Variability in the Management of Idiopathic Sudden Sensorineural Hearing Loss

2011 ◽  
Vol 145 (5) ◽  
pp. 813-817 ◽  
Author(s):  
Daniel H. Coelho ◽  
Leroy R. Thacker ◽  
David W. Hsu
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
The United States ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Educational Outreach ◽  
Diagnostic Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Oral Steroids

Objectives. To evaluate current trends in the management of idiopathic sudden sensorineural hearing loss (ISSNHL), determine if variance in diagnostic and treatment protocols exists, and compare diagnostic and treatment strategies of ISSNHL between nonotologists/neurotologists (NONs) and otologists/neurotologists (ONs). Study Design. Cross-sectional survey of practicing otolaryngologists. Setting. Otolaryngology practices within the United States. Subjects and Methods. In January 2010, a survey was mailed to 500 NONs and 500 ONs. Data were collected and analyzed using χ2, standard deviations, and variance. Results. A variety and distribution of responses were seen in the definition of ISSNHL, including dB loss necessary for diagnosis, number of consecutive frequencies involved, and maximum duration of hearing loss. Differences in diagnostic tools were also seen, with 50.4% of respondents (NON 34.2%, ON 66.7%; P = .0001) always using magnetic resonance imaging in their workup. Of the total respondents, 26.7% (NON 35.0%, ON 18.3%; P < .0001) preferred oral steroids alone; 22.1% (NON 11.7%, ON 32.5%; P < .0001) preferred a combination of oral and intratympanic steroids. Of the respondents, 68.6% (NON 57.5%, ON 80.0%; P = .0003) would continue with additional treatment after partial response; 20.8% (NON 33.3%, ON 8.3%; P < .005) would retreat with oral steroids alone and 46.6% (NON 35.8%, ON 57.3%; P < .05) with intratympanic injections. Overall, 69.2% (NON 45.8%, ON 92.5%; P = .0001) were very comfortable managing ISSNHL. Conclusion. Significant differences exist in the diagnosis and treatment of ISSNHL. Such lack of uniformity highlights the need for strong evidence-based research—ultimately leading to formalized practice guidelines and educational outreach.

scholarly journals A Prognostic Marker in Idiopathic Sudden Sensorineural Hearing Loss: Serum Calprotectin

2020 ◽  
Vol 13 (1) ◽  
pp. 36-40
Author(s):  
İhsan Kuzucu ◽  
Tuba Çandar ◽  
Deniz Baklacı ◽  
İsmail Güler ◽  
Rauf Oğuzhan Kum ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Response To Treatment ◽  
Control Group ◽  
Study Group ◽  
Cross Sectional ◽  
Historical Cohort ◽  
The Relationship

Objectives. Calprotectin, a protein released by neutrophils, has been used in many studies as a biomarker showing the presence of inflammation. In this study, it was aimed to investigate the relationship between serum calprotectin level and response to the treatment of idiopathic sudden sensorineural hearing loss (ISSHL).Methods. The present study is a prospective, cross-sectional historical cohort study. The study group consisted of 44 patients with ISSHL, and the control group consisted of 41 healthy volunteers without ear pathology. At the same time, patients in the study group were divided into three groups according to the response to ISSHL treatment (recovered, partially recovered, unrecovered). The relationship between the groups was statistically evaluated in terms of serum calprotectin levels.Results. The mean serum calprotectin value was 75.67±19.48 ng/mL in the study group and 50.24±29.14 ng/mL in the control group (<i>P</i>=0.001). Serum calprotectin value according to the severity of hearing loss in the mild, moderate and severe was 66.20±8.82, 70.35±16.77, and 91.23±19.73 ng/mL, respectively. Serum calprotectin value in the severe group was significantly higher compared to the moderate and mild groups (<i>P</i>=0.004, <i>P</i>=0.001, respectively). Serum calprotectin value according to the treatment response in the recovered, partially recovered and unrecovered groups was 63.36±11.54, 80.17±12.06, and 85.33±22.33 ng/mL, respectively. Serum calprotectin value in the recovered group was significantly lower compared to the partially recovered and unrecovered groups (<i>P</i>=0.002, <i>P</i>=0.001, respectively).Conclusion. Serum calprotectin value informs the clinician about both the severity of hearing loss and the response to treatment. Hence, serum calprotectin can be used as an important biomarker in ISSHL patients for the determination of the prognosis of disease.

scholarly journals A Smartphone-Based Approach to Screening for Sudden Sensorineural Hearing Loss: Cross-Sectional Validity Study

10.2196/23047 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e23047
Author(s):  
Heng-Yu Haley Lin ◽  
Yuan-Chia Chu ◽  
Ying-Hui Lai ◽  
Hsiu-Lien Cheng ◽  
Feipei Lai ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Gold Standard ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Scale Difference

Background Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that warrants urgent management. Pure-tone audiometry remains the gold standard for definitively diagnosing SSNHL. However, in clinical settings such as primary care practices and urgent care facilities, conventional pure-tone audiometry is often unavailable. Objective This study aimed to determine the correlation between hearing outcomes measured by conventional pure-tone audiometry and those measured by the proposed smartphone-based Ear Scale app and determine the diagnostic validity of the hearing scale differences between the two ears as obtained by the Ear Scale app for SSNHL. Methods This cross-sectional study included a cohort of 88 participants with possible SSNHL who were referred to an otolaryngology clinic or emergency department at a tertiary medical center in Taipei, Taiwan, between January 2018 and June 2019. All participants underwent hearing assessments with conventional pure-tone audiometry and the proposed smartphone-based Ear Scale app consecutively. The gold standard for diagnosing SSNHL was defined as the pure-tone average (PTA) difference between the two ears being ≥30 dB HL. The hearing results measured by the Ear Scale app were presented as 20 stratified hearing scales. The hearing scale difference between the two ears was estimated to detect SSNHL. Results The study sample comprised 88 adults with a mean age of 46 years, and 50% (44/88) were females. PTA measured by conventional pure-tone audiometry was strongly correlated with the hearing scale assessed by the Ear Scale app, with a Pearson correlation coefficient of .88 (95% CI .82-.92). The sensitivity of the 5–hearing scale difference (25 dB HL difference) between the impaired ear and the contralateral ear in diagnosing SSNHL was 95.5% (95% CI 87.5%-99.1%), with a specificity of 66.7% (95% CI 43.0%-85.4%). Conclusions Our findings suggest that the proposed smartphone-based Ear Scale app can be useful in the evaluation of SSNHL in clinical settings where conventional pure-tone audiometry is not available.

Intratympanic Steroid Use for Sudden Sensorineural Hearing Loss: Current Otolaryngology Practice

2019 ◽  
Vol 128 (6) ◽  
pp. 490-502 ◽  
Author(s):  
Matt Lechner ◽  
Liam Sutton ◽  
Mark Ferguson ◽  
Yasmin Abbas ◽  
Jaswinder Sandhu ◽  
...  
Keyword(s):  
United States ◽  
Hearing Loss ◽  
United Kingdom ◽  
Sensorineural Hearing Loss ◽  
The United States ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
British Society ◽  
Treatment Regimes ◽  
The United Kingdom

Objective: To investigate the current practice of intratympanic steroid (ITS) injection for sudden sensorineural hearing loss (SSNHL) in the United Kingdom and link the data with data from the United States and continental Europe. Methods: A survey of 21 questions was distributed to members of the British Society of Otology using an online survey platform via ENT UK. Data obtained from UK otolaryngologists (n = 171) were integrated with previously published data from other countries, including the United States (n = 63) and continental Europe (n = 908). Results: In the United Kingdom, 62% of responding otolaryngologists use ITS injection for SSNHL, while 38% do not. Of those using ITS, 59% use it as first-line treatment, either using it in conjunction with oral steroids (51%) or using it as monotherapy (8%). Of those that use ITS, a majority (83%) use it as salvage therapy when primary treatment with systemic steroids has failed, and similar results are found in the continental Europe and US surveys. The most commonly used preparation is dexamethasone. Responses to questions regarding treatment regimes used are enlightening and show considerable variation in the treatment regimes used within and between countries. Conclusions: There is a wide variation in practice with regards to ITS for SSNHL hearing loss in the United Kingdom, United States, and continental Europe. In the absence of protocols or definitive guidance from published literature, knowledge of contemporary practice may help guide or encourage reevaluation of clinical practice and will help guide the design of future clinical trials.

scholarly journals The role of intratympanic dexamethasone in sudden sensorineural hearing loss

2020 ◽  
Vol 6 (5) ◽  
pp. 821
Author(s):  
Vivek Samor ◽  
Sukhdev Khadav ◽  
Pooja Arya ◽  
Deepchand . ◽  
Ramniwas Dhaka
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Interaural Time Difference ◽  
Determine Factor ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Oral Steroids ◽  
Group A ◽  
Group B ◽  
Intratympanic Dexamethasone

<p class="abstract"><strong>Background:</strong> Present study was conducted to assess the efficacy of intratympanic dexamethasone in patients with sudden sensorineural hearing loss and to determine factor affecting treatment outcome for sudden sensorineural hearing loss.</p><p class="abstract"><strong>Methods:</strong> Prospective study was conducted on 24 patients of sudden sensorineural hearing loss between October 2019 to February 2020 in the department of ENT, OPD, SPMC, Bikaner. Group A were given oral steroids: prednisolone 1 mg/kg/day (maximal dose is 60 mg/day) full dose 14 days, then tapered over next 14 days. Group B were given intratympanic dexamethasone 4 mg/ml, 0.5 ml into middle ear space (into the posterior inferior quadrant) every 7 days for a total of 4 weeks. Audiogram was performed at end of every week for 4 weeks.  </p><p class="abstract"><strong>Results:</strong> Overall, 58% (n=14) patients showed improvement in pure-tone average. For ≤3 days of presentation; out of total 6 patients, 83.33% cases recovered. For 4 to 7 days of presentation; out of total 10 patients, 80% cases recovered. For 8 to 14 days presentation; out of total 8 patients 12.5% cases recovered (p=0.005).</p><p class="abstract"><strong>Conclusions:</strong> We suggest the treatment approach in which interaural time difference is used adjuvantly with oral steroids.</p>

Practice Guidelines for Sudden Sensorineural Hearing Loss

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P58-P58
Author(s):  
David Richard Friedland ◽  
Nima L. Shemirani
Keyword(s):  
Primary Care ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Treatment Protocols ◽  
Oral Steroids ◽  
Management Approaches

Objective To identify and compare patterns of treatment for sudden sensorineural hearing loss among otolaryngologists and primary care physicians. Methods A multiple choice and Likert scale survey was mailed to 1,306 otolaryngologists and primary care physicians throughout our state, regarding treatment and management approaches to SSNHL. Survey answers were analyzed by scope of practice and years of experience. Treatment protocols were compared among family practitioners, internists, general otolaryngologists, and otologists. Results A surprisingly large number of general practitioners treat SSNHL independent of an otolaryngologist. General practitioners as a group, however, are significantly less impressed than otolaryngologists that steroids are an effective treatment (p<0.0001). Over 99% of otolaryngologists start oral steroids at evaluation, as compared to approximately 30% of all general practitioners. Of those general practitioners treating on their own, without otolaryngology consultation, 78% use oral steroids. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone, while lower doses and Medrol dose packs are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond 1 week of hearing loss onset, while general practitioners overwhelmingly will only treat within the first week. Over 50% of otolaryngologists also add anti-viral medications. Conclusions Significant differences exist in the management of SSNHL between otolaryngologists and general practitioners. The lack of strong evidence-based guidelines for the treatment of SSNHL may underlie the variability in management by first-line providers.

scholarly journals Effect of Intratympanic Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss

2019 ◽  
Vol 27 (2) ◽  
pp. 135-139
Author(s):  
Rabi Hembrom ◽  
Indranil Sen ◽  
Bina Tamang ◽  
Satadal Mandal ◽  
Amit Chakrabarti
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Oral Steroid ◽  
Hearing Improvement ◽  
Oral Steroids ◽  
Oral Steroid Therapy ◽  
A Prospective Study ◽  
Intratympanic Dexamethasone

Introduction Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid. Materials and Methods A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment. Results Hearing improvement was found in 19 out of the 30 cases (63.3%).   Conclusions Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

scholarly journals A Smartphone-Based Approach to Screening for Sudden Sensorineural Hearing Loss: Cross-Sectional Validity Study (Preprint)

2020 ◽  
Author(s):  
Heng-Yu Haley Lin ◽  
Yuan-Chia Chu ◽  
Ying-Hui Lai ◽  
Hsiu-Lien Cheng ◽  
Feipei Lai ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Gold Standard ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Scale Difference

BACKGROUND Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that warrants urgent management. Pure-tone audiometry remains the gold standard for definitively diagnosing SSNHL. However, in clinical settings such as primary care practices and urgent care facilities, conventional pure-tone audiometry is often unavailable. OBJECTIVE This study aimed to determine the correlation between hearing outcomes measured by conventional pure-tone audiometry and those measured by the proposed smartphone-based Ear Scale app and determine the diagnostic validity of the hearing scale differences between the two ears as obtained by the Ear Scale app for SSNHL. METHODS This cross-sectional study included a cohort of 88 participants with possible SSNHL who were referred to an otolaryngology clinic or emergency department at a tertiary medical center in Taipei, Taiwan, between January 2018 and June 2019. All participants underwent hearing assessments with conventional pure-tone audiometry and the proposed smartphone-based Ear Scale app consecutively. The gold standard for diagnosing SSNHL was defined as the pure-tone average (PTA) difference between the two ears being ≥30 dB HL. The hearing results measured by the Ear Scale app were presented as 20 stratified hearing scales. The hearing scale difference between the two ears was estimated to detect SSNHL. RESULTS The study sample comprised 88 adults with a mean age of 46 years, and 50% (44/88) were females. PTA measured by conventional pure-tone audiometry was strongly correlated with the hearing scale assessed by the Ear Scale app, with a Pearson correlation coefficient of .88 (95% CI .82-.92). The sensitivity of the 5–hearing scale difference (25 dB HL difference) between the impaired ear and the contralateral ear in diagnosing SSNHL was 95.5% (95% CI 87.5%-99.1%), with a specificity of 66.7% (95% CI 43.0%-85.4%). CONCLUSIONS Our findings suggest that the proposed smartphone-based Ear Scale app can be useful in the evaluation of SSNHL in clinical settings where conventional pure-tone audiometry is not available.

Sign in / Sign up

Export Citation Format

Share Document