Abstract
Sudden sensorineural hearing loss (SSHL) not only involves cochlear function but might also be accompanied by vestibular disturbances. The assessment of vestibular function could be of great relevance in SSHL. To investigate the prevalence of vestibulocochlear lesions in SSHL and the correlation of specific vestibular organs with hearing prognosis. A complete literature search of eligible studies in the PubMed and EMBASE databases was performed. For our aim, studies that focused on vestibular examination in the case of SSHL were retrieved, including caloric tests, cervical vestibular-evoked myogenic potential (cVEMP) tests, or ocular vestibular-evoked myogenic potential (oVEMP) tests. Of the 18 studies included, a caloric test was performed in 16 studies, cVEMP in 13 studies, and oVEMP in 5 studies, and together the studies included a total population of 1,468 subjects. The scores on the Agency for Healthcare Research and Quality (AHRQ) questionnaire ranged from 6 to 11. These results indicated that the most commonly damaged vestibular organ in SSHL was the utricle and superior vestibular pathway (U + S) followed by the lateral semicircular canal and superior vestibular pathway (LSC + S), the saccule and inferior vestibular pathway (S + I), and the cochlea only (C only). The meta-analysis indicated that SSHL patients with vertigo have a statistically increased risk of vestibular organ lesions compared with those without vertigo, including the LSC + S subgroup (OR = 4.89, 95% CI = 1.20-19.93, I2 = 80%, p = 0.03) and the S + I subgroup (OR = 3.58, 95% CI = 1.61-7.95, I2 = 0%, p = 0.002). The pooled possibility of hearing recovery within the LSC + S lesion group was less than half that of the non-LSC + S lesion group (OR = 0.24, 95% CI = 0.11-0.52, I2 = 68%, p = 0.0003). This study shows the relevance of vestibular damage concomitant with SSHL and that SSHL patients with vertigo are at an increased risk of vestibular organ lesions compared with patients without vertigo. LSC + S lesions thus appear to be a critical variable that influence the possibility of hearing improvement in SSHL.
Highlights
Sudden sensorineural hearing loss (SSHL) is clinically characterized by a rapid onset sensorineural hearing loss of more than 30 dB for at least three contiguous audiometric frequencies within a period of 3 days [1,2,3]
The caloric test is a method for investigating lateral semicircular canal function and superior vestibular integrity, the cervical vestibular-evoked myogenic potential (cVEMP) can be used for assessing saccular function and the inferior vestibular pathway, and ocular vestibular-evoked myogenic potential (oVEMP) can be used for evaluating utricular function and the superior vestibular pathway [10,11,12,13]
We found that more than half of the patients suffered from some form of vestibular organ lesion in SSHL with vertigo, Figure 5 | Forest plots of the synthesized data from the selected studies. (A) Comparison of the occurrence rate of lateral semicircular canal and superior vestibular nerve lesion (LSC + S) between the vertigo and non-vertigo groups. (B) Comparison of the occurrence rate of saccule and inferior vestibular nerve lesion (S + I) between the vertigo and non-vertigo groups
Summary
Sudden sensorineural hearing loss (SSHL) is clinically characterized by a rapid onset sensorineural hearing loss of more than 30 dB for at least three contiguous audiometric frequencies within a period of 3 days [1,2,3]. The vestibulocochlear lesion patterns, the clinical relevance of vertigo in relation to vestibulocochlear lesion location, and the correlation of vestibular organ damage with the prognosis of hearing loss in SSHL have not yet achieved consensus. To address this issue, we performed a systematic review and meta-analysis to shed light on the presumed pathomechanisms that are involved in the clinical manifestation and prognosis of SSHL. Sudden sensorineural hearing loss (SSHL) involves cochlear function but might be accompanied by vestibular disturbances. The assessment of vestibular function could be of great relevance in SSHL
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