The impact of vestibular symptoms and electronystagmography results on recovery from sudden sensorineural hearing loss

Abstract Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. Methods An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. Results Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). Conclusions The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.

Download Full-text

Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study

Otolaryngology ◽

10.1177/0194599818785142 ◽

2018 ◽

Vol 159 (5) ◽

pp. 895-899 ◽

Cited By ~ 3

Author(s):

David L. Witsell ◽

Hillary Mulder ◽

Steven Rauch ◽

Kristine A. Schulz ◽

Debara L. Tucci

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Repeated Measures ◽

Small Sample Size ◽

Statistical Significance ◽

Small Sample ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Delivery Mode ◽

Pragmatic Clinical Trials

Objective The objective of this study was to describe patterns of corticosteroid treatment for sudden sensorineural hearing loss and to evaluate effectiveness based on delivery mode (oral vs intratympanic vs both). Study Design Cross-sectional repeated measures. Setting Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) Network. CHEER is a National Institutes of Health–funded nationwide network of 30 community and academic otolaryngology practice sites. Subjects and Methods A subset of 117 patients who had been treated with steroids for sudden sensorineural hearing loss were recruited from within a larger initial CHEER Network study on clinical practice guideline compliance. Outcomes included audiometric and speech scores and patient-perceived improvement. Descriptive analyses, Wilcoxon rank-sum tests, and Fisher exact tests were run. Results Two categories (oral and simultaneous oral + intratympanic) had adequate sample sizes to support statistical comparison of treatment results. Improvements were seen in both audiometry and speech testing scores; 57% of patients self-reported improvement perceived as either minor or major. There were no significant differences in degree of improvement between these treatment groups. Conclusions We observed that a majority of steroid-treated patients demonstrated hearing improvement, but this improvement did not meet criteria for statistical significance. As in other studies on this topic, the relatively small sample size may have prevented differentiation of effectiveness among steroid treatments. We propose that the use of alternative approaches, such as pragmatic clinical trials and multidisciplinary electronic health record systems and megadatabases, may hold the most promise for an approach to best practice development.

Download Full-text

Jugular valve function and petrosal sinuses pressure: a computational model applied to sudden sensorineural hearing loss

Veins and Lymphatics ◽

10.4081/vl.2017.6707 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Mirko Tessari ◽

Andrea Ciorba ◽

Lucas Omar Mueller ◽

Qinghui Zhang ◽

Mariapaola Cristini ◽

...

Keyword(s):

Mathematical Model ◽

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Clinical Information ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Mean Flow ◽

Venous Outflow ◽

Valve Function ◽

The Impact

Reports of extra-cranial venous outflow disturbances have recently been linked to sudden sensorineural hearing loss (SSNHL). Aims of the present study are: i) to quantify, with mathematical model, the impact of jugular valve function on the pressure of the superior and inferior petrosal sinuses (SPS, IPS) and the main auricolar veins; ii) to verify the feasibility of the application of mathematical model in the clinical setting in terms of consistency respect to the usual measures of SSNHL outcome. Extra-cranial venous outflow and post analysis were respectively blindly assessed by echo colour-Doppler (ECD) and a validated mathematical model for the human circulation. The pilot study was conducted on 1 healthy control and in a group of 4 patients with different outcome of SSNHL. The main finding was the significant increased pressure calculated in the SPS and IPS of patients with ipsilateral jugular obstruction due to not mobile valve leaflets (6.55 mmHg), respect to the other subjects without extracranial complete obstruction (6.01 mmHg), P=0.0006. Moreover, we demonstrated an inverted correlation between the extrapolated pressure values in the SPS/IPS and the mean flow measured in the correspondent internal jugular vein (r= –0.87773; r-squared= 0.7697; P=0.0009). The proposed mathematical model can be applied to venous extra-cranial ECD investigation in order to derive novel clinical information on the drainage of the inner ear. Such clinical information seems to provide coherent parameters potentially capable to drive the prognosis. This innovative approach was proven to be feasible by the present pilot investigation and warrants further studies with an increased sample of patients.

Download Full-text

Impact of COVID-19 on Presentation of Sudden Sensorineural Hearing Loss at a Single Institution

Otolaryngology ◽

10.1177/0194599820974685 ◽

2020 ◽

pp. 019459982097468

Author(s):

Divya A. Chari ◽

Ayush Parikh ◽

Elliott D. Kozin ◽

Meaghan Reed ◽

David H. Jung

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Time Frame ◽

Absolute Number ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Academic Center ◽

Number Of Patients ◽

Increased Risk ◽

The Impact

The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread unprecedented changes to the health care system. Herein, we sought to assess the impact of the viral outbreak on clinical presentations of sudden sensorineural hearing loss (SSNHL) at a single academic center. Our results demonstrate a decrease in the absolute number of patients presenting with SSNHL to our institution during the initial onset of the COVID-19 pandemic compared to an analogous time frame 1 year prior. However, the ratio of patients with SSNHL compared to total patients evaluated was largely similar during the 2 time periods. Based on data from our institution, the COVID-19 virus does not appear to confer a significantly increased risk for the development of SSNHL.

Download Full-text

Analysis of Caloric Test Responses in Sudden Hearing Loss

Ear Nose & Throat Journal ◽

10.1177/014556131709600207 ◽

2017 ◽

Vol 96 (2) ◽

pp. 59-64 ◽

Cited By ~ 4

Author(s):

Cheng-Ping Shih ◽

Yu-Ching Chou ◽

Hsin-Chien Chen ◽

Jih-Chin Lee ◽

Yueng-Hsiang Chu ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Caloric Test ◽

Significant Prognostic Factor ◽

Hearing Level ◽

Caloric Testing ◽

Hearing Recovery ◽

Caloric Response

Sudden sensorineural hearing loss is characterized by a rapid-onset hearing loss that develops within 3 days. Vertigo may also be present. We conducted a retrospective study to investigate whether the severity of a loss of caloric function is associated with the initial hearing loss and with hearing recovery. Our study population was made up of 135 patients—67 men and 68 women, aged 25 to 71 years (mean: 50.9)—with sudden sensorineural hearing loss who had undergone bithermal caloric testing. We compared various patient factors according to patients’ hearing level and their response to caloric testing. We also analyzed the canal paresis (CP) value in patients with an abnormal caloric response according to three factors: disease severity, vertigo, and hearing recovery, and we evaluated the correlation between the loss of caloric function and hearing outcomes. We found that an abnormal caloric response was significantly associated with a profound hearing loss at presentation, the presence of vertigo, and poor hearing recovery. Among patients with an abnormal caloric response, the CP value was significantly correlated with hearing recovery (r = 0.503, p = 0.001). Poor hearing recovery was seen in 80% of patients with a CP value of ≥40% but in only 25% of patients with a value of <40%; in addition, the degree of hearing recovery was worse in the patients with a CP value of ≥40% (p = 0.002). We conclude that a CP value of ≥40% is a significant prognostic factor for an unfavorable treatment outcome.

Download Full-text