A CRITICAL ANALYSIS OF THE MANAGEMENT PROTOCOLS FOR IDIOPATHIC SUDDEN SENSORI-NEURAL HEARING LOSS.

Shahid A. Shah, Asif Karim, Rehman Ghani

Abstract


Background: Sudden sensori-neural hearing loss (SSNHL) is a clinical dilemma with great diversity in presentation and poorly understood pathogenesis and hence no definitive treatment protocol as yet. Both sexes are affected, middle age to elderly being the commonest age group. A variety of causes have been implicated as responsible for this condition, but most of the times it is difficult to isolate one, and hence most of the times a battery of investigations proves to be a clinical exercise. A number of treatment protocols have been suggested and used over the years, based on presumed etiological theories, claiming varying degrees of success. Methods: Relevant literature available on the net regarding the management and the efficacy of various treatment regimens for ISSNHL was critically analyzed by the authors (who are professorial staff of a medical college and consultants of a teaching hospital) to develop a consensus and recommendations on the most appropriate protocol. Results: It was asserted that various treatment regimens have not proved beyond doubt to be superior to one another or spontaneous recovery rates. Conclusion: SSNHL is a medical emergency that entails thorough investigations to search for a possible cause and institution of appropriate therapy. Failing identifying a cause, i.e idiopathic group, combination therapy with steroids and antiviral drugs could prove beneficial provided treatment is instituted early. A number of placebo controlled trials consuming various modalities are needed to determine an optimal treatment of ISSNHL. Psychological and psychiatric assistance has a certain role and so has the rehabilitation in the management of these patients.

Key words: Deafness, Sensori-neural hearing loss, idiopathic, Management.


References


De Kleyn A. Sudden complete or partial loss of function of the octavus system in apparently normal persons. Acta Otolaryngol 1944; 32:407-29

Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol 1980 ;106(12):772-6.

Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 1977;86:463-80.

Byl FM. Sudden hearing loss: eight years experience and suggested prognostic table. Laryngoscope 1984;94:647-61.

Yimtae K, Srirompotong S, Kraitrakul S. Idiopathic sudden sensorineural hearing loss. J Med Assoc Thai 2001; 84(1):113-9

Wilson WR, Veltri RW, Laird N, Sprinkle PM. Viral and epidemiologic studies of idiopathic sudden hearing loss. Otolaryngology Head and Neck Surgery 1983;91(6):653-8

McCabe BF. Autoimmune sensorineural hearing loss. Ann Otol Rhinol Laryngol 1979;88:585-9.

Simmons FB. Theory of membrane breaks in sudden hearing loss. Arch Otolaryngol 1968;88:41-8.

Ito S, Fuse T, Yokota M, Watanabe T, Inamura K, Gon S, Aoyagi M. Prognosis is predicted by early hearing improvement in patients with idiopathic sudden sensorineural hearing loss. Clin Otolaryngol 2002;27(6):501-4

Furuhashi A, Matsuda K, Asahi K, Nakashima T. Sudden deafness: long-term follow-up and recurrence. Clin Otolaryngol 2002;27(6):458-63

Haberkamp TJ, Tanyeri HM. Management of sudden sensorineural hearing loss. AM J Otol 1999;20:587-95.

Schweinfurth JM, Parnes SM, Very M. Current concepts in the diagnosis and treatment of sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 1996;253(3):117-21.

Wilkins SA Jr, Mattox DE, Lyles. A Evaluation of a “shotgun” regimen for sudden hearing loss. Otolaryngol Head & Neck Surg 1987;97(5):474-80

Lamm K. Drug therapy of sensorineural hearing loss - critical remarks. Wien Med Wochenschr 1992;142(20-21):455-9.

Kronenberg J, Almagor M,Bendet E, Kushnir D. Vasoactive therapy versus placebo in the treatment of sudden hearing loss: a double blind clinical study. Laryngoscope 1992;102(1):65-8.

Fisch U. Management of sudden deafness. Otolaryngol Head & Neck Surg 1983;91(1):3-8

Gordin A, Goldenberg D, Golz A, Netzer A, Joachims HZ. Magnesium: a new therapy for idiopathic sudden sensorineural hearing loss. Otol Neurotol 2002;23(4):447-51.

Huang TS, Chan ST, Ho TL, Su JL, Lee Fp. Hypaque and steroids in the treatment of sudden sensorineural hearing loss. Clin Otolayngol 1989;14(1):45-51

Zadeh MH, Storper IS, Spitzer JB. Diagnosis and treatment of sudden-onset sensorineural hearing loss: a study of 51 patients. Otolaryngol Head Neck Surg 2003;128(1):92-8

Tucci DL, Farmer JC Jr, Kitch RD, Witsell DL. Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir. Otol Neurotol 2002;23(3):301-8.

Stokroos RJ, Albers FWJ, Schirm J. Therapy of idiopathic sudden sensorineural hearing loss; antiviral treatment of experimental herpes simplex virus infection of the inner ear. Ann ORL 1999;108::423-8

Lamm CH, Walliser U, Schumann K, Lamm H. Sauerstoffpartialdruckmessungen in der Perilymphe der Scala tympani unter normo- und hyperbare Bedingungen. HNO 1988;36: 363-6.

Dauman R, Cros A, Poisot D. Traitement des surdités brusques: premiers résultats d’une étude comparative. J Otolaryngol 1985;14:49-56.

Pilgramm MH, Lamm K. Schumann. Zur hyperbaren Sauerstofftherapie beim Hörsturz. Laryng Rhinol Otol 1985;64:351-4.

Fattori B, Berrettini S, Casani A, Nacci A, De Vito A, De Iaco G. Sudden hypoacusis treated with hyperbaric oxygen therapy: a controlled study. Ear Nose Throat J 2001;80(9):655-60.

Garcia-Callejo FJ, Velert-Vila MM, Morant-Ventura A, Orts-Alborch MH, Marco-Algarra J, Blay-Galaud L. Pathophysiological rationale for the use of piracetam in sudden deafness: Acta Otorrinolaringol Esp 2000;51(4):319-26

Alexiou C, Arnold W, Fauser C, Schratzenstaller B, Gloddek B, Fuhrmann S et al. Sudden sensorineural hearing loss. Does application of glucocorticoids make sense? Arch Otolaryngol Head Neck Surg. 2001;127(3):253-8.

Minoda R, Masuyama K, Habu K, Yumoto E. Initial steroid hormone dose in the treatment of idiopathic sudden deafness. Am J Otol 2000;21;819-25

Gianoli GJ, Li JC. Transtympanic steroids for treatment of sudden hearing loss. Otolaryngol Head Neck Surg 2001;125(3):142-6

Harris JP, Sharp P. Inner ear autoantibodies in patients with rapidly progressive sensorineural hearing loss. Laryngoscope 1990;100:516-24

McCabe BF. Autoimmune inner ear disease: results and therapy. Adv Otorhinolaryngol 1991; 46:78-8.


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