Unilateral Idiopathic Sudden Sensorineural Hearing Research Articles

Evaluation of Role of Prognostic Factors on Hearing Outcome in Unilateral Idiopathic Sudden Onset Sensorineural Hearing Loss

Introduction: Owing to its uncertain and multiple possible etiologies, use of multiple empirical treatment regimens and possibility of spontaneous recovery, it becomes important to look for the possible prognostic factors affecting the outcome of sudden sensorineural hearing loss (SSNHL). Material and methods: This prospective observational study was conducted with the primary aim of analyzing the role of various possible prognostic factors on the outcome of idiopathic SSNHL including demographic (Age, gender), audio-vestibular (Pre-treatment hearing loss in the affected ear, hearing in the contralateral ear, time elapse between onset of hearing loss and start of treatment, type of hearing loss in term of frequencies affected), presence of tinnitus / vertigo and Comorbidities (Diabetes, Hypothyroidism & Deranged lipid profile/ dyslipidemia). Result: The absence of vertigo and tinnitus led to better hearing outcomes while raised HbA1c levels, deranged lipids and thyroid profiles adversely affected the outcome. Conclusion: Vertigo, tinnitus, raised HbA1c levels, deranged lipids and thyroid profiles are possible negative prognostic factors. Better pretreatment hearing levels in the affected and unaffected ears prompted improved recovery.

The functional status of vestibular otolith and conductive pathway in patients with unilateral idiopathic sudden sensorineural hearing loss.

The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) remains unknown. It has been found that the functional status of the vestibular otolith is relevant to its prognosis; however, the evaluation of the vestibular otolith (intra-labyrinth) and superior and inferior vestibular nerve pathways (retro-labyrinth) in ISSNHL patients is not well-documented. This study aimed to investigate the functional status of the vestibular otolith and conductive pathway in patients with unilateral ISSNHL and analyze the correlations between vestibular evoked myogenic potentials (VEMPs) and hearing improvement after treatment. A total of 50 patients with unilateral ISSNHL underwent a battery of audio-vestibular evaluations, including pure tone audiometry, middle ear function, air-conducted sound-cervical VEMP (ACS-cVEMP), ACS-ocular VEMP (ACS-oVEMP), galvanic vestibular stimulation-cervical VEMP (GVS-cVEMP), and GVS-ocular VEMP (GVS-oVEMP). The results of auditory and VEMPs were retrospectively analyzed. The abnormal rates of ACS-cVEMP, ACS-oVEMP, GVS-cVEMP, and GVS-oVEMP in affected ears were 30, 52, 8, and 16%, respectively. In affected ears, the abnormal rate of ACS-oVEMP was significantly higher than that of ACS-cVEMP (p = 0.025), while it was similar between GVS-cVEMP and GVS-oVEMP (p = 0.218). Compared with GVS-cVEMP, affected ears presented with a significantly higher abnormal rate of ACS-cVEMP (p = 0.005), and the abnormal rate of ACS-oVEMP was significantly higher than that of GVS-oVEMP (p < 0.001). No significant difference existed in latency and amplitude between affected and unaffected ears in ACS-VEMPs or GVS-VEMPs (p > 0.05). The abnormal rate of VEMPs in the poor recovery group was significantly higher than that of the good recovery group (p = 0.040). The abnormality percentages of ACS-oVEMP and GVS-oVEMP in the poor recovery group were significantly higher than that of the good recovery group (p = 0.004 and 0.039, respectively). The good hearing recovery rates were 76.47% in the normal VEMPs group, 58.33% in the intra-labyrinth lesion group, and 22.22% in the retro-labyrinth lesion group. Hearing recovery worsened as a greater number of abnormal VEMPs was presented. Besides Corti's organ, the impairment of otolithic organs was prominent in patients with ISSNHL. The normal VEMPs group had the highest rate of good recovery, followed by the intra-labyrinth lesion group and the retro-labyrinth lesion group presented with the lowest recovery rate. Abnormalities in ACS-oVEMP and/or GVS-oVEMP were indicators of a poor prognosis.

Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses.

To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days. The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25-0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I 2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26-0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I 2 = 52.1%). The OR was 0.31 (95% CI, 0.21-0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I 2 = 0.0%). Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome. Level I.

Vestibular evoked myogenic potential may predict the hearing recovery in patients with unilateral idiopathic sudden sensorineural hearing loss.

This study investigates the association between vestibular function and prognosis in patients with unilateral idiopathic sudden sensorineural hearing loss (UISSNHL). A retrospective analysis of 64 patients with UISSNHL was performed. Pure tone audiometry and vestibular function tests for otoliths and semicircular canals were performed to assess the influence of vestibular functional status on the outcome of patients with UISSNHL. Patients with abnormal cervical vestibular evoked myogenic potential (cVEMP) or ocular vestibular evoked myogenic potential (oVEMP) responded less favorably to treatment. In the ineffective group, cVEMP was normal in four patients (6.3%) and oVEMPs in three (4.7%). Meanwhile, cVEMP was abnormal in 32 patients (50.0%) and oVEMP in 33 (51.6%). Better hearing recovery occurred in those with normal cVEMP (33.76 ± 15.07 dB HL improvement) or oVEMP (32.55 ± 19.56 dB HL improvement), but this was not the case in those with normal caloric tests. Patients with abnormalities in both cVEMP and oVEMP were less responsive to treatment and had worse hearing recovery than those with normal results in only one of the two tests. Abnormal oVEMP and/or cVEMP results indicate poor auditory outcomes in patients with UISSNHL. Patients with impaired otolith organ function are likely to have a larger and more severe pathological change in their inner ear.

Vascular loops in cerebellopontine angle in patients with unilateral idiopathic sudden sensorineural hearing loss: Evaluations by three radiological grading systems.

ObjectiveWe aimed to investigate the impact of the position, configuration and neurovascular contact of the anterior inferior cerebellar artery (AICA) in cerebellopontine angle (CPA) and internal auditory canal (IAC) on the clinical features of patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsOne hundred and thirty‐six patients with unilateral ISSNHL were enrolled. All patients received detailed history inquiry and standard treatments. Pure tone audiometry and magnetic resonance imaging (MRI) of CPA‐IAC were performed. The MRI findings of both ears were evaluated by the Chavda, Gorrie and Kazawa systems. The association between radiological findings and clinical data were analyzed.Results(1) No significant interaural difference in the position, configuration and neurovascular contact of AICA was observed. (2) There was no significant association between the AICA loop and concomitant vertigo or pre‐treatment audiometric configuration in the affected ear. (3) Concomitant tinnitus seemed to be affected by the configuration of AICA categorized by Kazawa system, while the Chavda and Gorrie classification of AICA loop was unassociated with tinnitus. (4) Hearing outcomes were not compromised by the position or configuration of AICA based on the Chavda and Kazawa systems. Patients with Gorrie type B tended to have better hearing recovery than those with type C.ConclusionsIn patients with ISSNHL, the position, configuration and neurovascular contact of AICA in the CPA‐IAC were unassociated with the side of hearing loss, audiometric configurations, or concomitant vertigo. The neurovascular contact graded by Gorrie system might be associated with hearing outcomes.

Otoacoustic emissions value in patients with idiopathic sudden sensorineural hearing loss

ObjectivesThis study aimed to determine the prognostic value of otoacoustic emissions (OAEs) in idiopathic sudden sensorineural hearing loss patients. MethodsThe study included 30 subjects with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). Each patient was evaluated four times: at baseline and after one week, one month, and three months of treatment. During each visit, each patient was subjected to full audiological history, otoscopic examination, basic audiological evaluations, and transiently evoked and distortion product otoacoustic emission (TEOAEs & DEOAEs). ResultsThe hearing thresholds (frequency range 250–8000 Hz) and word recognition scores of patients with detectable TEOAEs and DPOAEs improved significantly, whereas no significant improvements were observed in those with no response. ConclusionHearing improvement is better in patients with detectable TEOAEs and DPOAEs. As a result, TEOAEs and DPOAEs are recommended as routine tests in all SSNHL patients to predict outcomes and monitor treatment as TEOAEs and DPOAEs reflect the cochlear OHCs activity.

Clinical Significance of White Matter Lesions in Idiopathic Sudden Sensorineural Hearing Loss.

Background : We aimed to analyze the patient characteristics in accordance with white matter lesions and confirm whether white matter lesions affect final treatment outcomes in idiopathic sudden sensorineural hearing loss.Methods: Medical records of 126 patients treated for unilateral idiopathic sudden sensorineural hearing loss and who underwent magnetic resonance imaging of the brain at an otology clinic in a university hospital from 2013 to June 2019 were reviewed. The Fazekas scale was used to evaluate the severity of white matter lesions. Complete recovery was defined if final hearing at 3 months did not exceed 25 dB.Results: Overall, 107 patients were enrolled in this study. A score of 0 on the Fazekas scale was most frequent (n = 78, 72.9%), followed by 1 (n = 17, 15.9%), and 2 (n = 12, 11.2%). Prevalence of diabetes (P = .032) and/or hypertension (P = .006) and distribution of age (P < .001) were different according to Fazekas scale scores. Hearing level in the affected side was significantly different between those with scores of 1 and 2 (P = .009). Contralateral hearing thresholds were not different according to Fazekas scale scores, but hearing on the contralateral side was significantly poorer in patients with hypertension than those without hypertension (P < .001). Regression analysis revealed that Fazekas scale score and initial hearing thresholds of the affected side were significant prognostic factors for complete recovery.Conclusion: Although the prevalence of white matter lesions in idiopathic sudden sensorineural hearing loss was not high, severe white matter lesions and accompanying cardiovascular risk factors may increase the possibility of initially worse hearing and decrease response to treatment in idiopathic sudden sensorineural hearing loss. Therefore, it might be important to control cardiovascular abnormalities in idiopathic sudden sensorineural hearing loss to achieve a better prognosis.

The impairment of speech perception in noise following pure tone hearing recovery in patients with sudden sensorineural hearing loss

To explore whether patients with unilateral idiopathic sudden sensorineural hearing loss (uISSNHL) have normal speech in noise (SIN) perception under different masking conditions after complete recovery of pure tone audiometry. Eight completely recovered uISSNHL patients were enrolled in ISSNHL group, while 8 normal-hearing adults matched with age, gender, and education experience were selected as the control group. Each group was tested SIN under four masking conditions, including noise and speech maskings with and without spatial separation cues. For both ISSNHL and control groups a two-way ANOVA showed a statistically significant effect of masking type (p = 0.007 vs p = 0.012). A significant effect of perceived spatial separation (p < 0.001 vs p < 0.001). A significant interaction between masking type and perceived spatial separation was found (p < 0.001 vs p < 0.001). A paired sample T-test showed that the SIN perception of the control group was statistically significant lower than that of ISSNHL patients only under speech masking without spatial separation cues (p = 0.011). There were still abnormalities in the auditory center shortly after complete recovery in the ISSNHL group (within 2 weeks). However, the auditory periphery and higher-level ability to use spatial cues was normal.

Long-Term Prognosis of Tinnitus Associated with Idiopathic Sudden Sensorineural Hearing Loss

Objective: To analyze the factors affecting the long-term prognosis of tinnitus accompanied by unilateral idiopathic sudden sensorineural hearing loss (SSNHL). Methods: A total of 161 patients with sudden hearing loss (HL) accompanied by tinnitus were enrolled. All patients had two separate telephone follow-ups and were asked about changes in tinnitus. The severity of tinnitus at admission and the outcome at discharge were assessed in terms of the patients’ sex, age, level of HL, type of audiogram, etc. Results: The prognosis of tinnitus after SSNHL had no relationship with grades of HL or hearing recovery. Initial tinnitus level was remarkably associated with tinnitus improvement at discharge and was an independent risk factor for the long-term prognosis of residual tinnitus after SSNHL (odds ratio 0.722, 95% confidence interval 0.550–0.949, p = 0.019), and the median recovery time was 23.00 ± 3.80 months. Conclusions: Residual tinnitus after SSNHL has a tendency of self-recovery. The short-term prognosis of tinnitus may be related to psychological changes caused by hearing recovery, while the long-term prognosis of residual tinnitus after SSNHL is related only to the initial tinnitus level, with a median recovery time of approximately 2 years.

Visualization of Endolymphatic Hydrops in Patients With Unilateral Idiopathic Sudden Sensorineural Hearing Loss With Four Types According to Chinese Criterion.

Objective: The aim of this study is to evaluate the possible value of endolymphatic hydrops (EH) in patients with unilateral idiopathic sudden sensorineural hearing loss (UISSNHL) with four types according to audiometry.Methods: Seventy-two patients (40 men and 32 women; age range, 28–78 years; mean age: 50.0 ± 12.9 years) with UISSNHL were admitted retrospectively into this study. Based on the pure tone audiometry before treatment, the hearing loss of all these patients were categorized into four types: low-frequency group (LF-G), high-frequency group (HF-G), flat group (F-G), and total deafness group (TD-G). The average time from symptom onset to the first examination was 6.9 ± 4.4 days (1–20 days). 3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium (Gd) within 1 week after the UISSNHL onset. The incidence of EH in the affected ears based on four types of hearing loss were analyzed using the Chi-square test, and the possible relationship with vertigo and prognosis were also assessed.Results: Eleven of 21 patients (52.4%) in LF-G had the highest EH-positive rate, followed by 18.2% in HF-G, 11.8% in F-G, and 17.4% in TD-G. The significant difference was found in the four groups (P = 0.018). The EH rate of LF-G was statistically significantly higher than that of F-G and TD-G (P = 0.009, P =0.014), respectively. After being valued by the volume-referencing grading system (VR scores), the EH level was represented by the sum scores of EH. In LF-G, no statistically significant difference was found in the prognosis of ISSNHL patients between with the EH group and the no EH group (P = 0.586). The symptom “vertigo” did not correlate with EH and prognosis.Conclusions: EH was observed in UISSNHL patients by 3D-FLAIR MRI. EH may be responsible for the pathology of LF-G but not related to prognosis. It might be meaningless to assess EH in other hearing loss types, which might be more related to the blood-labyrinth dysfunction.

Imaging Parameters of the Ipsilateral Medial Geniculate Body May Predict Prognosis of Patients with Idiopathic Unilateral Sudden Sensorineural Hearing Loss on the Basis of Diffusion Spectrum Imaging.

Idiopathic sudden sensorineural hearing loss is an acute unexplained onset of hearing loss. We examined the central auditory pathway abnormalities in patients with unilateral idiopathic sudden sensorineural hearing loss using diffusion spectrum imaging and the relationships between hearing recovery and diffusion spectrum imaging parameters. Forty-eight patients with unilateral idiopathic sudden sensorineural hearing loss with a duration of ≤2 weeks (range, 8.9 ± 4.3 days) and 20 healthy subjects underwent diffusion spectrum imaging tractography. Hearing levels were evaluated using a pure-tone average at initial presentation and 3-month follow-up. Clinical characteristics and MR imaging findings were assessed. Compared with healthy control subjects, the generalized fractional anisotropy values of patients decreased significantly in the bilateral posterior limbs of the internal capsule, with no differences between the ipsilateral and contralateral sides. The quantitative anisotropy values decreased in the Brodmann area 41, contralateral medial geniculate body, bilateral lateral lemniscus, anterior limb of internal capsule, middle temporal gyrus, and anterior corona radiata. Furthermore, at 3-month follow-up, 14 patients had <15 dB of hearing gain. Receiver operating characteristic curve analysis demonstrated that generalized fractional anisotropy in the ipsilateral medial geniculate body was related to prognosis (sensitivity = 64.7%; specificity = 85.7%; area under the curve = 0.796, 95% CI, 0.661-0.931; P < .01). Diffusion spectrum imaging can detect abnormalities of white matter microstructure along the central auditory pathway in patients with unilateral idiopathic sudden sensorineural hearing loss. The generalized fractional anisotropy value of the ipsilateral medial geniculate body may help to predict recovery outcomes.

Basilar artery tortuosity as a predictive factor for the efficacy of heparin adjuvant therapy in unilateral idiopathic sudden sensorineural hearing loss

IntroductionCochlear ischemia is hypothesized as one of the major etiologies of idiopathic sudden sensorineural hearing loss. Therefore, anticoagulant therapies are designed to be beneficial in certain patients with this condition. ObjectiveThis study aimed to determine which patients with idiopathic sudden sensorineural hearing loss would benefit from heparin treatment as adjuvant therapy. MethodsIn total, 134 patients who underwent magnetic resonance imaging for unilateral idiopathic sudden sensorineural hearing loss at a tertiary referral hospital between January 2014 and December 2018 were included in this retrospective study. All patients received Intratympanic steroid injections or heparin therapy plus oral corticosteroids. Radiological parameters of the vertebrobasilar system and clinical data from pre- and post-treatment assessments were analyzed. ResultsMost patients (71.6%) had a tortuous basilar artery The 65 patients with severe-to-profound idiopathic sudden sensorineural hearing loss showed a significant relationship between idiopathic sudden sensorineural hearing loss laterality and basilar artery displacement to the opposite side (p = 0.036), while the 69 patients with mild-to-moderate idiopathic sudden sensorineural hearing loss did not (p = 0.950). Additionally, the degree of basilar artery tortuosity was significantly associated with the degree of hearing impairment in the severe-to-profound idiopathic sudden sensorineural hearing loss group (p = 0.015). When idiopathic sudden sensorineural hearing loss occurred on the opposite side to basilar artery displacement, the improvement of hearing was significantly greater in patients treated with heparin than in those treated with intratympanic steroids (p = 0.041). ConclusionIn a subset of patients with severe-to-profound idiopathic sudden sensorineural hearing loss, basilar artery tortuosity had a significant directional relationship with idiopathic sudden sensorineural hearing loss laterality. In these selected patients, a significant effect of heparin therapy on improving hearing was observed.

Comparison of the Treatment Outcome Between Primary Intratympanic Steroid and Salvage Intratympanic Steroid Protocol in Sudden Sensorineural Hearing Loss: Propensity Score Matching Analysis

Background and Objectives We aimed to compare the treatment outcomes of primary intratympanic steroid (ITS) and the salvage ITS protocol.Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37 patients received ITS only as a primary treatment while other patients received systemic steroid; of those remaining patients, 276 received systemic steroid as well as ITS as a salvage treatment. We performed a 1:2 propensity score matching analysis for both groups using parameters such as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertension and diabetes. The rate of hearing recovery was determinied by comparing the matching propensity score between the primary ITS and the control group according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline and Siegel’s criteria.Results Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% of patients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%) were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did not recover their hearing according to AAO-HNS guideline. The propensity score matching showed that the initial hearing level, age and onset of treatment were not significantly different between the primary ITS and control group. Regarding the treatment outcome, complete recovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of the primary ITS group, statistical significance was not identified.Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantly affect the clinical outcomes of ISSNHL differently.

The semicircular canal function tests contribute to identifying unilateral idiopathic sudden sensorineural hearing loss with vertigo.

Few studies focused on the prognosis of unilateral idiopathic sudden sensorineural hearing loss (UISSNHL) with vertigo. To describe how the semicircular canal (SCC) function tests may prove helpful in the diagnosis of UISSNHL with vertigo. 59 UISSNHL patients underwent audiometry, caloric test and video head impulse test (vHIT). The correlation between hearing loss and SCC dysfunction was analyzed. The results showed significant differences of hearing loss grades (p=0.004) and hearing loss configurations (p=0.009) between UISSNHL patients with and without vertigo. In vHIT, the gains of horizontal canal (HC) and posterior canal (PC) were more frequently impaired compared with that of anterior canal (AC). The abnormal rate of caloric test was the highest, followed by the abnormal rates of HC and PC gain. A significant difference of abnormal rate of HC gain was only found between the mild and moderate UISSNHL patients with and without vertigo (p=0.029). Abnormal SCC function happens frequently in patients with profound hearing loss. Ipsilesional abnormal vHIT (especially the HC gain) in the presence of abnormal caloric test is a pattern of findings observed in mild and moderate UISSNHL patients with vertigo.

Machine Learning Models for Predicting Hearing Prognosis in Unilateral Idiopathic Sudden Sensorineural Hearing Loss.

Objectives.Prognosticating idiopathic sudden sensorineural hearing loss (ISSNHL) is an important challenge. In our study, a dataset was split into training and test sets and cross-validation was implemented on the training set, thereby determining the hyperparameters for machine learning models with high test accuracy and low bias. The effectiveness of the following five machine learning models for predicting the hearing prognosis in patients with ISSNHL after 1 month of treatment was assessed: adaptive boosting, K-nearest neighbor, multilayer perceptron, random forest (RF), and support vector machine (SVM).Methods.The medical records of 523 patients with ISSNHL admitted to Korea University Ansan Hospital between January 2010 and October 2017 were retrospectively reviewed. In this study, we analyzed data from 227 patients (recovery, 106; no recovery, 121) after excluding those with missing data. To determine risk factors, statistical hypothesis tests (e.g., the two-sample t-test for continuous variables and the chi-square test for categorical variables) were conducted to compare patients who did or did not recover. Variables were selected using an RF model depending on two criteria (mean decreases in the Gini index and accuracy).Results.The SVM model using selected predictors achieved both the highest accuracy (75.36%) and the highest F-score (0.74) on the test set. The RF model with selected variables demonstrated the second-highest accuracy (73.91%) and F-score (0.74). The RF model with the original variables showed the same accuracy (73.91%) as that of the RF model with selected variables, but a lower F-score (0.73). All the tested models, except RF, demonstrated better performance after variable selection based on RF.Conclusion.The SVM model with selected predictors was the best-performing of the tested prediction models. The RF model with selected predictors was the second-best model. Therefore, machine learning models can be used to predict hearing recovery in patients with ISSNHL.

Tek Taraflı Ani İşitme Kayıplı Hastalarda Vestibüler Uyarılmış Miyojenik Potansiyel Bulguları

Tek Taraflı Ani İşitme Kayıplı Hastalarda Vestibüler Uyarılmış Miyojenik Potansiyel Bulguları

The Role of Endolymphatic Hydrops in Patients with Pantonal Idiopathic Sudden Sensorineural Hearing Loss: A Cause or Secondary Reaction

The purpose of this study was to investigate the presence of endolymphatic hydrops (EH) in both affected and unaffected ears of patients with pantonal unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) using three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) and further evaluate the significance of EH in this disorder. Twenty-seven ISSHL patients were enrolled in this study. 3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA). The incidences of EH in the affected ears and contralateral unaffected ears were compared and the correlations of EH with vertigo or prognosis were analyzed using the Chi-square test. The results showed that the incidence of EH was 68.0% (17/25) in the affected ears and 34.8% (8/23) in the unaffected ears. There was a statistically significant difference between affected ears and unaffected ears in regard to the incidence of EH (P&lt;0.05). There were no significant correlations of EH with vertigo (P=1.000) or with prognosis (P=0.359) in the affected ears. In conclusion, there is EH in the inner ear of patients with pantonal ISSNHL; EH is not related to vertigo, a concomitant symptom of ISSNHL, and the prognosis of this condition. The presence of EH may be a secondary reaction following the impairment of the inner ears with pantonal ISSNHL.

Outcomes of unilateral idiopathic sudden sensorineural hearing loss: Two decades of experience.

Objectives(a) Determine the demographic and medical risk factors for patients who presented with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL); (b) identify treatments that patients underwent; (c) evaluate the adequacy of follow‐up and compliance with long‐term hearing rehabilitation.MethodsRetrospective review of patients who presented with unilateral ISSNHL between January 1998 and December 2017 at a tertiary care academic medical center.ResultsTwo hundred‐four patients met inclusion criteria. Of these, 129 (63.2%) did not undergo treatment at an outside hospital prior to our evaluation. In this subgroup, the average pretreatment pure tone average (PTA) was 61.9 ± 2.5 dB (dB). The most common treatment was oral steroids and was recommended in 76 patients (59.9%). Patients also underwent intratympanic (IT) steroid injections (7.2%) or oral steroids followed by salvage IT injections (19.4%). Mean follow‐up duration was 17.9 (±29.2) months, and posttreatment PTA (45.6 ± 2.6 dB) was significantly better than baseline (P < .001). In this cohort, hearing amplification was infrequently recommended. Less than 20% of patients reported active hearing amplification use at their most recent visit. At follow‐up, 90 patients (69.8%) reported subjective improvement in hearing after treatment. Only 55 patients (42.6%) showed improvement in PTA compared to their pretreatment audiograms.ConclusionMany patients with ISSNHL experienced audiometric improvement after treatments, but most had persistent hearing loss. The duration of follow‐up was short. Most patients did not use long‐term hearing amplification. Future studies are needed to identify factors that contribute to reduced follow‐up and low compliance with hearing amplification use in ISSNHL.Level of Evidence2c.

Time and geographic clustering of adult patients with unilateral idiopathic sudden sensorineural hearing loss

For the preponderance of patients with unilateral idiopathic sudden sensorineural hearing loss (SSNHL), the etiology is unknown. The pathogenesis of disease and a definitive mechanism for this abrupt hearing loss has not yet been elucidated. We hypothesize that there is a time-clustered presentation for idiopathic SSNHL; from an epidemiological standpoint, this suggests an environmental or infectious etiology. At a tertiary referral center in the northeast United States, we have observed that adult patients with SSNHL present in clusters with interspersed intervals of time with no presentations.

Sleep quality analysis in patients with unilateral idiopathic sudden sensorineural hearing loss

Objective:To analyze the characteristics of sleep quality and its correlation with the clinical features and hearing curative effects in patients with unilateral idiopathic sudden sensorineural hearing loss (ISSHL). Method:Pittsburgh sleep quality index (PSQI) was applied to evaluate the sleep quality of unilateral ISSHL patients in our department. Patient group is divided into poor sleep quality subgroup (total PSQI score>7 points) and normal sleep subgroup (total PSQI score≤7 points). The differences of Patient group and two subgroups between hearing curative effect in the 30 days after treatment and sleep quality scores were compared and analyzed. Questionnaire survey was applied to control group, which contained 70 healthy people with normal hearing level and age matched. Result:A total of 75 cases were collected. To compare with control group, there were statistical difference in the scores of subjective sleep quality, habitual sleep efficiency, sleep disturbance and PSQI before treatment and in the score of habitual sleep efficiency after the treatment for 30 d (P<0.05). The sleep quality between poor sleep quality subgroup and normal sleep subgroup, total therapeutic effect after treatment for 30 d was no significant difference (P>0.05). The proportion for poor sleep quality were no statistically significant differences in the different efficacy of two subgroups (P>0.05). Two subgroups before treatment, in addition to sleep duration, there were statistically significant in all the sleep quality dimensions (P<0.05); after treatment for 30 d, in addition to subjective sleep quality, sleep duration, all have statistical difference (P<0.05). The poor sleep quality subgroup in the case group compared before and after treatment for 30 d, there was statistically significant in subjective sleep quality (P<0.05). The sleep disturbance before treatment, the sleep duration and PSQI scores after treatment for 30 d were associated with clinical features in patients with unilateral ISSHL (P<0.05). Conclusion:The sleep quality of patients with Unilateral SSNHL was significantly lower than that of normal hearing patients, the sleep quality had no significant effect on the general efficacy of unilateral SSNHL, but some sleep quality dimensions are associated with the clinical features before and after treatment.