Abstract
The standard treatment of Sudden Sensorineural Hearing Loss is based on oral steroids. In addition, intratympanic steroid is currently used in patients who fail to respond to oral treatment. The aim of the present study was to evaluate, in patients affected by SSHL, factors that influence the response to systemic and intratympanic steroid treatment. A retrospective analysis was conducted on 149 patients, all treated with systemic steroids. Moreover, patients not responsive to systemic therapy were treated with intratympanic steroids as salvage therapy. Auditory gain was assessed through the recovery rate at the discharge and after 30 days. Statistical analysis demonstrated that patients with delayed treatment and down-sloping auditory curve presented a poor recovery. Linear and stepwise regression showed that hypertriglyceridemia and hyperglycemia were negative prognostic factors. The prognosis of SSHL is affected by hyperglycemia and hypertriglyceridemia suggesting that a microvascular dysfunction within the cochlea could impair hearing recovery. Intratympanic steroid treatment was used as salvage treatment, however in patients with poor prognostic factors or at risk for side effects, it could be used in association with systemic treatment.
Highlights
The observation that sudden hearing loss has an acute onset, is generally unilateral and can resolve within a few hours or days, suggests that a disturbance of the cochlear microcirculation could be at the basis of this syndrome
Disturbance in cochlear blood flow due to alteration in plasma viscosity, cellular and platelet aggregability, red blood cell deformability index and endothelial function have been reported in patients affected by Sensorineural Hearing Loss (SSHL).[2]
The results of the present study showed that time between the cate a smaller probability of improvement for patients with SSHL, onset of symptoms and the beginning of treatment, and down-slop- a recent work by Jung et al demonstrated that the rate of ing audiometric curve are negative prognostic factors in patients recovery from SSHL was lower among patients with metabolic affected by SSHL
Summary
The observation that sudden hearing loss has an acute onset, is generally unilateral and can resolve within a few hours or days, suggests that a disturbance of the cochlear microcirculation could be at the basis of this syndrome. Disturbance in cochlear blood flow due to alteration in plasma viscosity, cellular and platelet aggregability, red blood cell deformability index and endothelial function have been reported in patients affected by SSHL.[2]. It is well known that the prognosis of SSHL declines in older patients, worse initial hearing level, longer time from onset to treatment, and presence of vertigo.[5] Among haematological indices, high fibrinogen levels, high White Blood Cells (WBC) counts, homocysteine concentration, and high LowDensity Lipoprotein (LDL) correlated with poorer hearing recovery in SSHL.[6,7,8] Our group has reported that high levels of cholesterol are a poor prognostic factor in terms of recovery.[9]. The aim of the present study was to evaluate in a series of patients affected by SSHL factors that influence the response to
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