Onset Of Sudden Sensorineural Hearing Loss Research Articles

Effect of pre-incident antiplatelet therapy on sudden sensorineural hearing loss

ObjectiveIdentify if pre-incident aspirin influences severity and outcome of idiopathic sudden sensorineural hearing loss (SSNHL). Study designRetrospective review. SettingTertiary care center. MethodsPatients with idiopathic SSNHL were identified and separated into aspirin and non-aspirin groups. Variables, including demographics, comorbid conditions, audiologic outcomes were identified and compared between groups. ResultsOne hundred forty-eight patients were included that met inclusion criteria. There were 38 patients who were on pre-incident aspirin therapy and 110 patients not on aspirin prior to the onset of SSNHL. Pre- and post-treatment audiologic status was worsened in the aspirin group. Other comorbid conditions, including hyperlipidemia, coronary artery disease (CAD), cerebrovascular accident (CVA), and vertigo symptoms had an effect as well. With multivariate analysis, CAD, CVA, and vertigo symptoms appeared to have an effect more than aspirin. ConclusionsPatients on aspirin have a worsened pre- and post-treatment audiologic status. This appears to be more due to the underlying CAD or history of CVA rather than aspirin use itself.

Genetically Predicted Sleep Traits and Sensorineural Hearing Loss: A Mendelian Randomization Study.

Observational studies suggest a potential association between sleep characteristics, sensorineural hearing loss (SNHL), and sudden SNHL (SSNHL), but causal evidence is scarce. We sought to clarify this issue using two-sample Mendelian randomization analysis. The inverse-variance weighted (IVW) method was performed as primary analysis to assess bidirectional causal associations between sleep traits (chronotype, sleep duration, insomnia, daytime sleepiness, and snoring) and SNHL/SSNHL using publicly available Genome-Wide Association Studies summary data from two large consortia (UK Biobank and FinnGen). Sensitivity analyses, including Mendelian randomization (MR)-Egger, Mendelian randomization pleiotropy residual sum and outlier, weight median, Cochran's Q test, leave-one-out analysis, and potential pleiotropy analysis, were conducted to ensure robustness. IVW analysis found suggestive associations of morning chronotype (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.01-1.16, p = 0.031) and daytime sleepiness (OR = 1.88, 95% CI = 1.24-2.87, p = 0.003) with SNHL onset. Additionally, morning chronotype was nominally associated with SSNHL onset using IVW method (OR = 1.37, 95% CI = 1.10-1.71, p = 0.006). However, there was no evidence for the causal effect of SNHL and SSNHL on different sleep traits (all p > 0.05). Sensitivity analysis showed that the results were stable. Within the MR limitations, morning chronotype and daytime sleepiness were underlying causal contributors to the burden of SNHL, indicating that optimal sleep might facilitate the prevention and development of SNHL. 3 Laryngoscope, 2024.

Debutul subliminal al surdităţii neurosenzoriale brusc instalate în hipotiroidism – revizuire a literaturii

Sudden sensorineural hearing loss (SSNHL) is a frequent oc­cur­rence in audiology and otolaryngology. It refers to a sen­so­rineural hearing loss of 30 dB or more across three con­se­cu­tive audiometric frequencies, developing within 72 hours. While the causes of SSNHL vary widely, most cases lack a clear origin. Studies have suggested a po­ten­tial re­la­tion­ship between thyroid dysfunction and the onset of SSNHL, yet establishing a definitive causal link re­mains un­cer­tain. Our review aims to meticulously explore the impact of thyroid function on SSNHL. The treatment for SSNHL with iden­ti­fiable causes typically targets the un­der­lying agent, often resulting in poor hearing outcomes due to inner ear hair cell damage. In cases of idiopathic SSNHL, steroid the­r­apy is the current standard of care. The prognosis for hea­r­ing recovery in idiopathic SSNHL hinges on factors such as the severity of hearing loss, age, presence of vertigo, and le­­­vels of thyroid hormones.

Importance of small vessel disease as a possible cause of sudden sensorineural hearing loss.

Vascular disease like small-vessel disease (SVD) is the most likely cause among the potential causes of Sudden sensorineural hearing loss (SSNHL). Understanding the relationship between SVD and SSNHL is crucial for developing effective prevention and treatment strategies. To confirm the relationship between SVD and SSNHL, the effect of SVD is confirmed by focusing on the duration and recurrence of SSNHL. This article reports a retrospective observational study that investigated the relationship between SVD and SSNHL using the South Korea Health Insurance Review and Assessment Service (HIRA) database from 2010 to 2020. This retrospective observational study included 319,569 SSNHL patients between 2010 and 2020. Participant demographics were controlled using Propensity Score Matching. The hazard ratios (HR) for the effect of SVD on the duration of SSNHL were 1.045 for the group with SVD before the onset of SSNHL and 1.234 for the group with SVD after the onset of SSNHL. SVD was statistically significant for the recurrence of SSNHL, with an odds ratio of 1.312 in the group with SVD compared to the group without SVD. The HR for the period until a recurrence in the group with SVD was 1.062. The study identified SVD as a possible cause of SSNHL and found that the duration of SSNHL increased only in the presence of SVD. SVD also affected the recurrence of SSNHL, with the recurrence rate being 1.312 times higher in the group with SVD.

Traditional and non-traditional lipid parameters as risk factors for sudden sensorineural hearing loss

ObjectiveThe purpose was to explore the effects of traditional and non-traditional lipid parameters on Sudden Sensorineural Hearing Loss (SSNHL). MethodsThe study included 452 patients diagnosed with SSNHL, among whom 206 patients had a level of hearing improvement ≥10 dB after one month of follow-up. A propensity score-matched (2:1) control group was used. Conditional and unconditional logistic regression were used to analyze the risk factors for SSNHL. ResultsPatients with SSNHL had a higher risk of concomitant hypertension and elevated atherosclerogenic lipid levels, with apolipoprotein B and apolipoprotein E identified as independent risk factors for the onset of SSNHL. Additionally, the Lipid Comprehensive Index (LCI) was an independent risk factor for the degree of hearing loss. A positive linear correlation was revealed between triglyceride, non-high-density lipoprotein cholesterol, atherogenic index, Castelli risk index, atherogenic index of plasma, LCI and hearing loss. However, no linear relationship was observed between hearing gain and any lipid parameters. When Total Cholesterol (TC) was in the range of borderline high, the treatment effect was the best. However, the statistical significance disappeared upon adjusting for confounding factors. ConclusionPatients with SSNHL exhibited markedly dysregulated lipid metabolism. Elevated serum lipid levels may be a causative factor in auditory impairment and can influence the extent of hearing loss. Promptly improving cochlear microcirculation may benefit patients with borderline elevated TC. Level of evidence4.

Evaluation of expression levels of microRNA processing elements in patients with sudden sensorineural hearing loss

BackgroundMicroRNAs have a significant role in the function and development of the hearing system. Idiopathic sudden sensorineural hearing loss (SSNHL) is a complicated disorder with no long-established reason. Since microRNAs play imperative roles in every aspect of the neural system, their dysregulation may contribute to the onset of SSNHL. The current study aimed to assess the expression patterns of microRNA processing elements (DROSHA, DICER, and DGCR-8) as the vital factors in microRNA biology that can affect the expression levels of microRNA. This study assessed DROSHA, DICER, and DGCR-8 mRNA expression levels in the peripheral blood mononuclear cells (PBMC) of 50 patients with SSNHL and 50 matched controls. After the isolation of PBMC, total RNA was extracted, and the expression levels of DROSHA, DICER, and DGCR-8 genes were evaluated using quantitative real-time PCR.ResultsThe results illustrated significant up-regulation of DICER and DGCR-8 genes in SSNHL patients at the mRNA level. Furthermore, despite no significant change in DROSHA level, DICER and DGCR-8 were significantly correlated with SSNHL. However, there was no significant correlation between these gene expressions and the clinicopathological features of patients.ConclusionThis study verified for the first time that the DGCR_8 and DICER mRNA expression levels were significantly up-regulated in patients with SSNHL, proposing that microRNAs and their processing pathways play key roles in the progression and development of SSNHL.

Causal role of immune cell phenotypes in idiopathic sudden sensorineural hearing loss: a bi-directional Mendelian randomization study.

A growing body of evidence suggests that immunological processes have a significant role in developing idiopathic sudden sensorineural hearing loss (SSHL). However, few studies have examined the association between immune cell phenotype and SSHL using Mendelian Randomization (MR). The online genome-wide association studies (GWAS) database was used to compile data from GWAS covering 731 immunophenotypes and SSHL. Inverse variance weighted (IVW) analysis was primarily used for MR study, and single nucleotide polymorphisms (SNPs) associated with immunophenotypes served as dependent variables. A sensitivity study and the false discovery rate (FDR) correction were used to examine the MR hypothesis. In addition, the possibility of reverse causality between immunophenotype and SSHL was validated by reverse MR. Reverse MR was analyzed in a manner consistent with forward MR. After FDR correction and sensitivity analysis, we screened 7 immunophenotypes, including IgD+ CD38dim %lymphocyte (95% CI: 1.0019, 1.0742, p = 3.87 × 10-2, FDR = 1.15 × 10-2); Unsw mem AC (95% CI: 1.004, 1.2522, p = 4.23 × 10-2, FDR = 2.25 × 10-2); CD86+ myeloid DC AC (95% CI: 1.0083, 1.1147, p = 2.24 × 10-2, FDR = 4.27 × 10-2); CD33dim HLA DR- AC (95% CI: 1.0046, 1.0583, p = 2.12 × 10-2, FDR = 4.69 × 10-2); SSC-A on CD8br (95% CI: 1.0028, 1.1461, p = 4.12 × 10-2, FDR = 4.71 × 10-2); CD45RA- CD4+ %T cell (95% CI: 1.0036, 1.0503, p = 2.32 × 10-2, FDR = 4.82 × 10-2); DP (CD4+CD8+) AC (95% CI: 1.011, 1.2091, p = 2.78 × 10-2, FDR = 4.97 × 10-2). There was a strong causal relationship with SSHL onset, and the reliability of the results was verified. Furthermore, the immunological cell profile and SSHL did not appear to be closely associated, as shown by reverse MR analysis. Our study provides more support for the current hypothesis that immunophenotypes and the pathophysiology of SSHL are closely associated. Further validation is needed to assess the role of these immunophenotypes in SSHL.

Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database

The World Health Organization lately described sudden sensorineural hearing loss (SSNHL) as a possible adverse effect of COVID-19 vaccines. Recent discordant pharmacoepidemiologic studies invite robust clinical investigations of SSNHL after COVID mRNA vaccines. This post-marketing surveillance study, overseen by French public health authorities, is the first to clinically document post-vaccination SSNHL in terms of severity, duration, positive rechallenge cases and to examine the role of potential risk factors. This nationwide study aimed to assess the relationship between SSNHL and exposure to mRNA COVID-19 vaccines and to estimate the reporting rates (Rr) of SSNHL after mRNA vaccination per 1,000,000 doses (primary outcome). We performed a retrospective review of all suspected cases of SSNHL after mRNA COVID-19 vaccination spontaneously reported in France between January 2021 and February 2022, based on a comprehensive medical evaluation including patient medical history, side and range of hearing loss, hearing recovery outcomes after a minimum period of 3 months. Quantification of hearing loss and assessment of hearing recovery outcomes were performed according to a grading system modified from Siegel's criteria. A cutoff value of 21 days was used for the delay onset of SSNHL. The primary outcome was estimated using as a denominator the total number of doses of each vaccine administered over the study period in France. From an initial number of 400 extracted cases for both mRNA vaccines, 345 spontaneous reports were selected for further analysis. After detailed review of complementary medical data, 171 fully documented cases of SSNHL were found. Of these, 142 SSNHL cases occurred after tozinameran vaccination, with the following characteristics: Rr=1.45/1,000,000 injections; no difference between the first, second, and booster injection; complete recovery for 32 cases; median delay onset before day 21 = 4 days; median (range) age=51 (13-83) years; no sex effect. A total of 29 SSNHL cases were identified after elasomeran vaccination, with the following characteristics: Rr=1.67/1,000,000 injections; rank effect in favour of the first injection (p=0.036); complete recovery for 7 cases; median delay onset before day 21 = 8 days; median (range) age=47 (33-81) years; no sex effect. Autoimmune, cardiovascular, or audiovestibular risk factors were present in nearly 30% of cases. SSNHL was more often unilateral than bilateral for both mRNA vaccines (p<0.001 for tozinameran; p<0.003 for elasomeran), and the hearing loss degree was slight to moderately severe (Siegel's grade 1 to 3) on 74% of audiogram tests. There was 23 (13%) of profound hearing loss (Siegel's grade 5), among which 17 (74%) did not recover a serviceable ear. A positive rechallenge was documented for 8 cases, reinforcing the hypothesis of a causal relationship between mRNA COVID-19 vaccination and the occurrence of SSNHL. Episodes of SSNHL after COVID-19 mRNA vaccines are very rare adverse events that do not call into question the benefits of mRNA vaccines but deserve to be known given the potentially disabling impact of sudden deafness. It is, therefore, essential to properly characterize any post-injection SSNHL, especially in the case of a positive rechallenge, to provide appropriate individualized recommendations.

Etiological analysis of patients with sudden sensorineural hearing loss: a prospective case–control study

Sudden sensorineural hearing loss (SSNHL) is a multifactorial emergency disease. Until now, the etiology of SSNHL is still unknown. Previous studies regarding the etiology of SSNHL are clinical studies depending on clinical data collection and analysis. Due to the insufficient sample size or various selective bias in clinical studies, the results of these studies may be inaccurate. This prospective case–control study aimed at exploring the possible etiology and risk factors of SSNHL. We enrolled 255 SSNHL patients and 255 sex-, age- and residence-matched non-SSNHL subjects in the control group. Our study shows that there was no significant difference in the prevalence of comorbidities including hypertension and diabetes, as well as the incidence of smoking and drinking habits between the case and control groups (P > 0.05). In addition, the peripheral blood white blood cell count, neutrophil count, platelet-to-lymphocyte ratio (PLR) and fibrinogen level of the case group were significantly higher than those in the control group (P < 0.05). These findings suggest smoking, drinking, hypertension and diabetes may not be related to the onset of SSNHL. However, hypercoagulable state and inner ear vascular microthrombosis related to an elevated fibrinogen level might be the risk factors of the disease. In addition, inflammation play an important role of SSNHL onset.Trial Registration: Chinese Clinical Trial Registry. Registration number: ChiCTR2100048991.

Nomogram for predicting the prognosis of sudden sensorineural hearing loss patients based on clinical characteristics: a retrospective cohort study.

Based on the clinical characteristics of patients, a nomogram predicting the prognosis of patients suffering from sudden sensorineural hearing loss (SSNHL) was constructed, which could aid in personalized treatment. Data on the clinical characteristics of patients with SSNHL were collected and statistically analyzed. A nomogram for predicting the hearing prognosis of SSNHL patients were then constructed. A total of 356 patients were included in this study, including 227 and 129 in the recovery group (63.76%) and non-recovery group (36.24%), respectively. Univariable logistic regression demonstrated that age, gender, body mass index (BMI), marital, Audiogram curve, vertigo, hearing loss degree, and time to initial treatment were associated with hearing outcomes. Multivariate logistic models showed that age [odds ratio (OR): 0.479, 95% confidence interval (CI): 0.301-0.748, P<0.001], descending (OR: 0.116, 95% CI: 0.047-0.275, P<0.001) and flat audiogram curves (OR: 0.397, 95% CI: 0.159-0.979, P=0.045), profound hearing loss (OR: 0.047, 95% CI: 0.013-0.152, P<0.001), and treatment initiation after 1 week (8-14 days: OR: 0.047, 95% CI: 0.013-0.152, P<0.001; >14 days: OR: 0.131, 95% CI: 0.039-0.413) were risk factors for the hearing recovery. Logistic regression analyses were conducted to construct the prognostic nomogram. As estimated by the area under the receiver operating characteristic curve (ROC), the model had an accuracy of 0.867 (95% CI: 0.709-0.747). The validation analysis confirmed the high accuracy of the nomogram, and the decision curve showed that the model has potential clinical application value. This study demonstrated that age, descending and flat audiogram curves, profound hearing loss, and initiating treatment after 1 week of SSNHL onset were independent risk factors associated with a worse hearing recovery prognosis. Using these factors, a nomogram with a high prediction accuracy was developed to predict the hearing recovery rate of SSNHL patients.

Sudden Sensorineural Hearing Loss in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Accumulating data indicate that patients with COVID-19 could be affected by sudden sensorineural hearing loss (SSNHL). The aim of the study was to analyze the epidemiological and clinical trend of SSNHL occurrence during the COVID-19 pandemic by applying a systematic review and meta-analysis approach. PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane databases were searched. The seven included studies had adequate relevance to the topic and the quality was fair. The mean age at SSNHL onset ranged from 39.23 to 62.18 years during the pandemic year period (PYP); a meta-analysis of four studies comparing these data with those of previous periods in the same institutions found a younger age during the PYP (pooled mean -0.2848). The heterogeneity was high (76.1935%) and no frank asymmetry was observed in the funnel plot. The SARS-CoV-2 positivity rate of SSNHL patients ranged from 0% to 57.53%. Standard steroid treatments were applied without significant adverse effects. Comprehensively, hearing improvement was achieved for more than half of the cases. No studies reported long-term follow-up data. Further prospective analyses on large series and a long-term follow up on COVID-related SSNHL cases are necessary to address the open questions regarding the causative link between COVID-19 infection and SSNHL.

Association between meteorological factors and audiogram configurations in patients with sudden sensorineural hearing loss: a cross-sectional study

ObjectiveWe aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations.DesignRetrospective review of medical records from 1 October 2007 to 31 December 2018.SettingA tertiary...

The Roles Played by Blood Inflammatory Parameters in Sudden Sensorineural Hearing Loss.

The etiology of sudden sensorineural hearing loss (SSNHL) remains unknown; inflammation may be one cause. We retrospectively studied SSHNL cases in terms of the inflammatory parameters involved. We reviewed 169 SSNHL cases. The control group contained 132 patients with vocal cord polyps. The C-reactive protein (CRP) level, CRP/serum albumin (Alb) ratio, and neutrophil/lymphocyte ratio (NLR) were compared between the 2 groups. The relationships between these parameters and the time to treatment after SSHNL onset, hearing level, and therapeutic effects were also analyzed. The CRP level, CRP/Alb ratio, and NLR were higher in SSNHL patients than in controls, but only the NLR differed significantly between the 2 groups. We found no significant differences between patients with different hearing levels, those evaluated at various times after SSNHL onset, and those with different outcomes. The NLR is a reliable SSNHL diagnostic marker. The CRP level and CRP/Alb ratio are not useful indicators.

Sudden Sensorineural Hearing Loss: A Guide to Causes, Treatment, Problems, and Coping Strategies

Sudden Sensorineural Hearing Loss: A Guide to Causes, Treatment, Problems, and Coping Strategies Christine Isley-Farmer (bio) CARE OF THE PROFESSIONAL VOICE Acomprehensive description of the various types of hearing loss singers can experience, authored by Drs. Amanda Hu and Robert Sataloff, appears in an earlier issue of the Journal of Singing. In it, the following types of hearing loss are discussed: Conductive (CHL), Sensorineural (SNHL), Mixed (MHL), and Occupational (OHL).1 Sudden Sensorineural Hearing Loss (SSNHL) is a designated type of Sensorineural Hearing Loss (SNHL). This article discusses the definition of SSNHL, causes, treatment, problems resulting from SSNHL onset, and coping strategies during treatment and after treatment. Portions of the article are written from a personal perspective, since I was diagnosed with SSNHL in January 2015 and treated until March 2015. DEFINITION OF SSNHL Unlike many cases of hearing loss that progress over a span of time, SSNHL can manifest within a matter of seconds or progress over several days. Incidence of SSNHL is estimated to be 1 in 5,000 Americans each year.2 Any age group can be affected, but incidence seems to be higher in the fifth and sixth decades of life.3 Onset manifests unilaterally in most cases; bilateral or simultaneous bilateral onset is infrequent.4 Associated symptoms with SSNHL onset are tinnitus (ringing in the ear), aural fullness (plugged ear), and vertigo (dizziness). Loss can be frequency range and pantonal.5 Considered an ear emergency, SSNHL requires early intervention. Patients with this condition have a short window to begin treatment. Delaying treatment for longer than two to four weeks after onset results in irreversible hearing loss.6 In my case, SSNHL onset occurred while practicing singing. Sound in the left ear suddenly became muffled. Inserting a wax solvent into the ear several times did not resolve the plugged feeling by the following morning. Believing there might be embedded wax or water in the ear, I went to a walk-in clinic. Blood pressure had spiked to 150, which was abnormal for me. The nurse said she saw a bit of fluid in the ear but no wax. She prescribed a nasal spray and a course of prednisone in case of infection. I was scheduled to judge a competition for the next two days. During the competition, which was over a weekend, [End Page 75] there was no improvement in hearing. Stressing that hearing had suddenly changed and not returned despite treatment, I was able to get an appointment with an ENT on the fifth day after SSNHL onset. The audiometry results (Figure 1) show speech discrimination as 100% in the right ear. Left ear speech discrimination is 12%. Loss of hearing in the left ear is diagnosed as severe to moderately severe at 90+dB. CAUSES OF SSNHL In a research study of SSNHL published in 2010, researchers divided into two research groups. The first group examined 23 articles in which multiple etiologies (causes) were identified; the majority were idiopathic (unknown cause). The second group evaluated SSNHL patients with specific diagnostic tests. The results revealed 71% of the cases to be idiopathic. Other diagnoses ranged from 2.2% to 12.8%, with infectious disease having the highest percentage after idiopathic. Attempts to pinpoint a specific cause or causes for SSNHL in this study remained unconfirmed.7 Since most causes of SSNHL onset are generally idiopathic, patients may undergo screenings and/or treatment for several possible disorders. They are as follows: viral ear infection, vascular impairment, autoimmune disease, inner ear problems, and central nervous system abnormalities. In the latter, an MRI is the most useful method for identifying temporal bone or intracranial pathology when SSNHL is the primary symptom.8 I was referred to a rheumatologist for testing for autoimmune disease and underwent an MRI after SSNHL diagnosis. SSNHL studies at Radebeul Hospital in Germany from January 2004 to December 2009 led to an interesting discovery. Of 489 SSNHL patients with a male to female ratio of 1:1.24, a slight predominance of left side hearing loss in female as opposed to male patients was discovered. Although the cause was unclear, researchers proposed the slight predominance of sudden deafness in the left ear...

Sudden Sensorineural Hearing Loss in Mild COVID-19: Case Series and Analysis of the Literature.

Background: There is growing evidence of otoneurological involvement of SARS-CoV-2, such as tinnitus and balance disorders and smell and taste disorders, but HL in COVID-19 patients has still been marginally studied. Investigating the role of SARS-CoV-2 as an aetiological factor of Sudden Sensorineural Hearing Loss (SSNHL) may offer the opportunity to address treatment strategies to maximize clinical recovery and avoid side effects. Methods and results: For this purpose, we will present case studies of five patients who experienced SSNHL during COVID-19. Patients were selected from COVID-19 positive adult subjects with mild clinical presentation, admitted to the outpatient Ear Nose and Throat Department of Cardarelli Hospital due to the onset of SSNHL during the infection. All underwent a complete audio-vestibular investigation before and after SSNHL treatment protocol. Each patient is described with a detailed analysis. Conclusions: SSNHL could be an occasional symptom of COVID-19, even in mild manifestations of the disease. Our experience leads us to underline the value of promptly recognizing and addressing this and other uncommon symptoms, giving patients the opportunity to receive early treatment.

Prognostic Value of Early Magnetic Resonance Imaging Patterns in Sudden Hearing Loss

Introduction: Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient’s SSHL and with treatment outcomes. Methods: In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later. Results: Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea (“pattern+ MRI”) correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always “pattern” negative at MRI (p = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (p = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (p = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI. Conclusions: The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient’s clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.

Treatment of Long-term Sudden Sensorineural Hearing Loss as an Otologic Migraine Phenomenon.

To describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy. Patients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate. Twenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p < 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial < 50% WRS, 8 (73%) had improved posttreatment >50% WRS with an average improvement of 39 ± 9%. Migraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.

Idiopathic Sudden Sensorineural Hearing Loss: Speech Intelligibility Deficits Following Threshold Recovery.

This retrospective study tests the hypothesis that patients who have recovered from idiopathic sudden sensorineural hearing loss (SSNHL) show deficits in word recognition tasks that cannot be entirely explained by a loss in audibility. We reviewed the audiologic profile of 166 patients presenting with a unilateral SSNHL. Hearing loss severity, degree of threshold recovery, residual hearing loss, and word recognition performance were considered as outcome variables. Age, route of treatment, delay between SSNHL onset and treatment, and audiogram configuration were considered as predictor variables. Severity, residual hearing loss, and recovery were highly variable across patients. While age and onset-treatment delay could not account for the severity, residual hearing loss and recovery in thresholds, configuration of the SSNHL and overall inner ear status as measured by thresholds on the contralateral ear were predictive of threshold recovery. Speech recognition performance was significantly poorer than predicted by the speech intelligibility curve derived from the patient's audiogram. SSNHL is associated with (1) changes in thresholds that are consistent with ischemia and (2) speech intelligibility deficits that cannot be entirely explained by a change in hearing sensitivity.

Association Between Sudden Sensorineural Hearing Loss and History of Statin Use: A Nested Case-Control Study.

The effect of statin on sudden sensorineural hearing loss (SSNHL) remains unclear. Thus, this study aimed to investigate the association between prior statin use and SSNHL. A nested case-control study. Participants aged ≥40 years were enrolled from the 2002-2015 Korean National Health Insurance Service-Health Screening Cohort. A total of 5876 patients with SSNHL were matched with 23,504 control participants for age, sex, income, and region of residence. History of statin use for 2 years before SSNHL onset was investigated between the groups. The odds ratios (ORs) of the length of statin use for SSNHL stratified by age, sex, income, and region of residence were analyzed with conditional logistic regression. Dyslipidemia, total cholesterol, blood pressure, blood glucose, hemoglobin, obesity, smoking, alcohol consumption, and Charlson Comorbidity Index score were adjusted. The adjusted variables were subjected to subgroup analyses. The SSNHL group had a longer duration of statin use than the control group (mean [SD], 81.9 [197.7] days vs 72.7 [188.0] days; P = .001). However, statin use was not associated with SSNHL after adjusting for the confounders (adjusted OR, 1.04; 95% CI, 0.98-1.11; P = .245). There was a positive correlation between statin use and SSNHL in the crude model (crude OR, 1.10; 95% CI, 1.04-1.16; P = .001). However, there was no association between statin use and SSNHL in all subgroup analyses. Previous statin use was not associated with SSNHL.

The Relation of Sudden Sensorineural Hearing Loss in Pediatric Patients With Recurrent Otitis Media: A Nested Case-control Study Using a National Sample Cohort.

The risk of sudden sensorineural hearing loss (SSNHL) was suggested to be increased in chronic otitis media patients. This study expanded previous findings by using pediatric patients with recurrent otitis media. A nested case-control study. Participants in the Korean National Health Insurance Service-National Sample Cohort that were less than 15 years old from 2002 to 2004 were included. Overall, 24,226 patients with ≥ 5 instances of otitis media were 1:1 matched with a group controlled for age, sex, income, and region of residence. The occurrence of SSNHL was followed until 2013. The hazard ratio (HR) for SSNHL was analyzed in the otitis media patients using a stratified Cox proportional hazard regression model. Matching variables were stratified. The histories of sinusitis and atopic dermatitis were adjusted. Subgroup analysis was performed according to age and sex. Overall, 0.14% (33/24,226) of the otitis media group and 0.06% (14/24,226) of the control group had SSNHL (p = 0.006). The otitis media group had a higher adjusted HR for SSNHL than the control group (adjusted HR = 2.13, 95% CI = 1.13-4.02). According to age, the 10- to 14-year-old group showed a 9.07-fold higher HR for SSNHL than the control group (95% CI = 1.14-72.54). According to sex, the female group showed a 3.74-fold higher HR for SSNHL than the control group (95% CI = 1.24-11.29). Recurrent otitis media in children was related to the onset of SSNHL.