores (mean 73%, median 75%, range 50-100%). Most websites conformed with the CPG for patient education at a reasonable level (mean 5.6, median 5.5, range 3-7). Notably, all websites encouraged seeking medical help. CONCLUSION: Internet resources for patient education on SSNHL vary in quality and are generally understandable to the average layman. There is still much room for better, more comprehensive and easier-to-read information to improve patients' medical knowledge about their condition.Level of Evidence: 1.

Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections.

OBJECTIVES/HYPOTHESIS: To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans-tympanostomy tube (TyT). STUDY DESIGN: Case series, systematic review and meta analysis. METHODS: Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed and meta-analysis was established. RESULTS: Eighteen studies describing 818 ears were included in the quantitative meta-analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%-3.27% and 0.028%-2.38%) in the TyT and trans-tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques. CONCLUSION: IT steroid therapy via trans-TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2583-E2591, 2021.

Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta-Analysis.

OBJECTIVES/HYPOTHESIS: The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs). STUDY DESIGN: Systematic review with meta analysis. METHODS: Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed. RESULTS: Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21). CONCLUSIONS: TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2091-2097, 2021.

The Actual Incidence and Types of Hearing Losses in Bullous Myringitis: Case Series and Systematic Review.

OBJECTIVE: To calculate the incidence of sensorineural hearing loss (SNHL; pure or as part of a mixed hearing loss, MHL) among bullous myringitis (BM) patients with a coexisting HL to assess whether steroidal treatment should be initiated even before the findings of a formal audiogram are available. METHODS: Retrospective medical record review in a tertiary referral center and systematic review of the English literature. RESULTS: The medical records of 81 patients with BM were retrieved among whom 50 patients (62%) had actually sustained a HL, although only 39/81 patients reported a HL when asked. Twenty-four patients had a MHL, 18 had a SNHL, and eight had a conductive HL (CHL). The systematic review included 106 ears: 17 had no HL, 53 had a MHL, 20 had a SNHL, and 16 had a CHL. The combined published and current results yielded a SNHL and MHL rates of 38/139 (27%) and 77/139 (55%), respectively of all BM patients with confirmed HL. CONCLUSION: BM is intuitively associated with a CHL resulting from the impeded function of the affected middle ear. Medical history and physical examination are not sufficient to exclude a SNHL in BM patients, and formal audiometry is mandatory for exclusion/confirmation in this setting. Nevertheless, steroidal treatment should not be delayed until the performance of formal audiometry because the actual rate of pure CHL in this setting is very low.Level of Evidence: 2.