Risk Of Sudden Sensorineural Hearing Loss In Patients Research Articles

Increased risk of sudden sensorineural hearing loss in patients with cervical spondylosis

Whether cervical spondylosis (CS) is a risk factor for sudden sensorineural hearing loss (SSNHL) remains unclear. This study used national population-based data to investigate the risk of SSNHL in patients with CS in Taiwan of different ages and sexes. This study used data covering 2 million people in Taiwan, which were obtained from the National Health Insurance Research Database. The data that support the findings of this study are available from National Health Insurance Research Database but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding authors upon reasonable request and with permission of National Health Insurance Research Database. This retrospective cohort study enrolled 91,587 patients with a newly diagnosed CS between January 2000 and December 2018. Case and control cohorts were matched 1:1 according to age, sex, and comorbidities. SSNHL incidence rate and risk were compared between the groups. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The mean follow-up period was 8.80 (SD = 4.12) and 8.24 (SD = 4.09) years in the CS and control cohorts, respectively. The incidence rate of SSNHL in the CS cohort (85.28 per 100 000 person-years) was 1.49-fold significantly higher than that in the non-CS cohort (57.13 per 100,000 person-years) (95% CI 1.32–1.68, P < .001). After age, sex, and selected comorbidities were adjusted for, CS exhibited an independent risk factor for SSNHL (adjusted HR = 1.52; 95% CI 1.34–1.71, P < .001). An age-stratified analysis in this study demonstrated a strong and highly significant association between CS and SSNHL in patients aged < 35 years (IRR = 2.28, 95% CI 1.18–4.39, P = .013). This large-scale Taiwanese-population-based retrospective study found that CS was associated with an increased risk of SSNHL. Acute hearing loss in patients with CS, particularly at a young age, should be carefully evaluated, and prompt treatment for SSNHL should be initiated.

Risk of sudden sensorineural hearing loss in patients with dysrhythmia: A nationwide population-based cohort study.

ObjectiveWhether dysrhythmia is a risk factor of sudden sensorineural hearing loss (SSNHL) remains unclear. In this study, we aimed to investigate the risk of developing SSNHL among patients with dysrhythmia in different age and gender groups by using population-based data in Taiwan.MethodsWe conducted a matched cohort study by analyzing data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. 41,842 newly diagnosed dysrhythmia patients and 83,684 comparison subjects without dysrhythmia were selected from claims. The incidence of sudden sensorineural hearing loss at the end of 2013 was determined in both groups. Univariate and multivariate logistic regression analyses were used to investigate the risk of SSNHL among patients with dysrhythmia.ResultsThe incidence of SSNHL was 1.30-fold higher in the dysrhythmia group compared with the control group (53.2 versus 40.9 per 100,000 person-years), and using Cox proportional hazard regressions, the adjusted hazard ratio (HR) was 1.40 (95% confidence interval [CI], 1.15–1.70). Gender-stratified analysis revealed a significantly higher risk of SSNHL in patients with dysrhythmia than in those without dysrhythmia for both men and women (HR = 1.34, 95% CI = 1.02–1.76, P = 0.039, HR = 1.35, 95% CI = 1.02–1.78, P = 0.035, respectively). Age-stratified analysis revealed remarkable associations between dysrhythmia and SSNHL among those aged less than 40 years and more than 65 years (HR = 2.18, 95% CI = 1.03–4.64, P = 0.043 and HR = 1.54, 95% CI = 1.14–2.09, P = 0.006, respectively).ConclusionsOur findings support dysrhythmia as an independent risk factor for SSNHL. Based on the study results, clinicians managing patients with dysrhythmia should be aware of the increased risk of developing SSNHL, especially among patients aged <40 and >65 years, and counsel patients to seek medical advice immediately if they experience any acute change in their hearing ability.

Risk of sudden sensorineural hearing loss in patients with common preexisting sensorineural hearing impairment: a population-based study in Taiwan.

ObjectiveThe role of preexisting sensorineural hearing impairment on the risk for sudden sensorineural hearing loss (SSHL) is still unclear. In this study, we aimed to assess the risk of SSHL in patients with common preexisting sensorineural hearing impairment using population-based data.MethodsA population-based case-control study design was used to analyze claims data between January 2001 and December 2011 obtained from the Taiwan National Health Insurance Research Database. The cases consisted of 514 patients with SSHL and the controls were frequency matched to 2,570 cases by sex, 10-year age group, and year of index date. Common sensorineural hearing impairments were retrospectively assessed in the cases and controls. Associations between sensorineural hearing impairment and risk of SSHL were evaluated using unconditional univariate and multivariate logistic regression analyses.ResultsThe mean age for the 3,084 study subjects was 53.1 years (standard deviation, S.D. = 15.6). Of the 514 cases, 49 (9.5%) had sensorineural hearing impairment while only 44 (1.7%) of the 2,570 controls had the same condition. Univariate logistic regression analyses indicated that preexisting sensorineural hearing impairment was significantly associated with SSHL (odds ratio, OR = 6.05, p < 0.001). Other comorbidities including hypertension, diabetes mellitus, and hyperlipidemia also showed significant associations with SSHL. Similar results were obtained when the association between SSHL and sensorineural hearing impairment was adjusted with either all the covariates (adjusted OR = 6.22, p < 0.001) or with only those selected using a backward elimination procedure (adjusted OR = 6.20, p < 0.001).ConclusionsResults from this population-based case-control study revealed that common sensorineural hearing impairment might be a novel risk factor for SSHL.

Risk of sudden sensorineural hearing loss in patients with psoriasis: a retrospective cohort study.

Psoriasis, a common immune-mediated disease, affects approximately 2% of the population worldwide. Sudden sensorineural hearing loss (SSNHL) might be a manifestation of systemic vascular involvement in autoimmune disease. However, to the best of our knowledge, there is no systematic English-language examination of the risk of SSNHL in patients with psoriasis. We tested the hypothesis that psoriasis is a risk factor for developing SSNHL. Using Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study to compare patients diagnosed with psoriasis from January 1, 2001 through December 31, 2006 (n=28,817) with gender-, age-, and comorbidities-matched controls (n=28,817). We followed each patient until the end of 2011 and evaluated the incidence of SSNHL for at least 6 years after the initial psoriasis diagnosis. The incidence of SSNHL was 1.51 times higher in the psoriasis cohort than in the control cohort (7.12 vs 4.73 per 10,000 person-years). Using Cox proportional hazard regressions, the adjusted hazard ratio (AHR) was 1.51 (95% confidence interval [CI] 1.18-1.93). Comorbid hypertension was an independent risk factor for SSNHL (AHR 1.49; 95% CI 1.05-2.13). However, the incidence rate ratios (IRRs) for each comorbidity subgroup in the psoriasis and control cohorts were not significantly different. Psoriasis was significantly associated with a higher risk of developing SSNHL. We suggest that physicians advise patients with psoriasis to seek medical attention if they have hearing impairments, because they may also have a higher risk of developing SSNHL.

Migraine a risk factor for SSNHL

Among patterns of hearing loss, sudden sensorineural hearing loss (SSNHL) ranks as one of the least common, accounting for 1% of all cases of hearing loss with approximately 4000 new cases reported each year (1). However, the inability to prepare for the sudden loss of function, the lack of a satisfying explanation for its cause, and the limited treatment options also make it a particularly devastating disorder. A specific cause for the hearing loss is found in less than 15% of cases and guidelines for management of SSNHL have only recently been published (2,3). Prior association studies have shown that traditional vascular risk factors such as smoking, hypertension, dyslipidemia, and diabetes can be risk factors for SSNHL, with one study even showing a higher risk of subsequent stroke in patients with SSNHL (4). However, meta-analyses have shown that these associations are also inconsistent (5). Although a history of migraine is not generally considered to be a risk factor for SSNHL, it has also not been systematically investigated. Case reports have indicated that some patients who experience SSNHL also experience other symptoms attributable to migraine and that sudden hearing loss associated with a severe migraine headache can be associated with ischemic changes in the inner ear (6,7). In this volume, Chu et al. report on the association between migraine and the incidence of SSNHL over a 10-year period using the National Health Insurance Research Database in Taiwan, which is based on a universal health care system with centralized information on all diagnostic codes and prescriptions. The study was designed as a retrospective case-control study, with the incidence of SSNHL in migraine patients and controls in the year 2000 used as the baseline. Migraine and SSNHL were both diagnosed by ICD9-CM codes, as were major vascular risk factors such as diabetes, hypertension, dyslipidemia, and atrial fibrillation. After exclusion of a history of SSNHL at baseline, Meniere’s disease, and acoustic neuromas, 10,280 migraine patients were compared to 41,120 controls. These subjects were followed for a median of five years until one of three outcomes was obtained: 1) development of SSNHL, 2) subject death, or 3) end of the study in 2009. The study required that the diagnosis of migraine be coded by a neurologist and that the diagnosis of SSNHL be coded by an otolaryngologist. The authors report a 1.8-fold increased risk of SSNHL in patients with migraine with a very small but detectable cumulative risk of SSNHL each year throughout the 10 years of observation. This cumulative risk amounted to 0.4% in migraine patients and 0.2% in controls. In a multivariate analysis, comorbidity with hypertension increased the risk to 1.92 in migraine patients, but this was not statistically significant. The role of hypertension in the risk of SSNHL in controls was not reported, however. The study provides a global perspective on the incidence of SSNHL. The authors calculated an incidence of 81.6 cases in 100,000 person-years in migraine subjects and 45.7 cases per 100,000 person-years in controls. The relative risk increased to 118.6 per 100,000 person-years in migraine subjects over the age of 40 years. These estimates are much higher than the often-reported incidence of five to 20 cases in 100,000 person-years for SSNHL (2,3,5). However, some widely cited incidence data in the current literature are extrapolated from as few as 18 patients cared for in one health care system or are reported frompersonal communications (8,9). Older studies also did not use the current, more generally accepted criteria for SSNHL that require a loss of 30 dBof hearing in three consecutive frequencies occurring over less than 72 hours. Conversely, the reported incidence in the study was lower than the 160 per 100,000 person-years reported in 2004 from a German population (10). One challenge to making an accurate assessment of the incidence of SSNHL in any setting is that acuity can often be difficult to determine, especially if the patient recovers quickly. Between one-third and two-thirds of

Recent advances in viral inner ear disorders

To highlight the recent advances in the understanding of the diagnosis and management of viral inner ear disorders. Congenital sensorineural hearing loss (cSNHL), sudden sensorineural hearing loss (SSNHL), Ménière's disease, and vestibular neuritis/viral labyrinthitis are discussed. Cytomegalovirus infection during pregnancy is an under-recognized cause of hearing loss and central nervous system disease amongst the general population. Prevention of maternal infection and treatment of affected newborns with ganciclovir are promising interventions. Recent evidence in SSNHL patients has resulted in recommendations against viral serology or the use of antivirals. There appears to be an increased risk of SSNHL in patients with comorbid hypertension and diabetes. The viral hypothesis of Ménière's disease remains unproven. In patients with an acute episode of vestibular neuritis, there is presently not sufficient evidence to support the routine use of corticosteroids or antiviral medications. cSNHL remains the most clearly defined of the viral inner ear disorders. The evidence for viral involvement in SSNHL, Ménière's disease, and vestibular neuritis is indirect and equivocal. This review highlights the recent advancements in the diagnosis and management of these disorders.