Abstract
BackgroundSubarachnoid hemorrhage (SAH) survivors experience significant neurological disability, some of which is under‐recognized by neurovascular clinical teams. We set out to objectively determine the occurrence of hearing impairment after SAH, characterize its peripheral and/or central origin, and investigate likely pathological correlates.MethodsIn a case‐control study (n = 41), participants were asked about new onset hearing difficulty 3 months post‐SAH, compared with pre‐SAH. Formal audiological assessment included otoscopy, pure tone audiometry, a questionnaire identifying symptoms of peripheral hearing loss and/or auditory processing disorder, and a test of speech understanding in noise. A separate cohort (n = 21) underwent quantitative susceptibility mapping (QSM) of the auditory cortex 6 months after SAH, for correlation with hearing difficulty.ResultsTwenty three percent of SAH patients reported hearing difficulty that was new in onset post‐SAH. SAH patients had poorer pure tone thresholds compared to controls. The proportion of patients with peripheral hearing loss as defined by the World Health Organization and British Audiological Society was however not increased, compared to controls. All SAH patients experienced symptoms of auditory processing disorder post‐SAH, with speech‐in‐noise test scores significantly worse versus controls. Iron deposition in the auditory cortex was higher in patients reporting hearing difficulty versus those who did not.ConclusionThis study firmly establishes hearing impairment as a frequent clinical feature after SAH. It primarily consists of an auditory processing disorder, mechanistically linked to iron deposition in the auditory cortex. Neurovascular teams should inquire about hearing, and refer SAH patients for audiological assessment and management.
Highlights
Subarachnoid hemorrhage (SAH) survivors experience significantly reduced quality of life which is not well reflected by conventional clinical outcome measures such as the modified Rankin Scale or Glasgow Outcome Score (GOS)
Subjective evidence is reported by 20–25% of patients if asked about a new onset worsening in hearing with the SAH
70 year old people in the general population (UK Biobank study) report hearing difficulty,[30] it is important to note that both in our study and the preceding one,[4] the hearing difficulty reported by 20–25% was new onset in nature, that is, presented only after SAH
Summary
Subarachnoid hemorrhage (SAH) survivors experience significantly reduced quality of life which is not well reflected by conventional clinical outcome measures such as the modified Rankin Scale (mRS) or Glasgow Outcome Score (GOS). This “hidden” disability is the topic of increasing research and is probably multifactorial, for example arising from cognitive deficits[1] and post-traumatic stress disorder.[2] Hearing impairment, whether it is of peripheral and/ or central origin, may be another mediator of poor outcome. Conclusion: This study firmly establishes hearing impairment as a frequent clinical feature after SAH It primarily consists of an auditory processing disorder, mechanistically linked to iron deposition in the auditory cortex. Neurovascular teams should inquire about hearing, and refer SAH patients for audiological assessment and management
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