Simultaneous idiopathic bilateral sudden hearing loss – characteristics and response to treatment

H Murat Yener,Umur Yollu,Mehmet Yilmaz,Ferit Akil,Ender Inci,Marlen Mamanov

doi:10.1016/j.bjorl.2016.12.003

Abstract

IntroductionThe aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. ObjectiveThe objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. MethodsThis is a case–control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. ResultsThe mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p<0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1dB for unilateral sudden hearing loss and 63.3dB for the left ears and 67.6dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0dB and 55.4dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p<0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p<0.001). Tinnitus scores decreased significantly in both groups of patients (p<0.001) in spite of there was no significant difference between the groups of patients. ConclusionPatients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Highlights

The aetiology of sudden hearing loss is poorly defined; infectious, vascular and neoplastic aetiologies are presumed to be responsible
132 patients treated with the same protocol, and who met the following criteria were included in this study: no history of previous ear diseases, head injuries and acoustic trauma
Blood samples were collected from the patients, a complete blood count and erythrocyte sedimentation rate (ESR) were conducted, and the alanine transaminase (ALT), aspartate transaminase (AST), serum glucose, cholesterol, lipid, urea, creatinine, thyroid hormone and antinuclear antibody (ANA) levels were measured

Summary

Introduction

The aetiology of sudden hearing loss is poorly defined; infectious, vascular and neoplastic aetiologies are presumed to be responsible. Pre-treatment audiologic thresholds were 69.1 dB for unilateral sudden hearing loss and 63.3 dB for the left ears and 67.6 dB for the right ears for bilateral sudden hearing loss without significant difference. SHL can affect any age group, but usually peaks at 60 years of age, without a gender difference.[1] Ear fullness and tinnitus are common complaints in the affected ear, while varying degrees of vertigo can be detected in 40% of SHL patients.[2] The estimated incidence of SHL in the United States per year ranges from 5 to 20 cases per 100,000 individuals.[3] Most cases of SHL develop unilaterally, with bilateral involvement comprising only 0.44---4.9% of the patients,1---5 which makes the incidence of bilateral SHL extremely low.[5] rare, this condition is more dramatic due to the bilateral loss of hearing

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