Sudden Hearing Research Articles

“Clinical Profile & Prognostic Factors In Patients with Sudden Sensorineural Hearing Loss”

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease requiring immediate diagnosis and treatment. The incidence of ISSNHL in the Western countries’ population was estimated to 5–20 per 100,000 inhabitants. The etiology of ISSNHL remains unknown. Its pathogenesis is most often suggested to be due to a disturbed microcirculation and infection.
 Objective: To study the clinical profile & prognostic factors in patients with sudden sensorineural hearing loss.
 Material and Methods: A retrospective study was carried out from patients of sudden sensineural hearing loss (SSNHL) presenting to ENT Department ofNorthern Private Medical College, Rangpur, Bangladesh from January to June-2020. All patients were given intravenous steroids as treatment modality for 14 days and pure tone audiogram was done every 3 days during hospital admission. It was followed by oral steroids in tapering dose for further 14 days. After 1 month, audiogram was done again. After 1 month if hearing threshold was decreased by more than 50% of presenting one, then it was labeled as improved.
 Results:Total 51 patients (55ears) with age ranging from 6-70 years (average-38.5 years) were included. Three fourth were male. Presentation was 1-14days after onset of hearing loss (average- 3.7days) with pure tone audiogram (PTA) of 38-117dB (average 83.1dB). The flat audiogram (62.3%) was most common type. Smoking was present in 14 patients and tinnitus in 30 ears. Hemoglobin ranged from 7.3-18.7gm %( average- 15.3gm/dl). PTA post treatment was 8-73dB (average- 56dB). Average age of improved patient was 39.8years which was lower than non-improved patients (42.3years). In improved patients, average PTA at presentation was 77.9dB while it was 86.6dB in non-improved patients.
 Conclusion: Our study demonstrates that the age distribution and clinical characteristics of ISSNHL patients vary according to levels of hearing loss. Moreover, ISSNHL patients with vertigo tend to sufer from a more severe hearing loss. Further studies are needed to obtain better knowledge about the etiopathogenesis of SSNHL. SSNHL is more commonly seen in male patients with polycythaemia and is commonly presented in winter season and is frequently associated with tinnitus. Young age and lower audiogram threshold at presentation favor prognosis.

Effect of Hyperbaric Oxygenation on Blood Cytokines and Arginine Derivatives; No Evidence for Induction of Inflammation or Endothelial Injury.

(1) Background: Hyperbaric oxygen therapy (HBOT) uses 100% oxygen delivered at 1.5–3 times the atmospheric pressure in a specialised chamber to achieve supraphysiological oxygen tension in blood and tissues. Besides its target, HBOT may affect inflammation, endothelial function or angiogenesis. This study analysed the effect of HBOT on blood concentrations of factors that may affect these processes in patients with necrotizing soft-tissue infections (NSTI), aseptic bone necrosis (ABN) and idiopathic sudden sensory neural hearing loss (ISSNHL). (2) Methods: Concentrations asymmetric dimethylarginine (ADMA) and other arginine derivatives were measured with liquid chromatography/mass spectrometry, whereas ELISA was used to quantitate vascular endothelial growth factor (VEGF) and cytokines (IL-1, IL-4, IL-6, IL-10, TGF-β) before and after HBOT in 80 patients (NSTI n = 21, ISSNHL n = 53, ABN n = 6). (3) Results: While some differences were noted between patient groups in ADMA and other arginine derivatives as well as in cytokine concentrations, HBOT did not affect any of these parameters. (4) Conclusions: While cytokines and arginine derivatives concentrations were modified by underlying pathology, hyperbaric oxygenation did not immediately modify it suggesting that it is neutral for inflammation and is not inducing endothelial injury.

T2 relaxation time shortening in the cochlea of patients with sudden sensory neuronal hearing loss: a retrospective study using quantitative synthetic magnetic resonance imaging.

High cochlear signal intensity on three-dimensional (3D) T2 fluid-attenuated inversion recovery (FLAIR) sequences in patients with sudden sensorineural hearing loss (SSNHL) has been reported. Here, we evaluated the cochlear T2 relaxation time differences in patients with idiopathic SSNHL using quantitative synthetic MRI (SyMRI). Twenty-four patients with unilateral SSNHL who underwent precontrast conventional 3D FLAIR and SyMRI were retrospectively included. T1 and T2 relaxation times and the proton density (PD) of the bilateral ears were measured by manually drawn regions of interest. Wilcoxon signed-rank tests and intra- and interobserver correlation analyses were performed. Qualitative analysis was also performed to determine the presence and laterality of the asymmetric high signal intensity on synthetic FLAIR (SyFLAIR) images. The T2 relaxation time was significantly lower in the affected (basal and apico-middle turns) than in the unaffected cochlea (basal turn: 519 ± 181.3 vs. 608.8 ± 203.6, p = 0.042; apico-middle turn: 410.8 ± 163.8 vs. 514.5 ± 186.3, p = 0.037). There were no significant differences in the T1 relaxation time and PD between the affected and unaffected ears (p > 0.05). Additionally, three patients without asymmetric signal intensity on conventional MRI showed asymmetric increased signal intensity in the affected ear on SyFLAIR. The T2 relaxation time was significantly shorter in the affected than in the unaffected cochlea of patients with idiopathic SSNHL. The SyMRI-derived T2 relaxation time may be a promising imaging marker, suggesting that the changes in inner ear fluid composition are implicated in the idiopathic SSNHL development. • T2 relaxation time was significantly lower in the affected than in the unaffected cochlea. • SyFLAIR showed increased lesion conspicuity compared to conventional 3D-FLAIR in detecting asymmetric high signal intensity of the affected side. • SyMRI-derived T2 relaxation time may be a promising imaging marker of the affected ear in patients with idiopathic SSNHL.

Save the hearing, an ear surgery training project program to combat deafness in developing countries

BackgroundHearing loss is one of the most common health problems affecting people in the developing countries so our aim of the “Save The Hearing Project” was to combat deafness by training local doctors for ear surgery in order to treat their local patients with low cost as possible. The project was done as ear surgery campaigns in peripheral areas in Egypt, Yemen, and other countries, to train young ENT specialists and to treat patients there. Our plan was put according to the frequency of different causes of deafness as shown by previous surveys. We used the previous local and evidence-based researches to make our protocols of management of different diseases. These protocols were further evaluated during our work.The project has five stages. The first stage included management of sudden sensory neural hearing loss (SSNHL), otitis media with effusion (OME), and local anesthesia for the ear surgery—cartilage tympanoplasty and ossiculoplasty. The second stage included mastoidectomy cholesteatoma surgery and otoendoscopy. The third stage included more advanced surgery as stapedectomy and tympanosclerosis. The fourth stage included combating SNHL mainly through audiology and rehabilitation program, beside referral for cochlear implants to specialized centers. The fifth stage was only a plan for doing stem cell research in management of hearing loss.ResultsOur teams did about 42 campaigns only and the data of 31 were recorded. There were 259 attendants, 70 had hands on training, and 35 were well trained and became trainers. We did 270 tympanoplasties, 52 mastoidectomies, and cholesteatoma surgery beside 16 operations of stage III.ConclusionTraining an ear surgeon is a tedious and long process, but it is at the end very fruitful and useful for the community. Most causes of HL are preventable. We think that our project plan to combat HL is very suitable to be applied in developing countries in Africa and the Middle East.

Diagnostic and treatment challenge of unrecognized subacute bacterial endocarditis associated with ANCA-PR3 positive immunocomplex glomerulonephritis: a case report and literature review

BackgroundDiagnosis and treatment of either ANCA disease or silent infection-related glomerulonephritis is complicated and is a huge treatment challenge when overlapping clinical manifestations occur. We report a case of ANCA-PR3 glomerulonephritis, nervous system involvement, hepatosplenomegaly and clinically silent subacute infectious endocarditis.Case presentationA 57-year-old man with known mitral valve prolaps was admitted for unexplained renal failure with signs of nephritic syndrome, hepatosplenomegaly, sudden unilateral hearing loss, vertigo, malaise, new onset hemolytic anemia and thrombocytopenia. Immunoserology revealed positive c-anti-neutrophil cytoplasm antibody (ANCA)/anti-proteinase 3 (anti-PR3), mixed type crioglobulinemia and lowered complement fraction C3. Head MRI showed many microscopic hemorrhages. Common site of infection, as well as solid malignoma were ruled out. In accordance with clinical and laboratory findings, systemic vasculitis was assumed, although the etiology remained uncertain (ANCA-associated, cryoglobulinemic or related to unrecognized infection). After kidney biopsy, clinical signs of sepsis appeared. Blood cultures revealed Streptococcus cristatus. Echocardiography showed mitral valve endocarditis. Kidney biopsy revealed proliferative, necrotizing immunocomplex glomerulonephritis. Half a year later, following intravenous immunoglobulins, glucocorticoids, antibiotic therapy and surgical valve repair, the creatinine level decreased and c-ANCA and cryoglobulins disappeared. A second kidney biopsy revealed no residual kidney disease. Four years after treatment, the patient is stable with no symptoms or signs of vasculitis recurrence.ConclusionsHere we describe the diagnostic and treatment challenge in a patient with unrecognized subacute bacterial endocarditis associated with ANCA-PR3 immunocomplex proliferative and crescentic glomerulonephritis. In patients with ANCA-PR3 immunocomplex glomerulonephritis and other overlapping manifestations suggesting systemic disease, it is important to recognize and aggressively treat any possible coexisting bacterial endocarditis, This is the most important step for a favorable patient outcome, including complete clinical and pathohistological resolution of the glomerulonephritis.

Herpes zoster does not increase the risk of sudden sensory neural hearing loss: a longitudinal follow-up study using a national sample cohort

Objective: This study aimed to investigate the risk of sudden sensorineural hearing loss (SSNHL) in Herpes zoster patients from a representative population cohort.Design: A longitudinal follow-up studyStudy sample: Data were obtained from the Korean National Health Insurance Service-National Sample Cohort for the period from 2002 to 2013. We matched 61,702 subjects in the Herpes zoster group with subjects in a control group (246,808 subjects with no history of Herpes zoster) based on demographic factors (age, sex, income, and region of residence) and medical history (diabetes, dyslipidemia, and hypertension). The crude (simple) and adjusted hazard ratios (HRs) for Herpes zoster with SSNHL were analysed using the Cox-proportional hazard model.Results: Only 0.5% (338/61,364) of the Herpes zoster group and 0.7% (1664/245,144) of the control group showed SSNHL. The Herpes zoster group did not exhibit a higher rate of SSNHL (adjusted HR = 0.81, 95% CI = 0.72–0.91, p < 0.001) than the control group. In subgroup analyses, no age subgroups showed a significant risk of SSNHL in the Herpes zoster group.Conclusions: After adjusting for confounding factors, the risk of SSNHL did not increase in the Herpes zoster group compared with the control group.

Oral Prednisolone Treatment of Sudden Sensory Neural Hearing Loss: 16 A Three Year Retrospective Analysis

Sudden Sensory Neural Hearing Loss (SSNHL) is a serious medical condition and requires prompt medical attention. The study was done to estimate the effect of different protocols of oral Prednisolone plus high dose vitamin B-complex and vitamin BI, 132. Be in patients with unilateral SSNHL who have failed to respond to treatment. A retrospective study was done from January 2015 to January 2018 at the outdoor patient department of Holy Family Red Crescent Medical College Hospital, Dhaka among 75 randomly selected patients with a mean age of 46.32 years (range 25-69 years). with the preselected criteria. Each of the patient received one of the four standard oral Prednisolone dosing protocols along with high dose of vitamin B-complex and BI, 132, Be orally 20mg four times for a total dose of 80mg daily for one week, Group A, n=18; orally 20 mg three times, for a total dose of 60mg daily for one week Group B, n=18; orally 20mg two times for a total dose of 40mg daily for one week Group C, n=18; orally 10mg three times for a total dose of 30mg daily for one week. Group a n=18. All the doses were then tapered for next 5 days. Patient characteristics and pharmacological effects were compared among the 4 groups. The mean age, average duration of symptoms from onset to treatment, and degree of hearing loss were analyzed by means oft-test Treatment effects were analyzed by means of Chi-square test. P&lt;0.05 was considered significant. Improvement of hearing was assessed by pure tone audiogram. The total effective rate was 88.89% 83.33%, 77.78% 66.67% for each treatment protocol, respectively, with no significant statistical difference between them (p00.05). The results suggest that a total dose of 80 mg is the most appropriate protocol. Prednisolone significantly improves the prognosis of SSNHL. Further multicenter studies are needed to determine the more standard treatment protocol.

Case Study: An Uncommon Case of Bilateral Superior Semicircular Canal Dehiscence Associated with Sudden Sensoryneural Hearing Loss

Case Study: An Uncommon Case of Bilateral Superior Semicircular Canal Dehiscence Associated with Sudden Sensoryneural Hearing Loss

難聴を来した椎骨動脈解離の1 例

症例は50 歳女性．2014 年10 月下旬（第1 病日）早朝，突然，回転性眩暈，右耳難聴を自覚し，当院に搬送された．神経学的所見では，左方向への回旋性眼振，右難聴を認めた．頭部MRI 拡散強調画像で小脳梗塞を認め，同日入院した．第22 病日に実施した脳血管造影検査では，右前下小脳動脈（AICA）は椎骨動脈から分岐し，右後下小脳動脈分岐部から椎骨動脈が狭小化していた．以上より，右椎骨動脈解離によって右AICA が閉塞し，内耳に虚血性障害を来した結果，難聴を呈したと判断した．第40 病日に当科を退院したが，現在も，難聴は残存している．

Sudden bilateral deep hearing loss in a child – case study

Sudden bilateral deep hearing loss in a child – case study

Monosymptomatic manifestation of clinically isolated syndrome with sudden unilateral sensory neural hearing loss: A rare case report

Monosymptomatic manifestation of clinically isolated syndrome with sudden unilateral sensory neural hearing loss: A rare case report

Sudden Sensoryneural Hearing Loss As a Rare Attack Type in Multiple Sclerosis.

Sudden Sensoryneural Hearing Loss As a Rare Attack Type in Multiple Sclerosis.

Role of Intratympanic Steroids in the Management of Idiopathic Sudden Sensori Neural Hearing Loss— Our Experience of 67 Cases

Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.

Traumatic Pericarditis in Cattle: Risk Factors, Clinical Features and Ultrasonographic Findings

Traumatic Pericarditis in Cattle: Risk Factors, Clinical Features and Ultrasonographic Findings Pericarditis is an inflammation of the pericardium with accumulation of serous or fibrinous inflammatory products. In cattle, it is always a common sequel to traumatic perforation of the reticular wall, diaphragm and pericardial sac by metallic and non-metallic sharp foreign body. A case series study was conducted between April, 2014 and December, 2015 in cattle herds in Mansoura, Egypt to determine the risk factors, clinical features and ultrasonographic findings of traumatic pericarditis. Forty cattle expressing clinical signs of cardiac problems were selected and thorough clinically examined. Statistical analysis using multivariable logistic regression showed that magnet administration, positive pain test, history of abrupt and sudden milk drop and hearing grunt were significantly associated with traumatic pericarditis in cattle.

P16.34 * BEVACIZUMAB TREATMENT FOR ACOUSTIC NEURINOMA IN NEUROFIBROMATOSIS TYPE 2: A CASE REPORT

Neurofibromatosis type 2 (NF2) is a dominantly inherited genetic condition. Unlike patients with sporadic tumours, NF2 patients often have multiple meningiomas, acoustic neurinomas and ependymomas. The multiplicity of tumours make surgery and radiation therapy for all tumours impracticable. In effect, bilateral acoustic neurinomas are the hallmark of this disease and these tumours cause progressive hearing loss in most patients. Neovascularization is necessary for tumour growth and is driven by tumour produced angiogenic factors such as vascular endothelial growth factor (VEGF). Bevacizumab is a humanized monoclonal antibody that neutralizes the activity of VEGF. Recent data showed that VEGF is produced by schwannoma tumour cells. Also, bevacizumab treatment, in patients with NF2 who were considered poor candidates for surgery and radiation therapy, was followed by clinically meaningful hearing improvement and tumour-volume reduction. We report the case of a 39 years old woman with sudden rightsided hearing loss. Magnetic resonance imaging (MRI) revealed multiple meningiomas and neurinomas (C2 and L5 lesions) and a right side acoustic neurinoma of 26x24 mm, confirming the diagnosis of NF2. Bevacizumab was given as an infusion every 2 weeks at a dose of 5.0 mg/kg body weight. Before the treatment, the patient has a thorough medical evaluation including blood pressure, urine analysis, liver and kidney function tests, coagulation status and history of thrombosis, hemoglobin, leukocyte count and thrombocyte count. Three months after the start of therapy the patient has reported an hearing response with progressive improvement in audiometry, word recognition and face-to-face conversation. Six months after the start of therapy, the right acoustic neurinoma had regressed and, also, mitigation of brain stem compression was clearly visible on the cranial MRI scans. The patient, after 12 months, continued to be treated with bevacizumab. In our experience no toxic effects drug-related has been seen; anyway, the absence of many common toxic effects of bevacizumab in our patient may have reflected her youth and the lack of other medical conditions. The exact mechanism of the action of bevacizumab on acoustic neurinomas remains to be elucidated. The drug may also suppress growth of tumour Schwann cells directly, a possibility that can be tested in vitro in future studies. The encouraging results with bevacizumab suggest consideration of a prospective clinical trial for progressive NF2-related acoustic neurinomas, especially for patients with imminent total hearing loss.

48 Years Old Patient Bilateral Sudden Sensorineural Hearing Loss Occurred in Order: Correlation of Hearing loss with Obstruction of Anterior Inferior Cerebellar Artery and Probability of Collateral Circulation of Cochlea.

He lost suddenly right hearing 2 months ago, but he didn't his sudden sensori neural hearing loss (SSNHL). He had left SSNHL 1 day ago, he visited Jeju National University Hospital. He only complained of hearing loss. In pure tone audiometry (PTA), his hearing was measured 62dB/24% at right side and 87dB/0% at left side respectively. The magnetic resonance image (MRI) and angiography (MRA) of the brain showed total occlusion of right internal carotid artery and both anterior inferior cerebellar artery (AICA) was invisible in MRA. There was no AICA infarction in diffusion image of brain MRI. We treated him with high dose methylprednisolone, intratympanic dexamethasone injection (ITDI), IV alprostadil 10pg, ginkobiloba, pentoxifyline and aspirin. In addition, we detected hypertension (HTN) and diabetes mellitus (DM) and treated diseases with department of internal medicine. After treatment for 2 months brain MRI and MRA showed more abundant collateral circulation of brain than initial MRA.But both AICA was invisible. After treatment for 4 months his left hearing was measured 30dB/90% at left side in PTA.

Unusual acute hearing loss after gamma knife surgery for a facial schwannoma

A 34-year-old female patient suffering from right-sided facial palsy presented to our hospital. Her hearing range was within normal limits. She had undergone GKS after receiving a diagnosis of facial nerve schwannoma (FNS). On the fourth day after GKS, the patient experienced sudden onset hearing loss on the right side without aggravation of the facial palsy. Intravenous corticosteroids were administered, and her hearing function improved gradually over the course of 15 days. This is the first case report of hyperacute hearing loss after GKS for FNS.

Susac’s Syndrome: A Case Presentation and Radiological Approach to this Rare Autoimmune Endotheliopathy

Susac's syndrome is an uncommon neurologic disorder, consisting of the clinical triad of encephalopathy, branch retinal artery occlusions, and hearing loss. We report a case of a sudden vision and hearing impairment in a 35-year-old female patient. Magnetic resonance imaging of the brain revealed multiple lesions in the white matter and the corpus callosum, typical of Susac's syndrome.

Unilateral Sudden Sensorineural Hearing Loss after Spinal Anesthesia for Elective Cesarean Section: A Case Report

The relationship between spinal anesthesia and hearing loss is not well understood, but is thought to be due to leakages of cerebrospinal fluid, which may or may not induce postural puncture headache. Previous studies have reported no risk of hearing loss in patients under 40 or the obstetric population. We present a case of a young woman who experienced severe sudden unilateral hearing loss after spinal anesthesia for elective cesarean section. This case illustrates that young, obstetric patients may experience hearing loss after spinal anesthesia.

Surdités brusques : place de l’imagerie

Sudden onset hearing loss is idiopathic. It occurs in less than 24 h and spontaneously resolves within 15 days in two thirds of cases. Imaging is performed to exclude other causes of sudden onset hearing loss (vestibular schwannoma, vertebral artery dissection, stroke) and evaluate the inner ear structures. A few anatomical anomalies have been associated with an increased risk of hearing loss. Morphological anomalies involved the following structures in decreasing order of frequency: lateral semicircular canal (hypoplasia and dilatation), superior semicircular canal, posterior semicircular canal, vestibule and cochlea. Enlargement of the vestibular aqueduct also is frequently observed.