Better late than never: initial experience of intra-arterial pulsed-urokinase-injection as a salvage therapy for refractory sudden sensorineural hearing loss

2021 ◽  
pp. 159101992110568
Author(s):  
Yang Cui ◽  
Wenzhao Liang ◽  
Mengxue Li ◽  
Zhongyu Zhao ◽  
Xinzhao Jiang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Salvage Therapy ◽  
Conventional Therapy ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Control Group ◽  
Before And After ◽  
Patient Database ◽  
Vascular Origin

Background and Purpose Cochlear vascular micro-thrombosis has been hypothesized as one of the pathogenic mechanisms for sudden sensorineural hearing loss (SSNHL) refractory to regular management. This study aimed to evaluate the feasibility and safety of intra-arterial pulsed-injection urokinase (IAPU) as a salvage therapy for SSNHL after the failure of conventional therapy. Methods We retrospectively reviewed our patient database to identify refractory SSNHL patients between November 2017 and July 2020. Study outcomes before and after the IAPU therapy were compared between IAPU and conventional therapy groups. Results Sixty-seven moderate-profound SSNHL patients (29 in IAUP group, 38 in control group) were included in this study. Compared to the control group, patients in the IAPU group showed more significant improvement in pure tone average (PTA) (34.2 ± 23.5 vs. 10.7 ± 13.1, p < 0.001) and degree of hearing recovery (total: 20.7% vs. 5.3%, partial: 24.1% vs. 10.5%, mild: 27.6% vs. 13.2% and non: 27.6% vs. 71.1%) 2 weeks after admission. In the IAPU group, a significant improvement of PTA (86.6 ± 11.5 vs. 54.6 ± 20.1 dB, p < 0.005) was observed on the first day after IAPU treatment. Conclusion In carefully selected SSNHL cases with a highly suspected vascular origin, IAPU is a safe and effective therapy when conventional treatments have failed. Despite the encouraging findings of our work, large studies are needed to better investigate the strengths and limitations of this salvage therapy.

Plasma levels of endothelial cell-specific molecule-1 and pentraxin-3 in idiopathic sudden sensorineural hearing loss

2018 ◽  
Vol 132 (11) ◽  
pp. 995-999 ◽  
Author(s):  
F Gündoğan ◽  
A Bayram ◽  
M Kalkan ◽  
İ Özcan
Keyword(s):  
Hearing Loss ◽  
Endothelial Cell ◽  
Sensorineural Hearing Loss ◽  
Group Treatment ◽  
Plasma Levels ◽  
Pure Tone Audiometry ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Control Group ◽  
Pentraxin 3

AbstractObjectivesTo evaluate the plasma levels of endothelial cell-specific molecule-1 (ESM-1) and pentraxin-3 (PTX-3) in patients with idiopathic sudden sensorineural hearing loss, and to compare the pre- and post-treatment levels in patients responsive and non-responsive to therapy.MethodsThe study included 108 subjects: 51 with idiopathic sudden sensorineural hearing loss and 57 controls. For ESM-1 and PTX-3 analyses, blood samples were collected before and three months after treatment initiation in the idiopathic sudden sensorineural hearing loss group and once for the control group. Treatment response was evaluated three months after therapy initiation with pure tone audiometry, and the patients were divided into two groups: responsive and non-responsive to treatment.ResultsSerum ESM-1 levels were significantly higher in the idiopathic sudden sensorineural hearing loss group than the control group, whereas the difference was not significant for PTX-3. In the responsive and non-responsive groups, ESM-1 and PTX-3 levels were not statistically different before and after treatment.ConclusionTo our knowledge, this is the first study investigating plasma ESM-1 and PTX-3 levels in idiopathic sudden sensorineural hearing loss. Increased plasma ESM-1 levels may confirm endothelial dysfunction involvement in idiopathic sudden sensorineural hearing loss pathogenesis, which could be associated with vascular impairment.

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.

The Roles Played by Blood Inflammatory Parameters in Sudden Sensorineural Hearing Loss

2021 ◽  
pp. 014556132096035
Author(s):  
Yan Guo ◽  
Jisheng Liu
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Control Group ◽  
Therapeutic Effects ◽  
Hearing Level ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Inflammatory Parameters

Objective: The etiology of sudden sensorineural hearing loss (SSNHL) remains unknown; inflammation may be one cause. We retrospectively studied SSHNL cases in terms of the inflammatory parameters involved. Methods: We reviewed 169 SSNHL cases. The control group contained 132 patients with vocal cord polyps. The C-reactive protein (CRP) level, CRP/serum albumin (Alb) ratio, and neutrophil/lymphocyte ratio (NLR) were compared between the 2 groups. The relationships between these parameters and the time to treatment after SSHNL onset, hearing level, and therapeutic effects were also analyzed. Results: The CRP level, CRP/Alb ratio, and NLR were higher in SSNHL patients than in controls, but only the NLR differed significantly between the 2 groups. We found no significant differences between patients with different hearing levels, those evaluated at various times after SSNHL onset, and those with different outcomes. Conclusion: The NLR is a reliable SSNHL diagnostic marker. The CRP level and CRP/Alb ratio are not useful indicators.

scholarly journals Correlations of MIF polymorphism and serum levels of MIF with glucocorticoid sensitivity of sudden sensorineural hearing loss

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989387
Author(s):  
Wen-Yan Zhu ◽  
Xin Jin ◽  
Yong-Chi Ma ◽  
Zhi-Biao Liu
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Serum Levels ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Control Group ◽  
Glucocorticoid Sensitivity ◽  
Resistant Group ◽  
Factor Α ◽  
Sensitive Group

Objective This study explored the relationship between macrophage migration inhibitory factor (MIF) gene polymorphism (−173G/C) and glucocorticoid sensitivity in sudden sensorineural hearing loss (SSNHL). Methods A total of 120 patients with SSNHL were divided into a glucocorticoid-sensitive group and a glucocorticoid-resistant group. A group of 93 healthy individuals served as the control group. Serum MIF levels of the participants were measured and MIF genotyping was performed. Results The frequency of the MIF −173C allele was significantly higher in glucocorticoid-sensitive patients than in glucocorticoid-resistant patients. Serum MIF levels were significantly higher in SSNHL patients than in healthy controls, and higher in the glucocorticoid-sensitive group than in the glucocorticoid-resistant group of SSNHL patients, which was unexpected. Compared with patients with the GG genotype, patients with the −173C allele (GC and CC genotypes) had significantly higher levels of serum MIF and superoxide dismutase activity and lower levels of tumor necrosis factor-α and malondialdehyde. Conclusion The MIF −173G/C polymorphism is associated with glucocorticoid sensitivity in SSNHL patients. The C allele can result in higher MIF production, reduced oxidative stress, and greater glucocorticoid sensitivity.

scholarly journals Hyperbaric Oxygen Therapy in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss

2015 ◽  
Vol 23 (3) ◽  
pp. 87-91
Author(s):  
Debashish Guha ◽  
Shaoni Sanyal ◽  
Chayan Bhattacharya ◽  
Abhijit Santra ◽  
Swagatam Banerjee
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Clinical Feature ◽  
Tertiary Referral Hospital ◽  
Before And After

Backgrounds and objectivesIdiopathic sudden sensorineural hearing loss (ISSNHL) is an entity whose diagnosis and treatment remain controversial to date. Various modalities of treatment have been tried with varying degrees of success. Hyperbaric oxygen therapy (HBOT) is a recent modality of treatment for this condition which acts by improving cochlear microcirculation. The objective of this study was to evaluate the effect of HBOT in improving hearing loss and secondary symptoms patients with ISSNHL.MethodsThis prospective study was undertaken over a 6 month period from the Department of Otorhinolaryngology in a tertiary referral hospital in eastern India. 48 consecutive newly diagnosed ISSNHL patients were included in this study. The patients were subjected to HBOT at 2 A.T.A (Atmosphere Absolute) for an hour over 45 days. Hearing status and secondary symptoms as assessed by clinical tests, pure tone audiogram were analysed before and after HBOT.ResultsMales comprised 62.5% (30/48) of our study population, mean age of the population was 49.3 ± 13.4 years. 45/48 patients (93.7%) had unilateral ISSNHL, while 3 (6.3%) had bilateral ISSNHL. Average hearing loss in the affected ear before and after treatment was 79.96dBHL and 62.27dBHL respectively. The most common secondary clinical feature was tinnitus (27/48, 56.3%), followed by vertigo (24/48, 50%), aural fullness (15/48, 31.25%) and nystagmus (5/48, 10.41%). After treatment tinnitus and vertigo were showed marked improvement; (22/27, 81.48%) and (18/24, 75%). 5 out of 15 (33.34%) patients showed reduced aural fullness. There was no improvement in patients suffering from nystagmus.

scholarly journals Thyroid-Related Hormone Levels in Clinical Patients With Moderately Severe-to-Profound Sudden Sensorineural Hearing Loss: A Prospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhong Zheng ◽  
Ying Shen ◽  
Liang Xia ◽  
Lili Xiao ◽  
Yuanyuan Sun ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Venous Blood ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Favorable Outcome ◽  
Control Group ◽  
Hormone Levels ◽  
Hearing Recovery ◽  
Tsh Levels

Objectives: Sudden sensorineural hearing loss (SSNHL) is a common otological emergency, causing a measure of hearing loss and affecting the quality of life. This study aims to investigate the association of thyroid-related hormone levels with moderately severe-to-profound SSNHL.Methods: The study included 70 patients with moderately severe-to-profound SSNHL and 100 age- and sex-matched healthy controls. Peripheral venous blood samples were taken from the participants, and their thyroid-related hormone levels were measured at admission and 1 week after treatment.Results: In moderately severe-to-profound SSNaHL patients, the concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) (all P &lt; 0.05) were significantly lower than in the control group. The TT3, TT4, FT3, and TSH levels were significantly higher in the effective group than in the ineffective group (all P &lt; 0.05). Linear correlation analysis revealed that TSH level (R = 0.707, P &lt; 0.05) elevation after treatment successfully predicted a favorable outcome of hearing recovery. Logistic regression analyses suggested low FT3 and TSH levels to be independent occurrence predictors, while the increase of TSH level may be an independent favorable outcome predictor.Conclusions: The results suggest that low FT3 and TSH levels are risk factors for moderately severe-to-profound SSNHL. By discovering the positive association between TSH elevation and hearing recovery, along with the potential novel predictors of FT3 and TSH, our study may contribute valuable insights to the research and treatment of moderately severe-to-profound SSNHL.

scholarly journals Effect of steroid therapy on saccule and semicircular canals function in patients with unilateral sudden sensorineural hearing loss

2020 ◽  
Author(s):  
Fahimeh Esmaeili ◽  
Mansoureh Adel Ghahraman ◽  
Reza Hoseinabadi ◽  
Reza Hoseinabadi ◽  
Shohreh Jalaie ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Steroid Therapy ◽  
Semicircular Canals ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Before And After

Background and Aim: In unilateral sudden sensorineural hearing loss (SSNHL), the ves­tibular system may be involved in addition to the auditory system. Several hearing assess­ments have shown that the disease course and the patient's improvement, at least two step of vestibular assessments can help in better control of the patient's balance function. The aim of this study was to evaluate the results of cervical ves­tibular evoked myogenic potentials (cVEMP) and video head impulse test (vHIT) used for assessment of saccule and semicircular canals before and after steroid therapy. Methods: Twenty three patients with SSNHL were evaluated for auditory and vestibular func­tion before and after steroid therapy. The results of cVEMP and vHIT were compared between intact and impaired ears and between pretest/posttest stages before and after treatment. Results: For 26.08% of patients, the cVEMP response was absent in the affected ear, but after treatment it was reported for all patients. There was a significant difference in vestibulo-ocular reflex (VOR) gain for both posterior and ante­rior semicircular canals of affected ear before and after treatment, but it was not significantly different after treatment as VOR gain increased. Conclusion: Dysfunction of nervous and vesti­bular systems in SSNHL is possible. Steroid therapy can improve the vestibular function and hearing of these patients. Therefore, vestibular evaluation can be used to determine the extent of lesions in SSNHL.   Keywords: Unilateral sudden sensorineural hearing loss; vestibular evoked myogenic potentials; saccule; semicircular canals; video head impulse test

scholarly journals Association of αENaC p. Ala663Thr Gene Polymorphism With Sudden Sensorineural Hearing Loss

2021 ◽  
Vol 12 ◽  
Author(s):  
Jialei Chen ◽  
Jing He ◽  
Jing Luo ◽  
Shixun Zhong
Keyword(s):  
Hearing Loss ◽  
Gene Polymorphism ◽  
Sensorineural Hearing Loss ◽  
Allele Frequency ◽  
Low Frequency ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Control Group ◽  
Increased Risk ◽  
Significant Difference

Objective: The etiology of sudden sensorineural hearing loss (SSNHL) is still unknown. It has been demonstrated that normal endolymph metabolism is essential for inner ear function and that epithelial sodium channels (ENaC) may play an important role in the regulation of endolymphatic Na+. This study aimed to explore the potential association between αENaC p. Ala663Thr gene polymorphism and SSNHL.Methods: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to examine the genotype and allele frequency of the αENaC p. Ala663Thr polymorphism in 20 cases of low-frequency SSNHL (LF-SSNHL), 19 cases of high-frequency SSNHL (HF-SSNHL), 31 cases of all frequency SSNHL (AF-SSNHL), 42 cases of profound deafness SSNHL (PD-SSNHL), and 115 normal controls.Results: The T663 allele was found to be significantly associated with an increased risk of LF-SSNHL (p = 0.046, OR = 2.16, 95% CI = 1.01–4.62). The TT genotype and T663 allele, on the other hand, conferred a protective effect for PD-SSNHL (AA vs. TT: p = 0.012, OR = 0.25, 95% CI = 0.08–0.74; A vs. T: p = 0.001, OR = 0.36, 95% CI = 0.21–0.61). However, there was no statistically significant difference in genotype or allele frequency between the two groups (HF-SSNHL and AF-SSNHL) and the control group.Conclusion: The αENaC p. Ala663Thr gene polymorphism plays different roles in different types of SSNHL.

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