This is a prospective in-depth study of patients with sudden idiopathic sensorineural hearing loss. We found that 65% recover completely to functional hearing levels spontaneously and independent of any type of medical treatment. The majority do so within 14 days and many within the first few days. Prognosis can be predicted according to the slope of the initial audiogram (low-frequency losses do better than high-frequency losses), hearing at 8 kHz, erythrocyte sedimentation rates, in some select instances spatial disorientation symptoms, and speech discrimination scores. There was a very poor correlation between hearing and vestibular test abnormalities, except hypoactive calories. There were no correlations with age (excepting the very elderly), with antecedent respiratory infections, hypertension, diabetes, or other chronic diseases. We conclude that there is a fundamental difference in the behavior of apical and basal cochlea losses, that hearing recovery is always better at low than at high frequencies, that because of the high spontaneous recovery rates, tympanotomies seeking peri-lymph fistulas should be delayed ten days unless there is a progressive hearing loss, and that none of the current recommended treatments, especially histamine, have any effect on the outcome.
Determining nerve survival is important in selecting patients for cochlear implants, and in predicting outcomes from such implants. In search of a possible method we deliberately destroyed nerve fibers (ganglion cells) in 17 cat cochleas to produce a range of degenerations. Months later, we electrically stimulated these ears (and seven controls) and recorded electrical ABR input-output functions. Cats with no surviving ganglion cells showed no ABR activity. Cats with 5%-10% surviving cells had ABRs which typically had normal thresholds but decreased input-output functions. The suprathreshold slopes of these input-output functions reliably predicted ganglion cell survival for all degrees of degeneration. Thus, perceptual (or electrical) threshold is a poor indicator of nerve survival. Loudness growth (or growth in the electrically-induced auditory brainstem response) is a good index of surviving ganglion cells.
Eight children, 5 to 14 years of age, were diagnosed by means of nocturnal polygraphic monitoring with a sleep apnea syndrome similar to that seen in adults. Excessive daytime sleepiness, decrease in school performance, abnormal daytime behavior, recent enuresis, morning headache, abnormal weight, and progressive development of hypertension should suggest the possibility of a sleep apnea syndrome when any of these symptoms is associated with loud snoring interrupted by pauses during sleep. Surgery may eliminate the clinical symptomatology.
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