Cases Of Sensorineural Hearing Loss Research Articles

Viral load in children with congenital cytomegalovirus infection identified on newborn hearing screening

BackgroundCongenital cytomegalovirus (CMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. However, congenital SNHL without other clinical abnormalities is rarely diagnosed as CMV-related in early infancy. ObjectivesThe aim of this study was to identify and treat patients with congenital CMV-related SNHL or CMV-related clinical abnormalities other than SNHL. The association between CMV load and SNHL was also evaluated. Study designNewborns who had abnormal hearing screening results or other clinical abnormalities were screened for congenital CMV infection by PCR of saliva or urine specimens, and identified infected patients were treated with valganciclovir (VGCV) for 6 weeks. The CMV load of patients with or without SNHL was compared at regular intervals during as well as after VGCV treatment. ResultsOf 127 infants with abnormal hearing screening results, and 31 infants with other clinical abnormalities, CMV infection was identified in 6 and 3 infants, respectively. After VGCV treatment, 1 case had improved hearing but the other 5 SNHL cases had little or no improvement. Among these 9 patients with or without SNHL at 1 year of age, there was no significant difference in CMV blood or urine load at diagnosis, but both were significantly higher in patients with SNHL during VGCV treatment. ConclusionsSelective CMV screening of newborns having an abnormal hearing screening result would be a reasonable strategy for identification of symptomatic congenital CMV infection. Prolonged detection of CMV in blood could be a risk factor for SNHL.

Curved adjustable fiberoptic laser for endoscopic cholesteatoma surgery.

To determine whether endoscopic cholesteatoma removal can be performed efficiently and safely using a curved fiberoptic-based laser. Angled instruments are required in endoscopic ear surgery to access recesses of the middle ear without extra drilling. Lasers are effective at ablating visible and microscopic cholesteatoma matrix and removing granulation tissue. Retrospective case review from 2006 to 2013. Single tertiary care center. Patients who underwent cholesteatoma surgery with otoendoscopy. Residual cholesteatoma that could not be reached by conventional microinstruments was identified using an endoscope. This residual cholesteatoma was ablated in a contactless manner using a fiberoptic-based curved laser carrier with an argon laser. The laser tip through the carrier probe has a 45-degree curve, and the length of the tip is adjustable, allowing it to be used in recesses or around corners, such as in the sinus tympani, around the stapes suprastructure, in the oval window, or in the Eustachian tube orifice. Presence or absence of residual cholesteatoma after laser ablation and complications. In 7 cases, the fiberoptic curved laser was used to ablate cholesteatoma completely with no injury to surrounding structures and with no evidence of recidivism with a mean follow-up period of 19 months. There were no cases of sensorineural hearing loss or perilymphatic fistula. The curved laser probe allows for precise removal of cholesteatoma endoscopically.

Exploration of molecular genetic etiology for Korean cochlear implantees with severe to profound hearing loss and its implication.

BackgroundSevere to profound sensorineural hearing loss (SNHL) requires cochlear implantation (CI) for auditory rehabilitation. Etiologic diagnoses can contribute to candidacy selection and decision-making regarding the timing of successful CI. However, few studies have been performed to address the etiologic spectrum of severe SNHL in the population where there is no consanguineous marriage and the majority of SNHL cases are sporadic in small sized families. The authors sought to comprehensively understand the etiologies of Korean cochlear implantees by incorporating the targeted resequencing of 204 candidate deafness genes (TRS-204) and a phenotype-driven candidate gene approach.MethodsNinety-three that consented to molecular genetic testing and underwent at least one molecular genetic test were included. Patients with a characteristic Phenotypic marker were subject to Sanger sequencing to detect variants in corresponding candidate genes. The rest of patients without any prominent phenotype were tested on GJB2. Next, TRS-204 was applied in GJB2-negative cases without any phenotypic marker. In addition, the sibling recurrence-risk of SNHL among families with non-diagnostic genotypes after TRS-204 was performed to gain insight of etiologies in non-diagnostic cases.ResultsOverall, we could find causative variants in 51 (54.8%) of the 93 cochlear implantees. Thirty (32.3%) probands could be diagnosed by direct Sanger sequencing of candidate genes selected by their phenotypes. GJB2 sequencing added 10 subjects to the group with a diagnostic genotype. TRS-204 could detect a causative variant from additional 11 cases (11.8%). We could not detect any pathogenic deletion or duplication on 204 target genes. The sibling recurrence-risk of SNHL among 42 genetically undiagnosed families with 0.03 (1/38) was significantly lower than among genetically diagnosed recessive families with 0.19 (7/37).ConclusionDespite that the majority of severe or more degree of SNHL occurs sporadically in Koreans, at least 54.8% of such cases that were willing to join the genetic study in the Korean population are monogenic Mendelian disorders with convincing causative variants. This study also indicates that a substantial portion of unsolved cases after applying our current protocol are predicted to have non-genetic or complex etiology rather than a Mendelian genetic disorder involving new genes beyond the 204 target genes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-014-0167-8) contains supplementary material, which is available to authorized users.

Isolated deafness in multiple sclerosis patients

Isolated cranial nerve involvement in multiple sclerosis (MS) patients is not frequent. Deafness is considered to be uncommon in MS patients. We have reviewed the sensorineural hearing loss episodes that had been thoroughly investigated in our hospital in the last 5years. We present three cases of sensorineural hearing loss in patients with MS and compare them with other previously reported and discuss this uncommon symptom. The cases that we present were firstly evaluated by an otolaryngologist. A lesion is seen at the root-entry zone of the eighth cranial nerve in only one case, but no lesions are seen in the other cases. A retrocochlear demyelinating disorder was demonstrated in the two patients in whom brainstem auditory evoked potentials were performed. All patients recovered at least partially their hearing functions.

A clinical analysis of sudden sensorineural hearing loss cases.

Background and ObjectivesHigh-dose systemic steroid therapy is the mainstay treatment for sudden sensorineural hearing loss (SSNHL). Recovery rates from SSNHL range are about 47-63% and are influenced by various prognostic factors. To evaluate the prognostic value of specific clinical parameters, we reviewed 289 cases by clinical and statistical analysis.Subjects and MethodsThis study included 289 patients with SSNHL who visited the Department of Otolaryngology at Soonchunhyang University Hospital from January 2005 to December 2012. The cases were reviewed retrospectively based on clinical charts. Hearing improvement was evaluated in relation to pure-tone audiogram results, duration between SSNHL onset and time of initial treatment, seasonal incidence, dizziness, patient age, degree of hearing loss, patterns of initial pure-tone audiogram and presence of underlying disease.ResultsHearing improvement was observed in 196 of 289 (67.8%) patients; such improvement began within 7 days in most patients, followed by rapid hearing recovery. Cases that failed to show improvement within 14 days were unlikely to achieve hearing recovery. The more severe the hearing loss during the early stage, the lower the hearing recovery rates. Patients aged less than 60 years appear to have better prognosis of hearing improvement compared to those who are over 60 years.ConclusionsImportant prognostic factors for recovery in patients with SSNHL include the time of initiating treatment after symptom onset, the degree of early-stage hearing loss, and the age of the affected patient.

Electrophysiological properties of neurosensory progenitors derived from human embryonic stem cells

In severe cases of sensorineural hearing loss where the numbers of auditory neurons are significantly depleted, stem cell-derived neurons may provide a potential source of replacement cells. The success of such a therapy relies upon producing a population of functional neurons from stem cells, to enable precise encoding of sound information to the brainstem. Using our established differentiation assay to produce sensory neurons from human stem cells, patch-clamp recordings indicated that all neurons examined generated action potentials and displayed both transient sodium and sustained potassium currents. Stem cell-derived neurons reliably entrained to stimuli up to 20 pulses per second (pps), with 50% entrainment at 50 pps. A comparison with cultured primary auditory neurons indicated similar firing precision during low-frequency stimuli, but significant differences after 50 pps due to differences in action potential latency and width. The firing properties of stem cell-derived neurons were also considered relative to time in culture (31–56days) and revealed no change in resting membrane potential, threshold or firing latency over time. Thus, while stem cell-derived neurons did not entrain to high frequency stimulation as effectively as mammalian auditory neurons, their electrical phenotype was stable in culture and consistent with that reported for embryonic auditory neurons.

Associations Between Antibodies Against the Endothelial Cell and T.gondii; Cytomegalovirus in Serum of Children with Cochlear Implant Surgery

Background: Cytomegalovirus (CMV) and T. gondii are two common causes of SNHL (Sensorineural hearing loss) in Iranian children. Immune-mediated vascular damage induced by endothelial cell antibodies may have a prominent role in sensorineural hearing loss. Objectives: To determine the serum CMV and T. gondii antibodies against endothelial cell in children with profound SNHL and cochlear implant surgery. Materials & Methods: A cross sectional study was performed on 76 cases with severe SNHL (mean age 32 ± 30.6 months) at cochlear implant ward of Rasoul hospital, Tehran Iran (2008-2010). The titers of antibodies against endothelial cell (Indirect immunofluorescence assay); were determined in sera of 66 cases. Specific antibodies (IgG & IgM) against T. gondi, CMV (Enzyme linked immunosorbent assay) determined in Idiopathic SNHL cases. Results: Idiopathic type of SNHL was diagnosed in 28.8% (19/66) of younger cases (mean age=20 months; PV=0.05). Positive AECAs was detected in 14.4% (11/76) of cases (with mean age 50 vs. 32 months in cases with negative test; P value=0.047). Positive AECAs had not significant differences between Idiopathic and Non idiopathic type of SNHL [10.5% vs. 9%; PV=0.1]. Positive AECAs were more frequent in cases with known postnatal infections (e.g. mumps, meningitis, chicken pox, etc.) in comparison with non-infection cases (P-value=0.05). Positive T. gondii -IgM (recent infection) was found in 8 /19 (%42); 1 case also had positive T. gondii -IgG. Positive CMV-IgM I 17/19 (%89) respectively. A meaningful correlation was observed between positive AECAs and those infections (Toxo, CMV) in Idiopathic (and unclassified) SNHL cases. Conclusion: Idiopathic type of SNHL with a poor outcome is common (28.8%) in children with cochlear implant surgery Positive AECAs cases had not differences between 2 type of SNHL but were more frequent in older cases with known postnatal infections (meningitis, mumps, chicken pox etc.). A good correlation (p=0.05) between the positive AECAs and known infections determined in studied cases. In contrast, those younger cases ( 2 year old) with Idiopathic SNHL and concomitant positive AECAs.

Outcome of Cochlear Implantation in Post-Meningitis Deaf Children

Outcome of Cochlear Implantation in Post-Meningitis Deaf Children

Sensorineural Hearing Loss Associated with Neomycin Eardrops and Nonintact Tympanic Membranes

Use of neomycin eardrops in nonintact tympanic membranes (NITMs) due to tympanic membrane (TM) perforation or tympanostomy tubes (TTs) is controversial because of the potential for ototoxicity. We sought to compare the risk of sensorineural hearing loss (SNHL) in patients with NITMs who received neomycin with those who received fluoroquinolone eardrops. Retrospective cohort study. Administrative claims data analysis, including diagnoses and procedure detail for physician office and hospital visits and pharmacy dispensing events in children eligible for Medicaid fee-for-service benefits in 29 states between 1999 and 2006. Eligible patients (age <18 years) had to have received a study eardrop within 12 months after first diagnosis of NITM. The follow-up period started from the first eardrop dispensing. We compared the 12-month risk of SNHL using Cox proportional hazards regression models adjusted for SNHL risk factors. We found 982 SNHL cases in 134,598 children treated with neomycin or fluoroquinolone eardrops. The adjusted hazard ratio (HR) for 1, 2, and 3 or more prescriptions of neomycin was 0.90 (95% confidence interval [CI], 0.76-1.07), 1.45 (1.05-2.01), and 1.30 (0.71-2.36), respectively, when adjusted for SNHL risk factors, the interval between initial diagnosis of NITM and eardrop initiation, and total number of eardrop prescriptions. The results remained unchanged for several sensitivity analyses. Short-term use of neomycin eardrops in patients with NITMs is not associated with an increased risk of SNHL; however, repeated doses (ie, ≥ 2 prescriptions) showed a significant association with an increased risk of SNHL.

Sensorineural Hearing Loss with Neomycin Ear Drops

Objective: Neomycin ear drops are contraindicated with non-intact TMs (NITM), either perforation (TMP) or tube (TT) because of the risk of ototoxicity. The aim of this study was to evaluate the comparative risk of sensorineural hearing loss (SNHL) with neomycin and quinolone ear drops and NITMs. Method: Pediatric Medicaid beneficiaries from 29 states, 1999-2006, were studied if they received a study drug within 12 months of TMP or TT, and were continuously enrolled ≥6 months before and 12 months after first dispensing. We compared the 12-month risk of SNHL using Cox regression adjusted for SNHL risk factors. Results: We found 1935 SNHL cases in 139,906 children treated with neomycin or quinolone eardrops (1-year incidence = 1.38). Within those with neomycin, 76.3% received 1 dose and 17.4% received 2. The adjusted hazard ratio (HR) for 1, 2, and ≥3 prescriptions of neomycin was 0.99 (95% CI 0.89-1.12), 1.32 (1.05-1.67), and 1.34 (0.89-2.01), respectively, when adjusted for SNHL risk factors and total number of otic antimicrobial prescriptions. Conclusion: Short-term use of neomycin ear drops in patients with NITMs does not appear to carry a significant risk of SNHL. Repeated doses of topical neomycin are associated with an increased SNHL risk.

Characteristics and application of inner ear CT in 20 cases of sensorineural hearing loss in children

Conclusion: This study shows that a number of children with sensorineural hearing loss (SNHL) have inner ear malformations demonstrated by multi-slice spiral computed tomography (MSCT). MSCT allows a comprehensive assessment of various congenital inner ear malformations through high quality multiplanar reformation (MPR) and can display the site and degree of the malformation three-dimensionally and intuitively. This is very useful for cochlear implantation. Objective: To evaluate the feasibility and usability of MSCT in pediatric SNHL with inner ear malformations. Methods: Sixty-five patients were diagnosed with SNHL by brainstem auditory evoked response (BAER). Inner ear MSCT scan and coronal MPR reconstruction were performed in all cases. Results: This study demonstrated 20 cases (33 ears) with inner ear malformations, which included 10 ears with cochlear malformations, 7 with vestibular malformations, 5 with semicircular canal malformations, 8 with internal auditory canal (IAC) malformations, and 15 with vestibular malformations. Cochlear malformations included one ear with Michel deformity, two ears with common cavity deformity, one with cochlear aplasia, one with hypoplastic cochlea, two with incomplete partition type I, and three with incomplete partition type II (Mondini deformity).

SU‐C‐BRB‐03: Modeling of Radiation‐Induced Sensorineural Hearing Loss from IMRT and Chemotherapy for Nasopharyngeal Carcinoma

Purpose: To model and predict radiation‐induced Sensorineural Hearing Loss (SNHL) from intensity modulated radiation therapy (IMRT) and cisplatin‐based chemotherapy for patients with nasopharyngeal carcinoma (NPC). Methods: Audiometry data of 53 patients (106 ears) treated with the chemoradiation therapy were collected with a median follow‐up time of 60 (28–84) months. Among them, 15 SNHL cases were observed. The correlation of the SNHL data with the dose volume histograms (DVH) of both inner ear and cochlea, chemotherapy dose and patient age for each patient were analyzed using the Lyman‐Kutcher‐Burman (LKB) model and relative seriality (RS) model with a modification to include the impacts from the cisplatin dose and patient age. There are 5 parameters in each model which were determined by a maximal likelihood fitting of the clinical data. Results: Both models fit the data reasonably well, indicating that SNHL is correlated to the volume and radiation dose to cochlea, thus, to inner ear. This correlation is modified by chemotherapy dose and patient age. TD50(1) is approximately 300 Gy when only radiation is considered and is 72 Gy when patient aging and the cisplatin dose are included. The parameter n and m in the LKB model and s and γ in the SR model were obtained to be n=0.035±0.010, m=0.45±0.11 and s=2.05±1.75, γ =0.71±0.15 averaged over those obtained using DVHs of the cochlea and inner ear. A multivariate analysis found that the normal tissue toxicity probability (NTCP) calculated by the models is a statistically significant factor to predict the ototoxicity rate. The modeling results show that both inner ear and cochlea have the characteristics of a serial organ in terms of radiation dose response. Conclusions: The biophysical models derived in this study can predict the incidence of SNHL and may be used to optimize radiation treatment plans to reduce SNHL.

7,8,3′-Trihydroxyflavone, a potent small molecule TrkB receptor agonist, protects spiral ganglion neurons from degeneration both in vitro and in vivo

Most sensorineural hearing loss cases occur as a result of hair cell loss, which results in secondary degeneration of spiral ganglion neurons (SGNs). Substantial loss of SGNs reduces the benefit of cochlear implants, which rely on SGNs for transmitting signals to the central auditory centers. Brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) play essential roles in cochlear development and are required for SGN survival. Here we report that 7,8,3′-trihydroxyflavone (7,8,3′-THF), which is a small molecule agonist of tyrosine receptor kinase B (TrkB), promoted SGN survival with high potency both in vitro and in vivo. The compound protected the SGNs in a TrkB-dependent manner, as its effects on SGNs disappeared when the TrkB was blocked. Application of 7,8,3′-THF in the bulla of conditional connexin26 (cCx26)-null mice dramatically rescued SGNs in the applied ear compared to untreated control cochlea in the same animal. Our findings suggest that 7,8,3′-THF is a promising therapeutic agent protecting the SGNs from degeneration both in vitro and in vivo.

Intratympanic Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss after Failure of Intravenous Therapy

Purpose. The aim of this study is the investigation of the effectiveness of intratympanic steroids therapy (IST) in patients with idiopathic sudden sensorineural hearing loss (ISSHL) who had not responded to intravenous treatment, evaluating the overall hearing recovery and comparing the results with different variables. Materials and Methods. Our study consisted of 55 patients with refractory ISSHL who, at the end of 10 days of therapy with intravenous steroids, had puretone 4-frequency average (PTA) of worse than 30 dB. The patients received 0.5 mL of methylprednisolone by direct intratympanic injection. The procedure was carried out up to 7 times within a 20-days period. Statistical analysis was carried out. Results. Overall 29 patients (52.7%) showed improvement in PTA, 24 (43.8%) had no change in hearing, and 2 (3.5%) worsened. There was a significant statistical correlation between hearing recovery and time to onset of symptoms, severity of hearing loss and frequency of hearing loss. Conclusions. IST is an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment. The earlier IST, the hearing losses less than 90 dB and the involvement of the low frequencies seem to influence positively the hearing recovery.

Inner ear infections as cause of perinatal deafness

Objective: To assess the role of infective agents as cause of sensorineural hearing loss (SNHL) in children. Setting: Tertiary care center actively involved in management of hearing impairment through cochlear implant program and other rehabilitation program. Materials and Methods: Retrospective chart review of 213 patients who underwent cochlear implantation at our center from 2007 to 2011 was carried out. Out of these, 185 were children. We have done the data analysis with regard to etiology of hearing loss in these 185 children. An etiology for SNHL could be established in 100 out of these 185 cases. Out of these 100 cases, we have further segregated cases where an infectious etiology was implicated. Results: Out of 185 prelingual cochlear implantees, etiology could be determined in 100 cases. Etiology was of infective origin in 26 of these 100 cases. Infective agents implicated in congenital acquired hearing loss were Toxoplasma, Rubella, Cytomegalovirus, and Herpes (TORCH) infections ( n = 9) including Rubella ( n = 7) and Cytomegalovirus (CMV) ( n = 2). Meningitis ( n = 11) and other infections ( n = 6) were responsible for secondary acquired hearing loss. Conclusions: Results showed that among the identified causes, infective agents were responsible in one-fourth cases of profound SNHL. Building awareness about such existence and their major role in causing SNHL among the otolaryngologists, pediatricians, obstetricians, physicians, audiologists and public is considered essential so that such preventable and controllable maladies are reduced by combined efforts from all these stakeholders.

Outcome of auditory neuropathy after cochlear implantation

Purpose: To record language and auditory skills development before and after cochlear implantation (CI) in children with auditory neuropathy (AN), and to determine the outcome after cochlear implant in patients with AN in comparison to patients with sensorineural hearing loss (SNHL) Material and Methods: Cases included in this study were divided into two groups. Group I included 13 children diagnosed with AN, 7 of them were subjected to CI. Group II included, 20 cases of SNHL, 10 of them were subjected to cochlear implant. For all cases language therapy was given regularly for 6 months pre-operatively and 6 months post-operatively. Auditory Skills Checklist (ASC) and The Arabic language test (receptive, expressive and total language Quotients) were used to monitor the progress concerning auditory skills and language development. Results: There was significant improvement in SNHL group and AN group after cochlear implantation concerning auditory skills (AS) and language development and almost the same outcome was obtained in both groups. Conclusions: Cases with AN improved markedly after cochlear implantation and no differences were noticed in outcome between SNHL & AN groups.

Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensorineural hearing loss

The etiology of sensorineural hearing loss (SNHL) in children may be viral. This cross-sectional study aimed to determine the role of viral infectious agents in children with idiopathic SNHL. Of 119 children with SNHL aged 3-168 months undergoing cochlear implant surgery at a hospital in Tehran, no cause could be established in 18 cases (15.1%). Cytomegalovirus (CMV) and herpes simplex virus (HSV) active infections (detected by DNA-PCR, confirmed by serology) were found in the perilymphatic fluid of 16.7% (3/18) cases of idiopathic SNHL. Serology was performed on blood samples from 11 of these cases: specific antibodies against CMV, Toxoplasma spp., HSV and rubella were determined in all cases; acute T. gondii infection was detected in 7 cases and rubella IgG was found in only 1 case. Neonatal screening for CMV, HSV and T gondii may be helpful in the Islamic Republi of Iran.

Clinical profile of hearing loss in children with congenital cytomegalovirus (CMV) infection: CMV DNA diagnosis using preserved umbilical cord

Conclusions: Congenital cytomegalovirus (CMV) infection is a major cause of bilateral and unilateral sensorineural hearing loss (SNHL) in children, accounting for 9.0% of SNHL cases. The diagnostic rate using combined genetic deafness test and CMV DNA detection test was determined to be 46.4% in bilateral profound SNHL. Objectives. The present study investigated the prevalence of congenital CMV infection diagnosed retrospectively by detection of CMV DNA in dried umbilical cord specimens from children with unilateral or bilateral SNHL up to the age of 12 years. Methods: Preserved dried umbilical cords were collected from 134 children with bilateral (46 children) or unilateral (88 children) SNHL. DNA was extracted from the dried umbilical cords and CMV DNA was detected by quantitative PCR. Genetic deafness tests based on the invader assay were performed in children with bilateral SNHL. Results: CMV DNA from the dried umbilical cords was detected in 8.7% of the bilateral SNHL and 9.1% of unilateral SNHL. Deafness gene mutations were identified in 21.7% (10/46) of children with bilateral SNHL.

Viagra deafness—Sensorineural hearing loss and phosphodiesterase‐5 inhibitors

Viagra and PDE-5 inhibitors use has mushroomed since its launch over a decade ago. A growing body of evidence indicates significant morbidity associated with the side effect profile of this class of drug. Hearing loss associated with PDE-5 inhibitor use has recently been reported, but few studies have evaluated the causal link. To review and scrutinise the current literature on the subject and propose possible physiologic mechanisms and to investigate the global reporting of this side effect. Pharmacovigilance agencies around North America, Europe, and Australasia were contacted requesting reports of hearing loss associated with PDE-5 inhibitors. Reports were scrutinised to exclude those where others causes of hearing loss existed. Forty-seven cases of sensorineural hearing loss with a temporal association with PDE-5 inhibitor ingestion were obtained from both published literature and pharmacovigilance agencies. Cases had a mean age 56.6 years, male-to-female ratio of 7:1. Eighty-eight percent of reports were unilateral with an even left/right distribution. Hearing loss occurred within 24 hours of ingestion of PDE-5 inhibitor in 66.7% (n = 18) of cases. Sildenafil accounted for over 50% of cases. There is increasing evidence that PDE-5 inhibitors may induce sensorineural hearing loss via plausible physiological mechanisms. There needs to be more awareness of this disabling side effect among healthcare professionals responsible for prescribing this drug.

Efficacy comparison of oral steroid, intratympanic steroid, hyperbaric oxygen and oral steroid + hyperbaric oxygen treatments in idiopathic sudden sensorineural hearing loss cases

Idiopathic sudden sensorineural hearing loss is a rare disorder of unknown pathogenesis in which hearing is lost partially or totally. About 60 treatment modalities have been described. We aimed to compare the efficacy of hyperbaric oxygen, oral steroid, intratympanic steroid therapy and their combinations in idiopathic sudden sensorineural hearing loss patients. Files of patients who were followed up between 2004 and 2010 in our clinic were examined retrospectively. Patients were divided into four groups according to the therapy received: Oral steroid, oral steroid+hyperbaric oxygen, intratympanic steroid and hyperbaric oxygen. Treatment success was assessed by Siegel criteria and mean gains using pre-treatment and post-treatment audiograms. 217 patients and 219 ears were examined. The proportion of patients responding to therapy was the highest in the oral steroid+hyperbaric oxygen group with 86.88% (53/61) followed by the oral steroid group with 63.79% (37/58), the intratympanic steroid group with 46,51% (20/43) and the hyperbaric oxygen group with 43.85% (25/57). The proportion of patients who had complete recovery was the highest in the oral steroid+hyperbaric oxygen group with 42.6% (26/61) followed by the oral steroid group with 19.0% (11/58), the hyperbaric oxygen group with 17.5% (10/57) and the intratympanic steroid group with 11.6% (5/43). The oral steroid+hyperbaric oxygen group has the highest mean hearing gain among all groups (p<0.05). Idiopathic sudden sensorineural hearing loss patients receiving oral steroid+hyperbaric oxygen combination therapy have a higher likelihood of recovery than patients receiving oral steroids, hyperbaric oxygen or intratympanic steroids alone.