Sudden Deafness Patients Research Articles

糖尿病をともなった突発性難聴

212 patients diagnosed with sudden deafness between October, 1978 and April, 1998 were reported in our department. In order to clarify the relationship between sudden deafness and diabetes mellitus, the treatment course of 18 patients with sudden deafness, who were affected by diabetes, was analyzed retrospectively. The patients with sudden deafness were divided into two groups (diabetic and non-diabetic) and were analyzed. The following results were obtained:1) The mean age of patients in the diabetic group was 51.8 years, approximately 8 years older than the non-diabetic group. The number of patients with diabetes mellitus increased markedly in the last 10 years.2) There was no significant difference in hearing improvement after treatment as well as in hearing levels between the two groups.3) The rate of patients with dizziness or vertigo in the diabetic group was significantly higher than in the non-diabetic group. The patients with dizziness or vertigo showed a poorer prognosis in their hearing loss.4) There was no relationship between the duration of diabetes and the prognosis of hearing loss. The patients with retinopathy due to diabetes tended to show less hearing improvement.5) Steroid therapy for sudden deafness patients with diabetes was executed without worsening the diabetic condition if insulin was administered adequately.

内耳障害患者のグルクロン酸含有特異酸性糖脂質抗体に関する研究

Glycosphingolipids are molecules present on the surface of normal nerve cells and are considered antigenic. Recent studies have isolated these antigens in vestibular neuroepithelia, cochleovestibular nerves and the endolymphatic sac. The purpose of this study was to determine the presence of antibodies against the glycosphingolipid antigen, sulfoglucuronyl paragloboside (SGPG), in the sera of patients suspected of autoimmune inner ear disease. The sera of a total 41 patients, including cases of progressive sensorineural hearing loss (PSNHL) (n= 19), sudden deafness (SD) (n = 8), Ménière's disease (n = 9), mumps hearing loss (n = 5), were tested for antibodies against the SGPG antigen. Antibody titers were determined by the microtiter ELISA method. Antibody titers were elevated in 36.8% of patients with PSNHL,25.0% of sudden deafness patients, while no elevation was observed in Mniere' s disease patients and mumps patients. Because SGPG antigens have been recently isolated in the inner ear, especially in the cochleovestibular nerve, these structures can potentially become targets for anti-SGPG antibodies.

Sudden bilateral hearing loss due to gastric carcinoma and its histological evidence

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.

突発性難聴に対するｂａｔｒｏｘｏｂｉｎの効果

The rapeutic approaches in the treatment of sudden deafness patients unresponsive to steroid treatment remains controversial. Defibrinogenation therapy using batroxobin is thought to be useful, because vascular disorders are potentially involved in the etiology of sudden deafness. Batroxobin was administered to twelve patients showing little improvement after steroid treatment. The patients included three males and nine females, average age 48.0 years, with a mean heahng level of 85.0dB.Following defibrinogenation therapy, eight of the twelve patients showed good recovery of hearing without any side effects. In this report, we summarize the results of defibrinogenation therapy and discuss the importance of these results.

Immunological and Virological Study of Sudden Deafness

Thirty-three patients with sudden deafness and 11 controls were selected from the patients admitted to the Department of Otolaryngology, Tokai University Hospital from November 1990 to October 1991. Viral titers were measured for mumps, adenovirus, rubella, measles, herpes simplex virus (HSV), varicella zoster virus (VZV), rhinosyncytial virus, cytomegalo-virus (CMV), and mycoplasma pneumoniae in 33 sudden deafness patients and 11 controls at a 2-week interval. In 20 of 33 sudden deafness patients and 5 of 11 controls, autoantibodies of rheumatoid factor (RF), anti-mitochondrial antibody (AMA), anti-nuclear antibody (ANA), anti-parietal cell antibody (APA), anti-smooth muscle antibody (ASA), and anti-type II collagen antibody were studied. Viral titer study did not reveal any significant change either in the patients or in the controls, whereas autoantibody study revealed a relatively high incidence for ASA in the patients as compared with the controls. The relatively high incidence for ASA suggests that immune-mediated processes may be involved in the etiology of sudden deafness.

糖尿病患者にみられた突発難聴症例

糖尿病患者にみられた突発難聴症例

Influence of a cold front upon the onset of Meniére's disease in Toyama, Japan.

In order to clarify the influence of a cold front (CF) upon the onset of Meniére's disease (MD), major CFs were defined by meteorological observations, and the influence of CFs on MD was evaluated by using the time n method. From our preliminary study it was seen that the onset of MD had its highest incidence exactly on days where a CF passed by. Out of the patients with MD, sudden deafness (SD) and Bell's palsy (BP) who visited our neurotological clinic of the Toyama Medical and Pharmaceutical University from 1987 to 1992, 67 MD patients, 70 SD patients and 70 BP patients could clearly define the date of the onset of their disease, and were therefore selected for this epidemiological study. Thirty-six our of the 67 MD patients had the first attack on the day when a CF passed by or on the next day. The results obtained from these studies were as follows. i) The onset of MD was influenced by the passing of a CF, and this influence was more specific in MD than in SD or BP. ii) In the 36 CF influence MD patients, the majority were over the forty years, and their hearing level was worse than that of the other 31 MD patients during the observation periods.

Hearing recovery in sudden deafness patients using a modified defibrinogenation therapy.

Ninety-eight patients with idiopathic sudden deafness were treated with a modified defibrinogenation (DF) therapy including batroxobin, low molecular dextran, vasodilators and vitamins. Hearing improvement was evaluated with two methods: categorical judgement and improvement rate (%). By categorical judgement, 60 patients (61% of the total) were classified into recovery or good improvement categories. The improvement rate was calculated for each of the 93 patients, and the average value was 64%. Modified DF therapy was effective especially for patients with severe hearing loss of 70-90 dB with flat audiogram. Although serum fibrinogen significantly decreased after batroxobin administration there was no correlation between the concentration of fibrinogen and hearing recovery. When prognostic factors were studied, the interval between the onset of hearing loss and start of treatment, initial hearing level, and the existence of vertigo all had significant correlation with the degree of hearing recovery.

Whole‐blood filterability in sudden deafness

Sixteen patients with sudden deafness (SD), diagnosed on the basis of a battery of audiometric tests, but with no other medical or surgical pathology requiring drug treatment, underwent monitoring of their hemorheological profiles to see whether disturbances in the microcirculation could be linked to SD. Plasma viscosity, the filterabilities, (using a low-shear positive pressure system) through 5-microns-diameter pore Nuclepore filters, of whole blood and red and unfractionated white cells were monitored in 16 SD patients and 32 controls matched for age, sex and socioeconomic status. Whole blood filterability and the filterability of the red blood cells were significantly impaired in the SD patients, which suggests that alterations in the microcirculation are linked, in some way, to sudden deafness.

Chronological Study of Recovery of Sudden Deafness Treated with Defibrinogenation and Steroid Therapies

The time courses of hearing recovery resulting from two types of treatment of sudden deafness patients, defibrinogenation (DF) therapy and betamethazone (BM) therapy, were analyzed and compared. A paired double-blind comparative study was performed on 168 patients. The average hearing level was 79.2 dBHL in the DF therapy group (n = 82) and 82.3 dBHL in the BM therapy group (n = 86). The DF group showed significantly better hearing 1 week after start of treatment at frequencies of 0.25, 0.5 and 1 kHz. After 2 weeks of treatment, the average hearing level for the frequency range of 0.25-4 kHz was 47.0 dBHL with DF therapy and 55.8 dBHL with BM therapy. Thus, the DF group still showed better hearing than the BM group (p less than 0.10, t-test), but not as significantly as after 1 week. It is concluded that therapy for increasing blood circulation is important in the early phase of sudden deafness, especially for hearing loss in the low to middle frequency range.

Studies on amidotrizoate therapy in sudden deafness (1978-1987).

The therapeutic effects of amidotrizoate in 47 sudden deafness patients from 1978 to 1987 were studied. The therapeutic results were investigated in terms of each of four variables: time from onset, degree of hearing loss, type of audiogram, and vertigo. Results showed that patients who had no vertigo, and were treated within 1 week of onset had satisfactory results. The degree of hearing loss did not influence recovery, although, all those with total loss type according to audiogram remained unchanged. Twenty-four of 34 cases (71%) treated within 2 weeks showed either complete or marked recovery; this proportion was not much different from the results in our previous investigations.

めまいを伴う突発性難聴の統計的観察

This report is based on 80 cascs of sudden deafness in patients with vertigo treated in the Department of Otolaryngology, Kanazawa University, from 1975 through 1984.There were 32 males and 48 females. The incidence was highest in the fourth decade. The hearing loss was severe more than 90dB in 53.8% of, indicating a parallel relationship between the degree of hearing loss and sudden deafhess in this groups of patients. About 60% of the patients complained of a whirling sensation. Spontaneous nystagmus and positional nystagmus were found in 37.5% of the patients.In 40% sudden deafness was accompanied by complaints of vertigo, and the prognosis in these cases was poor. There was a significant difference between the prognosis of sudden deafness with or without vertigo, especially in cases of severe hearing loss and fresh cases treated within 7 days after the onset of disease.These data indicate that the etiology and pathology of sudden deafness are different in patients with and without vertigo.

The Circulating Interferon (IFN) Assey of the Sudden Deafness Patients

The Circulating Interferon (IFN) Assey of the Sudden Deafness Patients

Otologic surgery in patients with one hearing ear only.

AbstractOn occasions, the otologist is confronted with the possibility of performing surgery on the ear of a patient with useless or no hearing in the opposite ear. Because any surgical procedure on a patient's ear may result in further loss of hearing or even total deafness in the operated ear, an ill‐advised operative procedure in such a patient may result in a catastrophe. Up to 2 percent of patients undergoing surgery for otosclerosis develop further severe sensori‐neural hearing losses in the operated ear. Idiopathic sudden deafness in patients following stapedectomy can occur for causes unrelated to surgery. Further loss of hearing can also occur after simple myringoplasty and tympanoplasty. Such a possibility must be considered and to a great degree should influence the otologist's decision as to whether or not surgery is indicated, and if so, what is the surgical procedure of choice?A deaf patient can be compared to a blind patient only superficially, and not at all when it comes to any consideration of surgery upon the remaining organ of hearing and vision. Consider the patient with total blindness in one eye who cannot be helped with glasses. Should blindness of any degree affect the remaining eye, an operative procedure which can restore vision may be the only recourse. On the other hand, should the patient with only one hearing ear lose some hearing acuity in that ear, it may always be corrected or helped by the use of amplification. Therein lies the great difference. Total deafness cannot be helped by a hearing aid, and such a catastrophe cannot be risked when any other choice is available. This must be the guiding principle of all otologic surgeons in such instances.