Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome

Abstract

Methods:The first 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected at the first visit about the patient's past medical history, potential precipitating events traumata, family medical history, hearing loss, current disease, diagnostic protocol and treatment using questionnaires as well as two audiograms for each patient, one at the first visit to the ENT-clinic and one three months later.Results: 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT.22/160 MRI investigated had pathological findings: five acoustic neuromas, one subdural hematoma, one pons infarction, five vascular abnormalities and ten patients had accidental findings not connected to the hearing tracts. 300 of these 400 patients were evaluated as idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological tests. No significant correlation was found between either the MRI findings or the laboratory findings with regard to either treatment or hearing recovery in patients with ISSNHL. Conclusion:Results from a database for SSNHL demonstrate no correlation between laboratory findings, treatment and outcome in 400 patients. The patients with pathological tests were not treated differently from those with normal tests or no tests taken. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses.

Sudden Sensorineural Hearing Loss

“…A recent study of practice patterns in Sweden found that all of the 400 patients with SSNHL in the study had standard audiography, but only 65% and 40% underwent laboratory testing or MRI imaging, respectively, even when treated by otolaryngologists (Nosrati-Zarenoe et al, 2010). In comparison, a recent review of the diagnostic evaluation of 128 patients presenting with SSNHL presenting to a major U.S. medical center revealed the average number of diagnostic tests they received was six.…”

“…The sensitivity and specificity of MRI with gadolinium in the diagnosis of vestibular schwannoma is nearly 100% for tumors over 3 mm in diameter (Cueva, 2004;Fortnum et al, 2009). A total of 1% to 6% of patients with SSNHL on average will have positive findings on MRI (Chaimoff, Nageris, Sulkes, Spitzer, & Kalmanowitz, 1999;Chau et al, 2010;Fetterman et al, 1996;Fitzgerald & Mark, 1998;Nosrati-Zarenoe et al, 2010;Tucci et al, 2002). Contraindications to use of gadolinium include glomerular filtration rate <30 mL/min and nephrogenic systemic fibrosis (Thomsen, 2009).…”

“…A few reports have shown that hearing can potentially recover following therapy for a few conditions, including vestibular schwannoma, mumps, and secondary syphilis (Berg et al, 1986;Jeans, Wilkins, & Bonington, 2008;Vuori et al, 1962). Unfortunately, disease-specific therapy treatment does not improve hearing to preonset levels in the majority of SSNHL cases of identifiable etiology (Garcia Berrocal et al, 1999;Lorenzi et al, 2003;Nosrati-Zarenoe et al, 2010;Yimtae et al, 2007).…”

“…The incidence of vestibular schwannoma in series of patients with SSNHL ranges from none to 48%, although most studies find at least one or two within their groups of patients (Byl, 1984;Cadoni et al, 2005;Chau et al, 2010;Fitzgerald & Mark, 1998;Heman-Ackah et al, 2010;Nosrati-Zarenoe, Hansson, & Hultcrantz, 2010;Tucci, Farmer, Kitch, & Witsell, 2002;Xenellis et al, 2006). One review estimated the incidence of all neoplastic causes of SSNHL at 2.3%.…”

The importance of the first three days and other diagnostic indicators in sudden hearing loss

“…[5,13] Auditory data were also classified according to the configuration of the audiogram into six subgroups including ascending type (hearing loss at 250-500 Hz), descending type (hearing loss at 4000-8000 Hz), flat type (hearing loss with a 10 dB or less difference between the best and worst thresholds), total and near-total (85 dB and above), cookie bite and reverse cookie bite hearing losses. [4,5,14,15] The patients were also classified according to their age as 7-40 years, 41-53 years and 54-87 years. [16] The patients were divided into two groups by the receiver operating characteristic (ROC) analysis method as those treated within the first three days and those treated after three days.…”