Idiopathic sudden sensorineural hearing loss: A review focused on the contribution of vascular pathologies.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is characterized by abruptly appearing hearing loss, sometimes accompanied by vertigo. Vascular pathologies (e.g., cochlear ischemia, or cochlear infarction) are one of the most likely causes of ISSNHL. This review aims to present current understanding of inner ear anatomy, clinical features of ISSNHL, and its treatment strategies. The labyrinthine artery is the only end artery supplying blood to the inner ear, and it has three branches: the anterior vestibular artery, the main cochlear artery, and the vestibulo-cochlear artery (VCA). Occlusion of the VCA can be caused by a variety of factors. The VCA courses through a narrow bone canal. ISSNHL is usually diagnosed after excluding retrocochlear pathologies of sudden sensorineural hearing loss (SSNHL), such as vestibular schwannoma. Therefore, a head MRI or assessing auditory brainstem responses are recommended for patients with SSNHL. Severe SSNHL patients with high CHADS2 scores, an index of stroke risk, have a significantly lower rate of vestibular schwannoma than severe SSNHL patients with low CHADS2 scores, suggesting that severe ISSNHL in individuals at high risk of stroke is caused by vascular impairments. Intralabyrinthine hemorrhage causes SSNHL or vertigo, as in ISSNHL. The diagnosis of intralabyrinthine hemorrhage requires careful interpretation of MRI, and a small percentage of patients diagnosed with ISSNHL may in fact have intralabyrinthine hemorrhage. Many studies have reported an association between ISSNHL and atherosclerosis or cardiovascular risk factors (e.g., diabetes mellitus, hypertension, dyslipidemia and cardiovascular disease), and subsequent risk of stroke in patients with ISSNHL may be elevated compared to controls. Increased hearing level on the healthy ear side, high Framingham risk score, high neutrophil-to-lymphocyte ratio, high platelet-to-lymphocyte ratio, and severe white matter lesions may be poor prognostic factors for patients with ISSNHL. The association between thrombosis-related genes and susceptibility to ISSNHL has been reported in many studies (e.g., coagulation factor 2, coagulation factor 5, plasminogen activator inhibitor-1, platelet-associated genes, a homocysteine metabolism-related enzyme gene, endothelin-1, nitric oxide 3, phosphodiesterase 4D, complement factor H, and protein kinase C-eta). Treatment of ISSNHL with the aim of mitigating the vascular impairment in the inner ear includes systemically administered steroids, intratympanic steroid injections, hyperbaric oxygen therapy, prostaglandin E1, defibrinogenation therapy, and hydrogen inhalation therapy, but there is currently no evidence-based treatment for ISSNHL. Breakthroughs in the unequivocal diagnosis and treatment of ISSNHL due to vascular impairment are crucial to improve quality of life.

Clinical Observations on the Combined Use of Hyperbaric Oxygenation and Conventional Medications in the Management of Type 2 Diabetes Mellitus Concurrent With Sudden Deafness.

Objective: The aim of this study is to investigate the effectiveness of combining hyperbaric oxygen therapy (HBOT) with conventional pharmacological interventions in the management of type 2 diabetes mellitus concurrent with sudden deafness. Methods: A cohort of 96 patients diagnosed with sudden deafness was enrolled and subsequently randomized into 2 groups: a treatment group (n = 50) and a control group (n = 46). The control group received standard conventional treatment aimed at enhancing microcirculation and nutritional support for nerves, while the treatment group underwent conventional symptomatic treatment coupled with HBOT. The evaluation encompassed the monitoring of blood glucose and blood lipid levels, clinical efficacy, and absolute hearing threshold improvement in both groups. Results: Following the intervention, noteworthy reductions in blood glucose and blood lipid levels were observed in both groups compared to their respective pretreatment values. Furthermore, posttreatment values in the treatment group exhibited a statistically significant decrease in comparison to those in the control group (P < .05). On assessing clinical efficacy posttreatment, the treatment group demonstrated a significantly higher efficacy than the control group (P < .05). In addition, the absolute hearing thresholds in both groups exhibited a significant decrease posttreatment compared to baseline values. Notably, the treatment group displayed a statistically significant reduction in absolute hearing thresholds compared to the control group posttreatment (P < .05). Conclusion: The combined therapeutic approach utilizing hyperbaric oxygen exhibits effectiveness in mitigating auditory impairment among individuals manifesting sudden deafness concomitant with type 2 diabetes mellitus. Furthermore, this treatment approach is associated with a concurrent reduction in blood glucose and blood lipid levels.

[Primary central nervous system lymphoma presenting as a unilateral internal auditory canal lesion: a case report].

A 61-year-old man with right hearing loss and staggering for seven months was diagnosed with sudden deafness although previous evaluation with MRI indicated minor abnormal findings. During follow-up, he developed hypogeusia, right facial nerve palsy, pain in right mandible, right-sided temporal pain, and cerebellar ataxia. Cerebrospinal fluid examination at admission revealed reduced glucose concentration and elevated soluble interleukin-2 receptor (sIL-2R) level, whereas serum sIL-2R level was within the normal range. Brain MRI showed a swollen contrast-enhanced lesion extending from the right internal auditory canal to the middle cerebellar peduncle. Gallium-67 (67Ga) single-photon emission-computed tomography-computed tomography (SPECT-CT) revealed abnormal accumulation at the lesion site. Pathologic analysis of the tumor after resection led to the diagnosis of primary central nervous system lymphoma. In the present case, the MRI and 67Ga SPECT-CT characteristics were distinct from those of vestibular schwannoma. In addition, elevation of sIL-2R in the cerebrospinal fluid but not in serum was useful for differential diagnosis.

Reactivation of hepatitis C virus caused by steroid monotherapy for sudden deafness.

Hepatitis C virus (HCV) reactivation has been reported to be caused due to several anticancer drugs and immunosuppressive agents; however, HCV reactivation after steroid monotherapy has rarely been reported. Here, we report the case of a 65-year-old Japanese man with HCV infection who developed HCV reactivation after the administration of prednisolone (PSL) for 6 days for sudden deafness. In the patient history, the positivity for anti-HCV antibody was observed, but serum level of HCV RNA was not measured. Two months after PSL administration, the patient experienced an alanine aminotransferase (ALT) flare and the serum level of HCV RNA was observed to be 6.2 log IU/mL; then, the patient was admitted to our hospital for hepatitis treatment. Based on the clinical course and laboratory findings, the patient was diagnosed with HCV reactivation. Although the ALT levels decreased spontaneously during follow-up, they did not drop to normal range; subsequently, sofosbuvir and ledipasvir treatments were started. A sustained virological response 24 weeks after the end of treatment was achieved. This case study suggests that HCV reactivation with hepatitis flare can occur even after a steroid monotherapy, and doctors should pay attention to HCV reactivation when administering PSL for patients with HCV infection.

Assessing the Effectiveness of Different Hyperbaric Oxygen Treatment Methods in Patients with Sudden Sensorineural Hearing Loss.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) is one of the treatment methods in patients with sudden sensorineural hearing loss (SSNHL). It is recommended as an elective treatment in patients undergoing steroid therapy. According to current scientific reports, HBOT should be implemented within two weeks after the first symptoms. However, as far as the profile of HBOT is concerned, there are no straightforward recommendations. METHODS: The data obtained from the medical records of 218 patients undergoing HBOT for SSNHL at the Military Institute of Medicine-National Research Institute were analyzed statistically for the impact of the duration and the delay in implementing HBOT on the end results of pure-tone audiometry (PTA). RESULTS: A statistically significant hearing improvement in patients undergoing more than 15 cycles of HBOT was detected at all frequencies except for 1500 Hz; in the group reporting for treatment with a delay of more than 10 days, hearing improvement was statistically unsignificant at frequencies of 1500, 3000, and 4000 Hz. CONCLUSIONS: The statistical analysis showed that the urgent onset of HBOT could be a significant factor in the therapy of SSNHL.

A Comprehensive Study on Sudden Deafness for Analyzing Their Clinical Characteristics and Prognostic Factors.

Background: To study the factors associated with the prognosis of patients with sudden deafness to facilitate clinical treatment and improve efficacy. Methods: A total of 414 patients with sudden deafness treated in Zhenjiang First People's Hospital from January 2020 to December 2022 were chosen. Relevant data were gathered and the effectiveness of treatment was assessed by comparing hearing test results before and after hospital admission and divided into effective and ineffective groups, and the effectiveness of each factor was analyzed using univariate analysis, Spearman's correlation analysis, and multifactor logistic regression. Results: The 2 groups had significant differences in age, presence of tinnitus, degree of hearing loss, and triglyceride levels. Spearman's rank correlation analysis showed a negative correlation between hearing threshold of at least 81 dB at 250 to 8000 Hz, the low-density lipoprotein (LDL), triglyceride levels, and the prognosis (r < 0, P < .001). A positive correlation exists between high-density lipoprotein levels and prognosis (r > 0, P < .001). Receiver operating characteristic curve showed LDL level, age, and time since disease onset appears to be highly predictive. Multivariable logistic regression analysis showed that age >47 years, LDL >2.93 mmol/L, and time to presentation >10 days after disease onset are at higher risk for poor prognosis. Conclusion: Factors that influence the prognosis of patients with sudden deafness include age, tinnitus symptoms, high LDL levels, and the type of hearing curve. Early intervention and targeted treatment should be given to high-risk patients to improve the outcome of sudden deafness in clinical practice.

Clinical Relevance of Plasma Lactic Acid in the Onset and Prognosis of Sudden Deafness.

Sudden deafness poses a significant threat to patients' quality of life, yet effective indicators for evaluating its onset and prognosis remain elusive. The inner ear is primarily supplied by the labyrinthine artery, which lacks collateral circulation. Changes in coagulation function and hemorheology can cause spasm or thrombosis of the labyrinthine artery, leading to ischemia, hypoxia, and microcirculation disorders in the inner ear, ultimately resulting in sudden deafness. This retrospective study examined 196 patients with sudden deafness, utilizing the 2015 Chinese guideline for diagnosis and treatment classification. Coagulation system analysis used the STA-R Evolution automatic coagulation analyzer, measuring activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen (FIB). Plasma lactate concentration was determined using a Johnson and Johnson Fusion 5.1 model plasma lactate detector. Results of the study revealed a correlation between the degree of hearing loss and disease prognosis. Patients with higher grade hearing loss exhibited elevated plasma lactate levels upon admission compared with those with lower grade hearing loss. Importantly, elevated plasma lactate levels at admission served as predictive indicators for treatment outcomes. In addition, patients with ineffective treatment demonstrated a more coagulable blood state, as evidenced by the lower APTT (ineffective treatment: 31.47 ± 4.55 seconds, effective treatment: 35.17 ± 5.38 seconds) and PT on admission, but higher plasma FIB. In conclusion, plasma lactate levels upon admission hold promise as prognostic markers for sudden deafness treatment outcomes, providing valuable insights for clinical management.

Sudden Hearing Loss as an Initial Symptom of Vestibular Schwannoma.

OBJECTIVE: This study aims to determine the prevalence of vestibular schwannoma (VS) among patients presenting with sudden hearing loss (SHL) and to characterize the clinical features of individuals diagnosed with both VS and SHL. METHODS: We conducted an observational retrospective review at a tertiary referral center, spanning a 30-year period, focusing on patients diagnosed with SHL where VS was confirmed as the underlying cause. We included patients meeting these criteria while excluding those lacking imaging or with a pre-existing diagnosis of VS. We evaluated the audiological characteristics at the time of diagnosis and assessed clinical outcomes following treatment. RESULTS: Among the 403 patients presenting with SHL during the study period, 9 (2.2%) were diagnosed with VS, aged between 25 and 72 years. Although audiometric profiles varied, high-frequency hearing loss predominated, mostly categorized as mild to moderate. Six patients (66%) had Koos grade I-II schwannomas. Only 2 patients achieved complete hearing recovery post-treatment, while 4 showed no improvement. CONCLUSIONS: VS is a rare etiology of SHL, accounting for slightly over 2% of cases. Its symptomatology, severity, and audiometric patterns do not significantly differ from SHL caused by other factors. Tumor size does not correlate with hearing characteristics. Treatment modalities resemble those for other SHL cases, and hearing improvement does not obviate the necessity for follow-up magnetic resonance imaging (MRI) scans.

Relationship Between Serum ET-1, HDL-C, and sVCAM-1 and Hearing Loss in Patients with Sudden Deafness.

Vascular causes are most commonly associated with sudden sensorineural hearing loss (SSHL). This study was performed to determine the relationship between serum endothelin-1 (ET-1), high-density lipoprotein cholesterol (HDL-C), soluble vascular cell adhesion molecule-1 (sVCAM-1) levels, and the degree of hearing loss in patients with SSHL. Firstly, 60 SSHL patients were admitted to The First Hospital of Shanxi Medical University. In the same period, 60 healthy subjects matching the age and gender of SSHL patients were selected as the control group. Then, serum levels of ET-1, HDL-C, and sVCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA). Next, the relationship between serum levels of ET-1, HDL-C, and sVCAM-1 with clinicopathological factors and their diagnostic and prognostic values were analyzed and evaluated. Serum ET-1 and sVCAM-1 were increased, and HDL-C was decreased in patients with SSHL. Serum ET-1 and sVCAM-1 were higher and HDL-C was lower in patients aged ≥ 45 years, or severe hearing loss patients (P < 0.05). ROC analysis determined that ET-1 (AUC = 0.839), HDL-C (AUC = 0.830), and sVCAM-1 (AUC = 0.865) had excellent diagnostic values. In addition, patients with low levels of ET-1 and sVCAM-1 and high levels of HDL-C had better hearing prognosis (P < 0.05). Abnormal serum ET-1, HDL-C, and sVCAM-1 in patients with SSHL are closely related to age, and degree of hearing loss, and perform diagnostic and prognostic values.

The construction and validation of prognostic prediction model for sudden sensorineural hearing loss in middle-aged and elderly people.

OBJECTIVE: Idiopathic sudden sensorineural hearing loss (ISSNHL), as an otologic emergency, is commonly encountered and its prevalence has been climbing every year recently. To our knowledge, the prognosis of middle-aged and elderly patients is worse than that of young patients. Previous researches mainly focused on the adult population, which was considered as prognostic models who performed hearing recovery in ISSNHL. However, few studies regarding the middle-aged and elderly population who are regarded as prognostic models have been reported. Therefore, we aim to construct and validate a nomogram-based prognostic prediction model, which can provide a reference for the prognostic assessment in the middle-aged and elderly patients with ISSNHL. METHOD: A total of 371 middle-aged and elderly ISSNHL patients who were admitted to the Department of Otolaryngology-Head and Neck Surgery, Yanbian Hospital, Yanbian University, from April 2018 to April 2023 were enrolled in the study. All subjects were randomly divided into two groups including training group (n = 263) and validation group (n = 108). Lasso regression and multi-factor logistic regression were jointly utilized to screen out prognosis-related independent risk factors and establish a nomogram-based risk prediction model. The accuracy and clinical application value of the model were evaluated by combining the Bootstrapping method and k-fold cross-validation, plotting the receiver operating characteristic  (ROC)  curve, calculating the area under the ROC curve (AUC), plotting the decision curve analysis (DCA), and the calibrating curve. RESULT: We used the method of lasso regression combined with multivariate logistic regression and finally screened out eight predictors (including age, number of affected ears, degree of hearing loss, type of hearing curve, duration of disease, presence of vertigo, diabetes, and lacunar cerebral infarction) that were included into the nomogram. The C-index were 0.823 [95% CI (0.725, 0.921)] and 0.851 [95% CI (0.701, 1.000)], and the AUC values were 0.812 and 0.823 for the training and validation groups, respectively. The calibration curve for the validation group was approximately conformed to that for the modeling group, indicating favorable model calibration. The DCA results revealed the modeling group (3%-86%) and the validation group (2%-92%) showed significant net clinical benefit under the majority of thresholds. CONCLUSION: This study developed and validated a nomogram-based prognostic prediction model which based on the eight independent risk factors mentioned above. The predictors are conveniently accessible and may assist clinicians in formulating individualized treatment strategies.

Batroxobin can improve the efficacy of combination therapy for profound sudden sensorineural hearing loss greater than but not less than 100 dB HL.

OBJECTIVE: To investigate the effects of combination therapy with and without batroxobin, and the frequency of batroxobin use on the prognosis of profound sudden sensorineural hearing loss. METHODS: Hearing recovery in the batroxobin group (231 patients) and non-batroxobin group (56 patients) was compared. The correlation between the number of times batroxobin was used and hearing recovery was analysed. RESULTS: The decrease in hearing threshold and overall improvement rate in the batroxobin group with hearing loss exceeding 100 dB HL was significantly higher than that in the non-batroxobin group. There was no linear correlation between the number of times batroxobin was used and the overall improvement rate. Using batroxobin two to three times achieved a therapeutic effectiveness plateau. CONCLUSION: Batroxobin can improve the efficacy of combination therapy for profound sudden sensorineural hearing loss exceeding 100 dB HL, and using batroxobin two to three times yields the maximum overall improvement rate.

The significance of masking for the poor hearing ear in pure tone audiometry.

BACKGROUND: In pure tone audiometry, when the difference of the Average Air Conduction Threshold of pure tone (AACT) between bilateral ears is more than 40 dB HL masking must be performed on the poor side, However, we found that masking also make significance difference when the binaural AACT difference (AACT-d)was less than 40 dB HL in some patients. AIMS/OBJECTIVE: Assessing the significance of masking for the poor ear in pure tone audiometry in patients with different types of deafness to obtain preoperative accurate hearing. MATERIAL AND METHODS: A comparative analysis of 163 cases (163 ears) with hearing difference between two ears was conducted, who were divided into three groups: G1 Congenital Malformation of the Middle and Outer Ear (CMMOE)as conductive deafness, 63 ears, G2 sudden deafness as sensorineural deafness, 65 ears, and G3 media otitis as conductive or mixed deafness,35 ears. AACT-d before and after the poor ear masking was analyzed under the following three conditions: (1) 0.125-8 KHz each frequency, (2) 0.5-4 KHz on average, (3) the frequencies of AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking. If the sample data did not follow a normal distribution, the Wilcoxon rank sum test was used for comparasion of AACT, and p < 0.05 was considered statistically significant. It is clinically effective for AACT-d ≥ 15 dB HL at 1 frequency or 10 dB HL ≤ AACT-d at 2 frequencies <15 dB HL before and after masking. RESULTS: Among the three groups, (1) the comparasion of AACT-d before and after the poor ear masking for each frequency of 0.125-8 KHz and 0.5-4 KHz on average with all p < 0.05, and the AACT-d of the G1 group was the largest, with an average 0.5-4KHz of 7.5 dB HL, and the first two were 14.5 dB HL and 13.8 dB HL at 0.125 KHz and 0.25 KHz, respectively. (2) AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking were distributed at the full frequency of 0.125-8KHz, the clinically effective rates of ≥40 dB HL groups were G1 (89.3%), G2 (45.5%) and G3 (5.3%), while those of < 40 dB HL groups were G1 (69.7%), G2 (34.4%) and G3 (31.3%), respectively. CONCLUSION AND SIGNIFICANCE: For all three groups, there was statistically significant in AACT-d before and after the poor ear masking across each frequency of 0.125-8 KHz and on average 0.5-4 KHz. The distribution of AACT-d ≥ 40 dB HL and <40 dB HL between the two ears before masking was observed throughout the full frequency range of 0.125-8 KHz. AACT-d before and after the poor ear masking showed clinical effectiveness in all three groups, with the highest effective rate observed in the G1 group and the highest AACT-d at 0.125 KHz and 0.25 KHz. Therefore, regardless of whether the AACT-d between the two ears before masking is ≥40 dB HL or <40 dB HL, the full frequency masking should be employed in three groups, especially for the G1 group of CMMOE, particularly at 0.125 KHz and 0.25 KHz.

[Repeated transcranial acupuncture combined with electroacupuncture for flat descending sudden deafness: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of repeated transcranial acupuncture combined with electroacupuncture on flat descending sudden deafness. METHODS: A total of 80 patients with flat descending sudden deafness were randomly divided into an acupuncture and medication group (39 cases, 1 case dropped off) and a western medication group (39 cases, 1 case dropped off). Patients in the western medication group were treated with glucocorticoid + batroxobin + ginkgo leaf preparation. On the basis of the western medication group, patients in the acupuncture and medication group were treated with acupuncture at Baihui (GV 20), Ningshen, Yunting area, Mastoid 1 point, Mastoid 2 point, Fengchi (GB 20), Gongxue, Tinghui (GB 2), etc., repeated transcranial acupuncture was applied at Baihui (GV 20), Ningshen and Yunting area; Mastoid 1 point and Mastoid 2 point, Fengchi (GB 20) and Gongxue of the affected side were connected to the electroacupuncture instrument, continuous wave, 2 Hz in frequency. The needle was retained for 30 min, once a day, and rest for 1 d after 6 d of continuous treatment. All patients were treated for 3 weeks. The average hearing threshold, tinnitus handicap inventory (THI) score, dizziness handicap inventory (DHI) score and speech discrimination test score were compared between the two groups before and after treatment, and the clinical effect was evaluated. RESULTS: After treatment, the average hearing threshold, THI and DHI scores of the two groups were lower than those before treatment (P<0.05), and above indexes in the acupuncture and medication group were lower than those in the western medication group (P<0.05). The speech discrimination test scores of the two groups were higher than those before treatment (P<0.05), and the score in the acupuncture and medication group was higher than that in the western medication group (P<0.05). The total effective rate was 87.2% (34/39) in the acupuncture and medication group, which was higher than 74.4% (29/39) in the western medication group (P<0.05). CONCLUSION: Repeated transcranial acupuncture combined with electroacupuncture can improve the hearing level of patients with flat descending sudden deafness, relieve tinnitus and vertigo symptoms.

Cerebellopontine Angle Lipoma with Contralateral Sudden Deafness: A Case Report and Review of Literature.

BACKGROUND: Cerebellopontine angle lipoma is a rare tumor that composes less than 1% of all CPA tumors. There has been no recorded case of unilateral CPA/IAC lipoma with sudden contralateral deafness yet. CASE PRESENTATION: We report a 52-year-old man diagnosed with right cerebellopontine angle lipoma and combined left total deafness. Pure-tone audiometry revealed total sensorineural deafness in his left ear and moderate sensorineural deafness in the right ear. The patient was treated with glucocorticoids, batroxobin, and other symptomatic treatments. There was no substantial improvement in hearing after 14 days' treatment. DISCUSSION: We chose conservative treatment for him. It is advised to wear hearing aids in the right ear and to undergo regular imaging monitoring. CONCLUSION: Treatment options for such patients should be chosen by taking into account the degree of bilateral hearing loss, the size and location of the tumor, the possibility of preserving hearing during surgery, the functional level of the patient's facial nerve, and other factors.

Is repetitive systemic corticosteroid therapy effective for idiopathic sudden sensorineural hearing loss? a retrospective study.

Introduction: Some idiopathic sudden sensorineural hearing loss (ISSHL) cases experience repetitive systemic corticosteroid treatment, but studies focusing on repetitive systemic corticosteroid administration have not been reported. Thus, we investigated the clinical characteristics and usefulness of repetitive systemic corticosteroid treatment in ISSHL cases. Methods: We reviewed the medical records of 103 patients who received corticosteroids only in our hospital (single-treatment group), and 46 patients who presented at our hospital after receiving corticosteroids in a nearby clinic and were subsequently treated with corticosteroids again in our hospital (repetitive-treatment group). Clinical backgrounds, hearing thresholds, and hearing prognosis were assessed. Results: The final hearing outcomes were not different between the two groups. Further, in the repetitive-treatment group, statistical differences were found between the good and poor prognosis groups in the number of days to start corticosteroid administration (p = 0.03), the dose of corticosteroid (p = 0.02), and the duration of corticosteroid administration (p = 0.02) at the previous facility. Multivariate analysis revealed a significant difference in the dose of corticosteroids administered by the previous clinic (p = 0.004). Conclusion: The repetitive systemic corticosteroid administration might play a supplementary role in hearing improvement, and initial sufficient corticosteroid administration would lead to good hearing outcomes in an early phase of ISSHL.

Local vs Systemic Use of Steroids for Sudden Deafness with Diabetes: A Systematic Review and Meta-Analysis.

BACKGROUND: Diabetes is associated with a risk of idiopathic sudden deafness. The main treatment of diabetic sudden deafness is systemic and topical application of steroids. Topical steroid therapy reduces systemic adverse reactions compared with systemic therapy. PURPOSE: The aim of this study was to conduct a meta-analysis design on the improvement value and recovery rate of pure tone mean hearing threshold (PTA).To investigate whether there is difference between local and systemic steroid treatment as the initial treatment for sudden deafness patients with diabetes. METHODS: We searched databases from publication date to October 1, 2022 including PubMed, EMBASE, Cochrane Library, web of science, CNKI, Wan fang Database, China Biomedical Literature Database (CBM), and VIP information resource system. A systematic literature review was conducted on the efficacy and safety of local and systemic steroid therapy for diabetic sudden deafness. RevMan5.4 and stata14 software were used for Meta-analysis. RESULTS: A total of 23 studies were included in this study, covering 1777 patients, including 885 cases in the observation group (local steroid group) and 894 cases in the control group (systemic steroid group). Meta-analysis showed that there was a significant difference in the total effective rate of local and systemic steroid treatment for diabetic sudden deafness between groups (RR = 1.17, 95% CI = 1.11-1.22, P < 0.05). The effective rate in the observation group was higher than that in the control group. For the improvement of PTA, the difference between groups was statistically significant (RR = 6.60, 95% CI = 3.07-10.14, P < 0.05). The improvement of PTA in the local steroid group was higher than that in the systemic steroid group. Subgroup analysis showed that there were significant differences between groups in hormones, drug administration, follow-up time and course of disease. CONCLUSION: Topical steroid therapy is effective in the treatment of diabetic sudden deafness. Hormone methylprednisolone has high effective rate; the shorter the course of disease and the longer the follow-up time are, the higher the total effective rate will be. Tympanic injection is more effective than post-aural injection. Topical steroid injections are safer for hormonal side effect.

Correlation of coagulation states with prognosis of sudden deafness.

Prognosis of sudden deafness remains a challenge in clinics because of inhomogeneity of the disease. Here we report our retrospective study aimed to explore the value of coagulative markers including activated partial thromboplastin time (APTT), prothrombin time (PT), plasma fibrinogen (FIB), and plasma D-dimer in the prognosis of patients. The study included a total of 160 patients, of whom 92 had valid responses, 68 had invalid responses, and 68 had ineffective responses. APTT, PT, and the levels of FIB and D-dimer in serum were compared between the two groups, and their prognostic values were determined in terms of area under the curve (AUC) in receiver operating curve (ROC) analysis, sensitivity, and specificity. The correlations of APTT, PT, and FIB to degree of hearing loss were also assessed. Serum APTT and PT, FIB, and D-dimer levels were lower in patients with sudden deafness who responded poorly to treatments. ROC analysis showed that APTT, PT, FIB, and D-dimer had high AUC, sensitivity, and specificity for nonresponders, particularly when used in combination (AUC = 0.91, sensitivity = 86.76%, and specificity = 82.61%). Patients with a higher degree of hearing loss (>91 dB) also demonstrated significantly lower values of APTT and PT and higher levels of serum FIB and D-dimer than those with a lower degree of hearing loss. Our study demonstrated that APTT, PT, and serum levels of FIB and D-dimer could serve as strong predictors of sudden deafness, potentiating the use of these tests to identify patients who respond poorly to treatments.NEW & NOTEWORTHY Our retrospective study indicated that lower serum APTT and PT levels and higher fibrinogen (FIB) and D-dimer levels are characteristics associated with poor treatment responses among patients with sudden deafness. A combination of these levels had a high accuracy in identifying the nonresponders. APTT, PT, and serum levels of FIB and D-dimer could serve as strong predictors of sudden deafness, potentiating the use of these tests to identify patients who respond poorly to treatments.

Practice trends in pediatric sudden sensorineural hearing loss management: An unresolved diagnosis.

PURPOSE: Assess practice patterns amongst pediatric otolaryngologist for the management of children with SSNHL. MATERIALS AND METHODS: A cross-sectional online survey of members of the American Society of Pediatric Otolaryngology (ASPO) was performed; 135 responded. Patterns in treatment modalities, ancillary tests, and timing of treatment and follow-up were evaluated. These patterns were compared between respondents with different characteristics (number of years in practice, clinic location, and number of pediatric SSNHL cases within the last year) using ordered logistic regression, Kruskal-Wallis, Wilcoxon rank-sum, and Fisher's exact tests. RESULTS: Mean time from onset of hearing loss to presentation to a pediatric otolaryngologist was 10 days (range 1-60 days). The most cited reasons for delay in care were 'patient not seeking any healthcare evaluation' (65 %) and 'lack of access to obtain an audiogram' (54 %). The most ordered blood work was complete blood count (14 %) and herpes simplex testing (15 %). Complete blood count was ordered more frequently by physicians in practice for >10 years compared with those in practice 1-10 years, P = 0.03. Most respondents reported treating with systemic steroids (86/92, 93 %), including intratympanic steroids (32/92, 35 %). Treatment with systemic steroids was more common in academic compared with private practice, P = 0.03. Antivirals were the most common additional agent prescribed (14/89, 16 %). Most patients were seen in follow-up 1-4 weeks after diagnosis (63/85, 74 %). CONCLUSIONS: Most pediatric otolaryngologists treat SSNHL with systemic steroids. The remainder of the diagnostic and management paradigm varies significantly, highlighting the need to systematically define which treatment optimizes outcomes in this population.

The Relationship between the Characteristics of Tinnitus and the Hearing Curative Effect of Sudden Deafness.

BACKGROUND: Tinnitus is the most common complication of sudden deafness. There are many studies on tinnitus and tinnitus as a prognostic factor for sudden deafness. SUMMARY: We collected 285 cases (330 ears) of sudden deafness to investigate the relationship between tinnitus psychoacoustic characteristics and the hearing curative effective rate. The hearing curative effective rate was analyzed and compared between the patients whether it is accompanied by tinnitus, with different tinnitus frequency and different tinnitus loudness. KEY MESSAGES: Patients with tinnitus frequency (125-2,000 Hz) and no tinnitus have better hearing efficacy, and those with high frequency tinnitus (3,000-8,000 Hz) have worse hearing efficacy. Test the tinnitus frequency of patients in the initial stage of sudden deafness has some guiding significance for the evaluation of hearing prognosis.

Neurovascular conflict and sudden unilateral sensorineural hearing loss: coincidence or coexistence?

OBJECTIVE: To study the association between neurovascular conflict (NVC) of the 8th cranial nerve (CN8) and unilateral sudden sensorineural hearing loss SSNHL (SSNHL). METHODS: A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Google-Scholar" was conducted. Meta-analysis of pooled data was performed for NVC prevalence of SSNHL affected ears versus controls. RESULTS: The literature search identified 941 publications, of which, 9 included in qualitative synthesis (1030 ears) and 5 in quantitative synthesis (484 ears). NVC was as prevalent as 0.8-69% for affected ears and as 19-57% for controlled ears. No association between MRI protocol and NVC prevalence was proved. An odds ratio of 1.05 (95% confidence interval = 0.79-1.39) was calculated for association of NVC in unilateral SSNHL ears versus controls. CONCLUSION: The prevalence of NVC of CN8 in unilateral SSNHL affected ears is not significantly bigger than controls. Hence, NVC of CN8 is probably NOT associated with unilateral SSNHL.