Idiopathic Sudden Sensorineural Hearing Loss: Average Time Elapsed Before Presentation to the Otolaryngologist and Effectiveness of Oral and/or Intratympanic Steroids in Late Presentations.

Anwuli Anyah,Kenneth Markiewicz,Erin Kevern,Devin Mistry

doi:10.7759/cureus.1945

Anwuli Anyah, Kenneth Markiewicz + Show 2 more

Open Access

https://doi.org/10.7759/cureus.1945

Copy DOI

Abstract

ObjectivesTo determine how long after symptom onset that the average patient with an idiopathic sudden sensorineural hearing loss (ISSNHL) presents to the otolaryngology clinic. In late presentations, to determine the time to presentation cutoff after which intervention may not be effective. To evaluate the effectiveness of oral steroids versus a combination of oral and intratympanic steroid therapy in late presentations of ISSNHL. Methods and proceduresSixty-four patients met inclusion criteria after chart review of 2,037 patients seen at Metro Health Hospital from 2006 to 2016 for sensorineural hearing loss. All sixty-four patients were used to calculate the average time to presentation, but only 40 were included to evaluate treatment efficacy because 24 were lost to follow-up or declined treatment. Audiograms were analyzed for baseline status and response to treatment. Therapy was either oral steroids or intratympanic (IT) steroids. Thirty-nine of the 40 treated patients received oral steroid therapy. Eighteen of these 39 patients received both oral and IT steroids. One patient received IT steroids only. ResultsFor all 64 patients in the study, the average time to presentation was 55 days, ranging from one day to 240 days. Data for 32 of the 40 treated patients were analyzed. These patients were further divided into smaller groups: Group 1 (N = 11) - treatment within seven days of symptom onset, Group 2 (N = 17) - time to treatment greater than seven days but less than 90 days of symptom onset, and Group 3 (N = 4) - greater than 90 days of symptom onset. In Group 2, there was a significant improvement in pure tone average (P-value: 0.005). Forty-seven percent of patients in this group had objective treatment response utilizing Wilson’s criteria. Two patients had a complete recovery and six had a partial recovery. Hearing gains ranged from 10 dB (decibels) to 23 dB. Sixty-three percent of patients with objective improvement also had subjective improvement. In Group 3, none of the patients met Wilson’s criteria for recovery. There was no statistically significant difference in response between patients treated with oral steroids only versus a combination of oral and IT steroids.ConclusionPatients with ISSNHL present to an otolaryngologist on average 55 days after symptom onset. There is statistically and clinically significant response to treatment in late presenters. Improvement can be seen up to three months from symptom onset. Oral steroid therapy is effective. IT steroid therapy may have an added benefit.

Highlights

Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as sensorineural hearing loss of 30 decibels or more over at least three contiguous audiometric frequencies with an onset of fewer than three days
Data for 32 of the 40 treated patients were analyzed. These patients were further divided into smaller groups: Group 1 (N = 11) - treatment within seven days of symptom onset, Group 2 (N = 17) - time to treatment greater than seven days but less than 90 days of symptom onset, and Group 3 (N = 4) - greater than 90 days of symptom onset
Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as sensorineural hearing loss of 30 dB or more over at least three contiguous audiometric frequencies and an onset of fewer than three days, it is acceptable and often necessary to expand the definition to cases of sudden hearing loss that is less than 30 dB [6]

Summary

Introduction

Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as sensorineural hearing loss of 30 decibels (dB) or more over at least three contiguous audiometric frequencies with an onset of fewer than three days. This definition is often used in order to be consistent with the literature and the National Institute on Deafness and Other Communication Disorders criteria. No histologic correlates were found in two ears that recovered hearing after treatment. In the remaining 15 ears, the predominant abnormalities included loss of hair cells and supporting cells of the organ of Corti, loss of the tectorial membrane, loss of stria vascularis, and loss of cochlear neurons

Objectives

Methods

Results

Discussion

Conclusion