Optimal timing of salvage intratympanic steroids in idiopathic sudden sensorineural hearing loss.

Background: Salvage intratympanic steroids (ITS) works in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of initial therapy, but optimal timing of administration is unknown. Methods: Two hundred and seventy patients with ISSNHL were included. Among them, 180 were treated with ITS and standard medical treatment (SMT) and the other 90 received SMT along. The hearing threshold before and after salvage treatment were compared. The relationship between the salvage starting time and hearing recovery was analyzed. Results: The hearing of ITS group improved more than that of the SMT group in all frequency bands. The effect of both strategies decreases with the delay of the starting time. ITS can improve hearing even if being administrated 5 weeks after onset while SMT failed after 3 weeks. Conclusion: Patients with profound ISSNHL can obtain extra hearing recovery from salvage ITS. The earlier salvage starts, the greater the patient benefits.

Clinical features and prognostic factors of pediatric idiopathic sudden hearing loss from moderate to profound degree.

BACKGROUND: The pediatric idiopathic sudden sensorineural hearing loss (PISSNHL) is not rare in the clinics, however, the prognostic factors of PISSNHL are still unclear. OBJECTIVES: To investigate the clinical and audiologic characteristics associated with prognosis in PISSNHL. MATERIAL AND METHODS: Clinical and audiological characteristics and possible prognostic factors were retrospectively evaluated in 76 PISSNHL patients aged less than 19 years. RESULTS: Hearing loss was moderate in nine patients, severe in 21 patients, profound in 46 patients. Among five types of audiogram, 3.9% were classified as ascending, 11.8% as descending, 25.0% as flat, 55.3% as profound, and 3.9% as concave. The recovery rate according to Siegel's criteria was 55.3%. There was no significant difference between the recovery group and the poor recovery group in terms of age, sex, laterality of hearing loss, the onset of treatment, and accompanying symptoms (p > 0.05). The initial hearing levels and the audiogram type were significantly different in the two groups (p < 0.001) according to univariate analysis, while only the initial hearing level was significantly different (p = 0.046) according to multivariate analysis. CONCLUSIONS AND SIGNIFICANCE: Prognosis of PISSNHL was mainly related to initial hearing at onset. An initial hearing level greater than 80 dB was a poor prognostic factor.

Intratympanic dexamethasone for managing pregnant women with sudden hearing loss.

OBJECTIVE: This study aimed to investigate the effect and safety of intratympanic dexamethasone in pregnant women with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: We performed a prospective study on pregnant women who suffered from ISSNHL and were treated in our clinic during 2016. The patients received intratympanic treatment three to four times a week. A pure tone audiogram (PTA) was performed before treatment and patients were followed up until 2 months after treatment was finished. RESULTS: A total of six pregnant women were included. All of the patients tolerated intratympanic treatment well. The mean improvement in hearing was 48 ± 7.33 dB. There were no complications, including permanent perforation of the ear drum or middle ear infection. Each patient delivered a healthy newborn. CONCLUSION: Intratympanic dexamethasone is effective and safe for treating pregnant women with ISSNHL. Further randomized, controlled studies on this treatment need to be performed.

[Different prognostic characteristics between profound sudden sensorineural hearing loss and total sudden hearing loss].

OBJECTIVE: To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss (SSNHL) and total SSNHL. METHODS: The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average (PTA) threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed. RESULTS: There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64.9% (37/57) patient with total SSNHL group and 45.6% (67/147) patients with profound SSNHL, which had significant difference between the two groups (χ(2) = 5.72, P = 0.017). The PTA threshold improvement in total SSNHL group and profound SSNHL group was (36.4 ± 19.3) dB and (40.2 ± 21.3) dB respectively, which was no significant difference between the two groups (t = 1.165, P = 0.245). The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2.6% (1/38) patients in the total SSNHL group and 14.3% (14/98) patients in the profound SSNHL group (P = 0.045). Furthermore, 3.5% (2/57) patients in total SSNHL group as well as 29.9% (44/147) patients in profound SSNHL group obtained a good result with PTA threshold ≤ 50 dB after therapy (χ(2) = 15.92, P = 0.001). In addition, the favorable prognosis was related with the onset-therapy time point(P = 0.001), but not related to the patients' age. CONCLUSION: Profound SSNHL and total SSNHL though both with PTA threshold > 90 dB had significant differences recovery rate and need to be studied separately.

[Preliminary study on intratympanic dexamethasone injection for management of patients with profound sudden hearing loss].

OBJECTIVE: To evaluate the effects of intratympanic dexamethasone injection on patients with profound sudden hearing loss. METHODS: All patients in the present study were profound sudden hearing loss, with initial hearing loss of more than 90 dB, but no previous interventions was conducted on the 78 patients within 2 weeks onset of sudden hearing loss. Patients were assigned to 3 groups according to patients' choice, Group I (local and general dexamethasone administration, 22 cases), Group II (Intravenous dexamethasone injection, 44 cases), Group III (intratympanic dexamethasone injection, 12 cases). In addition, vessel dilation drugs, neurotrophic and hyperbaric oxygen therapy were also conducted on all patients. Intravenous dexamethasone was applied 15 mg/dx3 d, 10 mg/dx3 d and 5 mg/dx3 d, respectively. Intratympanic dexamethasone (5 mg/ml, 0.8 ml) injection was performed during 10 days (1 injection/2 days). Pure tone test was conducted on 10th, 20th, and 30th day after intervention. RESULTS: The factors which may impact on the prognosis were matched in all three groups. The threshold improvement more than 30 dB was 81.82% in group I, 83.3% in group II and 88.64% in group III. Statistical study showed there was no significant different among 3 groups (P=0.726). On the 30th day after intervention, pure tone threshold improvement was 41.36 dB in group I (local and general dexamethasone administration), 43.08 dB in group II (intravenous dexamethasone injection) and 51.70 dB in group III (intratympanic dexamethasone injection). Furthermore, pure tone threshold improvement among the 3 groups was no statistical different (F=1.58, P=0.2133). Obvious hearing improvement was noted on the 10th day after intervention, but no further improvement showed after 20 days intervention. More hearing improvement was revealed in the low frequency, while less hearing improvement was achieved in the high frequency. CONCLUSIONS: Comparison with intravenous dexamethasone injection, intratympanic dexamethasone injection did not provide more hearing improvement on patients with profound sudden hearing loss.

[Prognostic factors for patients with the idiopathic sudden sensorineural hearing loss].

OBJECTIVE: To assess the prognostic factors associated with the sudden idiopathic sensorineural hearing loss, to predict the prognosis of patient with idiopathic sensorineural hearing loss precisely. METHODS: Eight hundreds and eighty two patients with idiopathic sudden sensorineural hearing loss were retrospectively reviewed during January 2006 to March 2007. Patients whose initial hearing threshold < or =40 dB were excluded. The patients with initial hearing threshold >40 dB were recruited, which was divided into six subgroups based on the patterns of audiogram: downgrade audiogram subgroup, upgrade audiogram subgroup, flat audiogram subgroup, concave audiogram subgroup, profound audiogram subgroup and total deafness subgroup. RESULTS: Regarding to the relationship between the time point for initial intervention and the prognosis, better prognosis was obtained in patients whose initial intervention was within 3 days of the disease, good prognosis was achieved within 1 or 2 weeks of the disease, poor prognosis was noted beyond 2 weeks of this disease. Furthermore, comparison with the initial intervention within 3 week, 1 month and 1 month later, the prognosis among them was not statistical different. 97.7% hearing recovery was achieved in the concave subgroup with the initial hearing threshold >40 dB group. Comparison with the other subgroup (except total deafness subgroup), the cure rate and recovery rate was 23.8% and 57.9% respectively in the profound subgroup. Poor prognosis was demonstrated in the total deafness subgroup and inefficacy rate was 67.4% in the total deafness subgroup. Comparison with patients without companying complications, the prognosis of patients with companying complications such as diabetes or high blood pressure has negative impact in hearing recovery. The age was correlated with the prognosis, elder had poor prognosis, patients more than 50 years old present with worse hearing than that less than 50 years old (H = 7.851, P = 0.0051). CONCLUSIONS: The initial intervention beyond 2 weeks had negative impact on the prognosis. The initial audiogram patterns and hearing threshold were both significant factors on the prognosis of idiopathic sudden sensorineural hearing loss. In addition, old patient had poor prognosis. The companying complications such as high blood pressure and diabetes had negative impact on the prognosis of idiopathic sudden hearing sensorineural loss.

Reanimation of paralyzed laryngeal muscles by electrical stimulation synchronized with inspiration.

OBJECTIVE: To determine the effects of electrical stimulation on denervated cat posterior cricoarytenoid (PCA) muscle. STUDY DESIGN AND SETTING: This study was conducted on six cats with PCA muscle denervation. All animals were sacrificed 12 weeks after surgery and the glottal area in the live animals and the fiber diameters of PCA muscle were obtained. RESULTS: Signals synchronized with inspiration were recorded and transmitted to stimulate PCA muscle. The abduction of the paralyzed vocal cord during inspiration was observed; this allows enough flow of air through the larynx to maintain the respiration. The stimulated fiber diameters of PCA muscle were different from that of nonstimulated (P < 0.01). Although all denervated muscles were degenerated, electrical stimulation was used to prevent muscular atrophy. CONCLUSIONS: This study indicates that electrical stimulation of the PCA muscle synchronized with inspiration could restore the abduction of a paralyzed vocal cord and prevent the denervated muscles from atrophying. SIGNIFICANCE: Electrical stimulation synchronized with inspiration may lead to reanimation of paralyzed laryngeal muscles.