Treatment Of Sudden Hearing Loss Research Articles

Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments.

Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.

A randomized controlled clinical trial of acoustic resonance combined with systemic steroid therapy for sudden hearing loss

Objective:To study the short-term and long-term therapeutic effect of acoustic resonance combined with systemic steroid therapy in treatment of Sudden hearing loss (SHL).Method:Clinical data of 128 patients with SHL were analyzed in the randomized controlled trial. Patients were divided into study group (68 cases) and control group (60 cases). Patients in control group received steroid therapy and conventional drug therapy, while study group received acoustic resonance therapy combined with systemic steroid therapy and conventional drug therapy.Result:The total effective rate of study group and control group was 66.18% and 65.00% respectively at the end of treatment; the total effective rate of study group and control group was 72.06% and 70.00% 4 weeks after treatment; the total efficiency of study group and control group was 73.53% and 68.33% respectively 8 weeks after treatment. The total effective rate of study group was not significantly higher than that of the control group in the three periods (P> 0.05). But the PTA significantly improved in study group 4 weeks and 8 weeks after treatment [(43.87±16.73)dB, (40.96±17.11)dB], while the PTA of control group is (50.89±18.41)dB, (48.93±17.84)dB (P< 0.05), and no serious adverse events were happened during treatments and after treatments.Conclusion:Acoustic resonance combined with systemic steroid therapy can significantly improve the therapeutic effect of SHL with no obvious side effects, which is worth clinical promotion.

The progress of glucocorticoids via postauricular injection in treatment of sudden hearing loss

Corticosteroids are commonly accepted and recommended for treating sudden hearing loss.In recent years，postauricular delivery attracts attention due to the advantage of high drug concentration in cochlear and minimal side effects.This article reviews the published literature related the application of glucocorticoids via postauricular injection in treatment of sudden hearing loss and its animal experiments, speculates the possible pathway that drugs enter inner ear, and put forward the idea of treating facial nerve diseases via postauricular injection.

Evaluation of Compliance for Treatment of Sudden Hearing Loss: A CHEER Network Study.

The objective of this study is to describe the presentation and management of sudden sensorineural hearing loss for patients seen in academic and community-based practices within the context of the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline: Sudden Hearing Loss." The intention is to use these findings to guide implementation strategies and quality improvement initiatives and as pilot data for the development of clinical research initiatives. A cross-sectional study of patients with sudden hearing loss. Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) network. The CHEER network is an National Institutes of Health-funded network of 30 otolaryngology sites across the country, half of which are community based and half of which are academic practices. A total of 173 patients were recruited. Data were gathered via custom questionnaires collected by study site coordinators and entered into a secure online platform. Descriptive analyses and correlation statistics were run with SAS 9.3.1. Of the 13 guideline statements in the American Academy of Otolaryngology-Head and Neck Surgery Foundation's clinical practice guideline on sudden hearing loss, 11 statements were evaluable through this study. Compliance for otolaryngologists was >95% for key action statements (KASs) 1, 3, and 6; 90% to 95% for KASs 5 and 10; and <90% for KASs 7 and 13. Compliance was <45% for nonotolaryngologists for KASs 3 and 5-7. There is opportunity for nonotolaryngologists to improve for statements 3 and 5-7. Otolaryngologists are compliant with many of the KASs overall, but there is significant room for improvement.

Evidence and Evidence Gaps - an Introduction

Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the medical education of students.One problem is the wealth of information, so that in clinical practice there may be gaps in knowledge of actual evidence. Usually it still takes several years until new knowledge is fully implemented in daily practice. The German Society of Otolaryngology, Head and Neck Surgery (DGHNOKHC) and the German professional association of otolaryngologists (BVHNO) have a vested interest in supporting their members in the generation, processing and dissemination of evidence, and to foster the transfer of knowledge into practice. This includes the areas of diagnosis, treatment, prognosis and prevention as well as drug therapies or the application of medical devices or surgical procedures. Crucial is the regular determination of existing evidence gaps, including in the area of already established procedures, which must be followed by a prioritization of research questions and subsequent conduct of clinical research. Only with combined efforts even large trials can be performed, to test therapies and diagnostics for example, also after approval under everyday conditions. Methods, Results and Vision: The executive committees of DGHNOKHC and BVHNO have together founded the German Clinical Trials Unit for Ear, Nose and Throat medicine, Head and Neck Surgery (DSZ-HNO) to assist their members in the identification of evidence gaps and the planning and conduct of systematic reviews and clinical trials. The first projects have been started, including a BMBF(German Ministry for education and research)-funded clinical trial for the treatment of sudden hearing loss and a survey to detect evidence gaps in Otolaryngology. It seems both reasonable and feasible to provide a structure such as a jointly-run study center for doctors in hospitals and medical practices to assist in clinical research and to anchor the principles of evidence-based medicine in daily life.

The curative effect analysis between postauricular injection and systemic application of glucocorticoids in the treatment of sudden hearing loss

Objective To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of sudden hearing loss. Methods Total of 58 patients with sudden hearing loss were randomly divided into two groups.The systemic application group:dexamethasone(DEX) was applied by intravenous injection in dose of 10mg×3d,followed by 5mg×4d.And the postauricular injection group: methylprednisolone sodium succinate of 40mg was injected into cortical bone of mastoid region every three days, until hearing back to normal,or 15 days.SPSS 13.0 software was used to analyze the data. Results The total effective rate of systemic application group was 67.7%,the total effective rate of postauricular injection group was 64.7%.There was no statistical difference between the two groups(χ2= 2.58,P= 0.316).The recovery rate in cases with postauricular injection group was significantly increased in comparison with the systemic application group,but no statistical difference between the two groups(t= 2.71,P= 0.062).Patients with hearing loss in low frequencies(250Hz,500 Hz),the recovery rate in cases with postauricular injection group was significantly increased in comparison with the systemic application group(t= 3.82,P= 0.031;t= 3.26,P= 0.042). Conclusion Postauricular topical injection and systemic application of glucocorticoids in the treatment of sudden hearing loss are all have good curative effect.Systemic application is selected by conventional treatment,and topical injection has a better effect in the hearing loss of low-middle frequencies. Key words: Hearing loss; Sudden; Glucocorticoids; Drug administration routes

Efficacy of multimodality approach to sudden hearing loss.

This study aims to investigate whether addition of intratympanic steroid (ITS) to systemic steroid and hyperbaric oxygen (HBO) is effective in the treatment of sudden hearing loss (SHL). Between January 2008 and October 2011, 58 patients diagnosed with SHL were enrolled in the study. Twenty patients (11 males, 9 females; mean age 45.3±21 years; range 24 to 66 years) who received systemic steroid and HBO composed group 1, while 38 patients (19 males, 19 females; mean age 41.6±16 years; range 25 to 61 years) who received ITS in addition to systemic steroid and HBO composed group 2. Post-treatment hearing improvement was statistically significant in both groups in terms of the mean pure tone according to the Siegel's criteria (p<0.05). Treatment was successful at 55% of patients in group 1 and 63% in group 2. Despite increased success rate with the addition of ITS, it did not indicate statistical significance (p>0.05). However, there was a strong statistically significant difference in terms of profound hearing loss over 90 dB (p<0.05). None of six patients (0%) with profound hearing loss in group 1 benefited treatment, while addition of ITS to the treatment yielded success in six of 12 patients with profound hearing loss (50%) in group 2 (p<0.05). Addition of ITS to systemic steroid and HBO treatment may yield better results in patients with SHL. However, ITS injection seems beneficial for patients with profound SHL.

Therapeutic effect of combined steroid–lipoprostaglandin E1 for sudden hearing loss: a propensity score-matched analysis

ObjectivesThe aim of this study is to analyze the synergistic effect of combined steroid–lipoprostaglandin E1 for the treatment of sudden hearing loss. MethodsA prospective observational, non-randomized study with a historical cohort was performed at a university hospital. Between 2005 and 2012, 421 patients with idiopathic sudden sensorineural hearing loss were enrolled in this study and treated with combined steroid–lipoprostaglandin E1 treatment. Additionally, 132 patients were prospectively enrolled and treated with steroid treatment alone between January 2013 and March 2014. After performing a propensity score-matched analysis, final hearing levels and the degree of recovery were compared according to treatment options. ResultsA total of 240 patients were enrolled after propensity score-matching, with 180 patients classified as combined steroid–lipoprostaglandin E1 treatment group (group I) and 60 patients as steroid treatment alone group (group II). The final hearing level (35.56±34.64dB) in group I was not significantly different from that in group II (34.64±24.67dB) (p<0.05). Logistic regression analysis revealed that the combined treatment did not influence recovery, and the probability of recovery was 1.881 times higher in the absence of dizziness (95% confidence interval: 1.022–3.464, p=0.042), and 1.026 times higher in patients with better hearing in healthy ears (95% confidence interval: 1.010–1.041, p=0.001). ConclusionCompared to steroid treatment alone, combined steroid–lipoprostaglandin E1 treatment failed to improve sudden hearing loss.

Transtympanic dexamethasone injection in the treatment of sudden hearing loss after otologic surgery

Transtympanic dexamethasone injection in the treatment of sudden hearing loss after otologic surgery

Phosphodiesterase Type 5 Inhibitors and sudden sensorineural hearing loss

Phosphodiesterase type 5 Inhibitors, such as sildenafil, vardenafil and tadalafil have been increasingly used today and some of the users have developed sudden sensorineural hearing loss. ObjectiveTo present two patients with sudden deafness developed after an occasional use of the drug and review studies on the use of phosphodiesterase type 5 inhibitors and sudden hearing loss. MethodAnalytical study of two cases and review of the subject matter in the Pubmed/Medline and Bireme databases using the keywords: phosphodiesterase type 5 inhibitors and sudden deafness and its correlates in the English language. ResultsThe patients analyzed are young without additional disorders, using phosphodiesterase type 5 inhibitors, and after combination treatment for sudden hearing loss only one had hearing improvement. We found nine scientific studies and reviewed preclinical studies, clinical trials, prospective and cross-sectional investigations. ConclusionIncreased occurrence in clinical practice and scientific reports in the literature suggest that the phosphodiesterase type 5 inhibitors are considered a risk factor for sudden deafness. Further studies with larger samples and control groups are needed for better assessing this association.

The role of allergy in the etiopathogenesis of idiopathic sudden sensorineural hearing loss

To evaluate the role of allergy in the etiopathogenesis of sudden hearing loss using cytokine profile, allergic parameters, and lymphocyte subgroups, a total of 31 patients aged between 30 and 62 years (mean age: 42.48 ± 15.86 years) with the diagnosis of sudden hearing loss were enrolled in the study between 2008 and 2011. The control group comprised 30 age-matched adult subjects accepted as clinically healthy individuals living in the same region with comparable socioeconomic parameters. The patient and the control group were questioned for history of allergy. Lymphocyte subgroups in the peripheral blood were evaluated using Becton-Dickinson monoclonal CD4, CD8, CD19, and CD23 antibodies. In the patient and control groups, the levels of IFN- γ, IL4, IL10, and total IgE were measured and compared between the groups. Skin test was used for detection of inhaler allergens in the patient and the control groups, and specific IgE tests were performed using the RAST method for food allergens. The Spearman's rho correlation, the unpaired t test, the Mann-Whitney U test, and the Shapiro-Wilk test were used to determine the differences between the groups. The limit for statistical significance was p < 0.05. When the patient and the control group were compared, the differences between CD4, CD23, IL4, IL10, and IgE were statistically significant. On analyses of the patients' serum samples, strongly positive correlations were determined between IgE and CD23, IL10, IL4; IL4 and IL10, CD23, CD4; IL10 and CD23, CD4 (Spearman rho, p = 0.000), while a weakly positive correlation was found between IgE and CD4 (Spearman rho, p = 0.020). A correlation between IFN-γ and CD4 was weakly negative (Spearman rho, p = 0.040). The total IgE levels were estimated to be above the normal reference ranges (0-100 IU/ml) in 25.8 % of the cases in the patient group. History of allergy was found in 61.9 % of the patients. The results of this study substantiate the role of allergy in the etiopathogenesis of sudden hearing loss. We think that during the diagnostic work-up of these patients allergy should be interrogated seriously, necessary tests should be performed, and allergy should be considered in the decision-making process of the treatment of sudden hearing loss.

Fabry disease presenting with sudden hearing loss and otosclerosis: a case report

IntroductionFabry disease is an X-linked lysosomal storage disorder resulting in a multiple-system disorder with a wide spectrum of physical signs and symptoms, predominantly affecting the central and peripheral nervous systems, skin, heart, kidneys, and eyes.Case presentationWe describe the case of a 26-year-old European Caucasian man who had Fabry disease and who presented with episodic sudden unilateral hearing loss and was treated with glucocorticoids, pentoxifylline, hyperbaric oxygen, and fluoride because of concomitant audiometric evidence of otosclerosis. This case demonstrates the partial and transient beneficial effect of standard treatment for sudden hearing loss not related to Fabry disease and analyzes the possible connection between typical Fabry disease inner-ear lesions and otosclerosis. Whereas hearing loss has been described in connection with Fabry disease, otosclerosis-associated hearing loss in Fabry disease has not yet been described.ConclusionsAlthough progressive hearing loss in patients with Fabry disease seems to be influenced by replacement therapy, few data concerning treatment of sudden hearing loss are available. The lack of literature concerning the pathogenesis of the otological involvement in Fabry disease makes it impossible to identify a connection between the latter and otosclerosis. Therefore, this report may help to reinforce the importance of a thorough evaluation of hearing in patients with Fabry disease and may be of help with therapeutic decision-making.

Ani İşitme Kaybında İntratimpanik Metil Prednizolon Kurtarma Tedavisi

Objective: The aim of the study was to determine effectiveness of intratympanic methyl prednisolone injection as a salvage therapy for sudden sensorineural hearing loss in patients who did not have complete recovery with systemic treatment. Material and Methods: Sixteen patients with sudden hearing loss who did not have complete recovery or had a partial recovery with systemic treatment enrolled in this prospective study. After the topical anesthesia, 0.4-0.5 mL of methyl prednisolone (40 mg/mL) was administered into the middle ear from the postero-inferior quadrant of the tympanic membrane. Pure tone audiometry test was performed before each injection and after the final injection. A change more than 10 dB in the pure tone average was considered as an alteration in hearing (improvement or worsening). Complete recovery was accepted when the pure tone average was 20 dB or lower. Results: The mean onset of intratympanic methyl prednisolone treatment after the hearing loss was 16±6.6 days (range: 7 -30 days). The average number of injections was 3.8±1.3 (range: 2-6). The improvement in pure tone average was statistically significant [initial median of pure tone average was 85 dB (minimum 28 dB, maximum 107 dB), final median of pure tone averages was 42.5 dB (minimum 12 dB, maximum 107dB), p=0.007]. Eleven (68.75%) patients improved, but no change was observed in 5 (31.25%) patients. Two (12.5%) patients attained complete recovery. Four (25%) patients improved to 30 dB or less in pure tone average. Statistically significant improvement was also obtained at 250, 500, 1,000, 2,000, 4,000 and 6,000 Hz frequencies. Conclusion: These results suggested that intratympanic methyl prednisolone treatment for sudden hearing loss in patients who did not respond to systemic therapy appears to be a good alternative for better hearing results.

Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

Evaluation of effectiveness of stellate ganglion block (SGB) treatment of sudden hearing loss

Conclusion: A stellate ganglion block (SGB) based on the goal of improving internal ear circulatory disturbance appears to be beneficial for the treatment of sudden hearing loss. Objectives: To evaluate the effectiveness of SGB for sudden hearing loss. Methods: This retrospective study reviewed the medical records of 49 patients who received SGBs and 496 patients who received only conservative therapy, primarily with systemic steroids, for treatment of sudden hearing loss. Propensity scores were used in pairwise matching of these patients to avoid selection biases between the two treatment modalities. Results: Propensity score matching yielded 48 pairs. The mean therapeutic effect of the SGB was calculated to be 0.40 ± 0.20 (mean ± standard error, p = 0.051).

Clinical Practice Guideline: Sudden Hearing Loss

Program DescriptionThe miniseminar will consist of a lively panel discussion on the evidence‐based recommendations for the diagnosis and treatment of sudden hearing loss. The panel will discuss the newly developed AAO‐HNS clinical practice guideline. The primary purpose of the guideline is to improve the diagnosis and management of sudden hearing loss in adults aged 18 years and older. In creating this guideline the AAO‐HNSF selected a panel representing the fields of otolaryngology‐head and neck surgery, audiology, otology, neurology, neurotology, family medicine, emergency medicine, and consumers.Educational Objectives1) Learn diagnostic criteria for sudden sensorineural hearing loss. 2) Plan treatment based on current best evidence from randomized, controlled trials. 3) Identify management and counseling strategies that improve quality of care.

Oxygenation at high pressure in the primary treatment of sudden hearing loss

Oxygenation at high pressure in the primary treatment of sudden hearing loss

Unacceptable Subgroups

In his CME article on the treatment of sudden idiopathic sensorineural hearing loss, Professor Suckfull postulates several allegedly necessary diagnostic measures ranging from ear microscopy to tympanometry to acoustic evoked response audiometry. However, he does not deliver any proof of the benefits of these recommendations—decided on the basis of a consensus. He rightly points out that no confirmed proofs exist for the treatment of sudden hearing loss. In this context, the “selective literature search” takes its revenge, so to speak: the studies by Desloovere (1, 2), which—in addition to the cited one by Klemm et al—disprove the benefits of treatment with plasma expanders, are not mentioned. It is entirely unacceptable to extract subgroups from studies with negative evidence, with the intention of deducing positive recommendations. The recommendation to offer HAES infusions—which are known for their potential to cause renal damage (3) and lifelong persistent pruritus (4, 5)—as individual health services is completely misplaced in a CME article.

Intratympanic Methylprednisolone in Refractory Sudden Hearing Loss

Treatment of sudden hearing loss is a significant matter of discussion. Lack of knowledge of the natural history of the disease and the use of different success criteria are 2 of the main reasons why it is difficult to critically evaluate the data available in the literature. To date, no therapy has proved effective according to the evidence criteria. However, there has been a trend toward the use of steroids in recent years. The management of patients who fail to respond to standard therapy is even more complex; in these cases, intratympanic steroids have been proposed as a valuable solution. Twenty-seven patients unresponsive to traditional systemic therapy were treated with intratympanic steroids. The mean pure-tone average before intratympanic treatment was 79.9 +/- 21.4 SD dB; at Day 30, after local steroid administration, the mean pure-tone average was 60.6 +/- 24.9 SD dB. According to our criteria, 15 (55%) of 27 patients presented a "useful" improvement in the hearing status. No serious complications have been observed. Local application is confirmed as easy to perform and is associated with negligible complications. Our experience, although retrospective, seems to confirm the usefulness (at least in 50% of patients) of local steroids administration in cases of refractory sudden sensorineural hearing loss. Our encouraging data strongly call for further and serious evaluation through randomized studies.

Fibrinogen/LDL apheresis as successful second-line treatment of sudden hearing loss: a retrospective study on 217 patients

Background Sudden sensorineural hearing loss (SSHL) may be caused by a reduction of cochlear perfusion. Cholesterol and fibrinogen negatively influence rheological properties of blood thus leading to alteration of microcirculation. Fibrinogen/LDL apheresis improves cochlear blood flow by acutely decreasing plasma cholesterol and fibrinogen. Methods Remission rates of 217 patients with SSHL were analysed retrospectively after single apheresis. All patients had been treated otherwise before without any improvement of hearing. We investigated data in regard to frequency of hearing loss and time between onset of symptoms and apheresis. Results 15% of all patients had complete remissions, whereas partial remissions were seen in 46%. No change of hearing threshold was seen in 33%, 2% worsened. Remission rates decreased from 70% for a time of 2 weeks between onset of SSHL and apheresis to 63% and 21% for 6 weeks and 3 months. Conclusion The present study shows that apheresis was followed by complete or partial remissions in 61% of patients even as second line therapy. The window for good therapeutic success is approximately 6 weeks.