Abstract
Acute low-tone sensorineural hearing loss (ALHL) is a type of idiopathic sudden sensorineural hearing loss. ALHL is rarely a solitary condition but rather co-occurs with vertigo and tinnitus, being an element of contemporary diagnostic criteria for Menière's disease (MD). The goal of our present study was to determine the value of ALHL for the early diagnosis of MD in patients presenting in the emergency room with ALHL as a main complaint. The files of 106 patients with ALHL who were admitted to the emergency room over the period of 7 years and 104 patients with acute high- tone sensorineural hearing loss (AHHL) from the same period were included in this retrospective study. Forty ALHL patients presented with recurrent episode of hearing loss and 66 remaining patients presented with ALHL for the first time. Of the latter group, 25 patients gave consent for the follow-up. First, we analyzed the difference in the occurrence of tinnitus and vertigo between the ALHL and AHHL groups. In patients with ALHL, the incidence of vertigo with tinnitus and the number of recurrent episodes were statistically higher than in patients with AHHL. Next, we focused on the ALHL follow-up group (25 patients). In that group, two patients had all MD symptoms at presentation, 18 had ALHL and tinnitus and five ALHL only. Of 18 patients with ALHL and tinnitus at admission, five developed vertigo and thus the triad of Menière's disease. None of the five patients with AHLH as a sole symptom developed MD during the follow-up time but four of them have developed tinnitus. Patients with recurrent ALHL had significantly higher incidence of MD than the patients with first episode. We conclude that some patients who present with ALHL and concomitant tinnitus or have recurrent episodes of ALHL are more likely to develop Menière's disease than these patients, who present with ALHL as a sole symptom. Nonetheless, we recommend otological follow-up for all patients presenting with ALHL.
Highlights
PATIENTS AND METHODSReported incidence of sudden idiopathic sensorineural hearing loss (SSNHL) varies between the countries and ranges between 27/100,000 in the United States [1] and 168/100,000 in Germany [2]
Based on the frequencies affected by the hearing loss, SSNHL can be divided into two subgroups: the acute highfrequency hearing loss (AHHL), consisting of roughly 80% of SSNHL cases and an acute low-frequency sensorineural hearing loss traditionally called acute low-tone hearing loss (ALHL), consisting of 17 to 23% of all SSHL cases [3]
In addition to two or more episodes of vertigo and fluctuating aural symptoms such as tinnitus or ear fullness, the diagnostic criteria of definite Meniere’s disease (MD) include low- up to middletone unilateral hearing loss during or after the vertigo attack documented by pure tone audiometry
Summary
Reported incidence of sudden idiopathic sensorineural hearing loss (SSNHL) varies between the countries and ranges between 27/100,000 in the United States [1] and 168/100,000 in Germany [2]. In addition to two or more episodes of vertigo and fluctuating aural symptoms such as tinnitus or ear fullness, the diagnostic criteria of definite MD include low- up to middletone unilateral hearing loss during or after the vertigo attack documented by pure tone audiometry. 104 patients with an acute high- tone hearing loss (AHHL) were included. All of these patients (ALHL and AHHL) were seeking medical help solely because of sudden hearing loss (see Figure 1) and some of them had additional symptoms, such as tinnitus or vertigo; which, were not the reason for their hospital admission. Of 40 patients with more than one episode of ALHL, 16 reported having vertigo
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