Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss

Bogaz, Eduardo Amaro; Maranhão, André Souza de Albuquerque; Inoue, Daniel Paganini; Suzuki, Flávia Alencar de Barros; Penido, Norma de Oliveira

doi:10.1016/j.bjorl.2015.07.012

Cited by 34 publications

(30 citation statements)

References 28 publications

(54 reference statements)

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“…8 In earlier literature, older age in treated ISSNHL patients tends to be associated with a worse prognosis [12][13][14][15] or no change in hearing improvement. [16][17][18] One prospective, longitudinal cohort study of 127 ISSNHL patients found no significant difference in PTA recovery rates in the various age groups studied (30, 31-50, 51-70, 71 years old), but did note a trend in poorer results in the more extreme age groups (30, 71 years old) 19 Attanasio et al 20 found increased age was associated with worse hearing outcomes in their study of 496 patients; on subgroup analysis divided by age >65 years old, patients in the older subgroup had a statistically significant higher PTA both pre-and posttreatment.…”

Section: Discussionmentioning

confidence: 95%

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

Hara

Zhang

Gandhi

et al. 2018

Laryngoscope Investig Oto

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ObjectiveTo investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsThis study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology. Fifty‐three ISSNHL patients were analyzed in the following subgroups: oral steroids (n = 8), combination oral+IT (n = 39), and IT (n = 6). Main outcomes measured were pre/posttreatment pure tone average (PTA) scores.ResultsThe PTA changes for all treatment groups improved by 8.0 ± 19.5 dB (P = .004); for 31 patients treated ≤2 weeks after onset, PTA improved by 13.8 ± 16.6 dB (P < .001). Multivariable generalized linear model for repeated measures was conducted to investigate the association between PTA changes for treatment groups adjusted for age, gender, time‐to‐treatment, and vertigo. Earlier time‐to‐treatment and older age were statistically correlated towards improved outcomes. As time‐to‐treatment increased by each day, change in PTA decreased by 0.324 (95% CI [0.12, 0.52], P = .002). As age increased by each year, PTA changes increased by 0.802 (95% CI [0.36, 1.24], P < .001). For the oral+IT group, PTA changes for concurrent oral+IT (n = 20, 7.10 dB) and delayed/salvage oral+IT (n = 19, 5.43 dB) were not statistically different (P = .79); earlier time‐to‐treatment (P = .001), and older age (P = .006) remained statistically correlated towards improved outcomes.ConclusionResults suggest outcomes can be improved with early identification and oral steroid therapy by primary care providers. Poorer prognosis for younger patients potentially suggests a need for more aggressive diagnostic and therapeutic management for this subgroup.Level of Evidence3b.

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Section: Discussionmentioning

confidence: 95%

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

Hara

Zhang

Gandhi

et al. 2018

Laryngoscope Investig Oto

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“…The co-presence of vertigo is shown to worsen the treatment outcomes in sudden hearing loss cases. 26 27 We also found lower success rates in patients with accompanying vertigo without statistical significance.…”

Section: Discussionmentioning

confidence: 58%

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss

Bulğurcu

Şahin

Akgül³

et al. 2017

Int Arch Otorhinolaryngol

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Introduction Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4–7 days after the occurrence of the hearing loss were compared ( p > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

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“…When medium and high frequencies were affected, the means of 1, 2, 3, 4, 6, and 8 KHz were calculated. When only high frequencies were affected, the means of 3, 4, 6, and 8 kHz were used [ 4 ]. The audiology baseline for each patient was calculated as the average of the pure tone averages (PTA) from a pre-ISSNHL audiogram of the frequencies affected.…”

Section: Methodsmentioning

confidence: 99%

“…From the few good studies available, it is generally accepted that early intervention in ISSNHL may increase recovery [ 1 ]. It is well known that patients who start treatment within seven days of symptom onset have a higher rate of recovery [ 4 ]. According to the current American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) clinical practice guidelines, oral steroids, intratympanic (IT) steroids, and hyperbaric oxygen therapy are the recommended treatment options for ISSNHL [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Marco, et al showed that time elapsing between symptom onset, the start of therapy, and duration of treatment was not a factor in hearing recovery [ 5 ]. Bogaz, et al studied the response of oral steroid treatment as it relates to the time elapsed prior to treatment initiation [ 4 ]. They demonstrated that response was better when treatment was initiated early (within seven days), but their study was limited because it only evaluated response to oral steroids.…”

Section: Introductionmentioning

confidence: 99%

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Idiopathic Sudden Sensorineural Hearing Loss: Average Time Elapsed Before Presentation to the Otolaryngologist and Effectiveness of Oral and/or Intratympanic Steroids in Late Presentations

Anyah

Mistry

Kevern

et al. 2017

Cureus

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ObjectivesTo determine how long after symptom onset that the average patient with an idiopathic sudden sensorineural hearing loss (ISSNHL) presents to the otolaryngology clinic. In late presentations, to determine the time to presentation cutoff after which intervention may not be effective. To evaluate the effectiveness of oral steroids versus a combination of oral and intratympanic steroid therapy in late presentations of ISSNHL. Methods and proceduresSixty-four patients met inclusion criteria after chart review of 2,037 patients seen at Metro Health Hospital from 2006 to 2016 for sensorineural hearing loss. All sixty-four patients were used to calculate the average time to presentation, but only 40 were included to evaluate treatment efficacy because 24 were lost to follow-up or declined treatment. Audiograms were analyzed for baseline status and response to treatment. Therapy was either oral steroids or intratympanic (IT) steroids. Thirty-nine of the 40 treated patients received oral steroid therapy. Eighteen of these 39 patients received both oral and IT steroids. One patient received IT steroids only. ResultsFor all 64 patients in the study, the average time to presentation was 55 days, ranging from one day to 240 days. Data for 32 of the 40 treated patients were analyzed. These patients were further divided into smaller groups: Group 1 (N = 11) - treatment within seven days of symptom onset, Group 2 (N = 17) - time to treatment greater than seven days but less than 90 days of symptom onset, and Group 3 (N = 4) - greater than 90 days of symptom onset. In Group 2, there was a significant improvement in pure tone average (P-value: 0.005). Forty-seven percent of patients in this group had objective treatment response utilizing Wilson’s criteria. Two patients had a complete recovery and six had a partial recovery. Hearing gains ranged from 10 dB (decibels) to 23 dB. Sixty-three percent of patients with objective improvement also had subjective improvement. In Group 3, none of the patients met Wilson’s criteria for recovery. There was no statistically significant difference in response between patients treated with oral steroids only versus a combination of oral and IT steroids.ConclusionPatients with ISSNHL present to an otolaryngologist on average 55 days after symptom onset. There is statistically and clinically significant response to treatment in late presenters. Improvement can be seen up to three months from symptom onset. Oral steroid therapy is effective. IT steroid therapy may have an added benefit.

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Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss

Abstract: During the onset of ISSHL, the following variables were correlated with a worse prognosis: dizziness, profound hearing loss, impaired hearing in the contralateral ear, and delay to start treatment. Tinnitus at the onset of ISSHL correlated with a better prognosis.

Cited by 34 publications

References 28 publications

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss

Idiopathic Sudden Sensorineural Hearing Loss: Average Time Elapsed Before Presentation to the Otolaryngologist and Effectiveness of Oral and/or Intratympanic Steroids in Late Presentations

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