Cardiovascular and Thromboembolic Risk Factors in Idiopathic Sudden Sensorineural Hearing Loss: A Case-Control Study

Abstract

Objective: The pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) remains unknown, but vascular involvement is one of the main hypotheses. The main objective of this study was to investigate the association between ISSHL and cardiovascular and thromboembolic risk factors. Study Design: Multicentric case-control study. Methods: Ninety-six Caucasian patients with ISSHL and 179 sex- and age-matched controls were included. Patients were evaluated on the day of the inclusion and 1 week, 3 weeks and 3 months later. Clinical information concerning personal and familial cardiovascular and thromboembolic risk factors and concerning the ISSHL was collected. Blood samples were collected for genetic analysis of factor V Leiden and G20210A polymorphism in the factor II gene. The severity of the hearing loss was classified as mild (21–40 dB), moderate (41–70 dB), severe (71–90 dB) and profound or total (>90 dB). Hearing improvement was calculated as a relative improvement of hearing thresholds using the contralateral ear as baseline. Results: Systolic blood pressure was higher in patients (130 ± 1.7 mm Hg) than in controls (124 ± 1.1 mm Hg, p = 0.003). The personal/familial history of cardiovascular events was also more prevalent in patients (p = 0.023 and p = 0.014, respectively), whereas no difference was found in the prevalence of personal cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking habits). There was no correlation between the audiogram type, the hearing outcome and the presence of cardiovascular risk factors. No significant difference was observed in the personal/familial history or in the presence of thromboembolic risk factors. The prothrombin and factor V mutations were uncommon in both patients and controls. The final hearing threshold was only correlated with the severity of the initial hearing loss (p < 0.001), but not influenced by the presence of vertigo, audiogram type, time elapsed from onset of ISSHL to hospitalization or failure of a previous oral therapy. Hearing stabilization was obtained at 21 days in 92% of patients. Conclusion: These results support the theory of vascular involvement as the etiology of some cases of ISSHL. The sole predictive factor of poor final hearing is the severity of the initial hearing loss.

Idiopathic Sudden Sensorineural Hearing Loss: Classic Cardiovascular and New Genetic Risk Factors

“…Additionally, this study does not distinguish between patients with SSNHL and iSSNHL. Furthermore, only 0.8% of the cohort described by Lin et al [2008] had hyperlipidemia, whereas in European studies, cholesterol levels are higher than in their control groups [Capaccio et al, 2005;Marcucci et al, 2005;Rudack et al, 2006;Cadoni et al, 2010;Mosnier et al, 2011]. In our sample, 28% of patients had total cholesterol levels 1 220 mg/dl.…”

“…We have previously reported on a series of 99 patients presenting the single nucleotide polymorphism Factor V Leiden (R506Q) and the prothrombin polymorphism (PT G20210A), and found no significant relationship to iSSNHL [Ballesteros et al, 2009], a finding that confirms the results of Mosnier et al [2011] and Marcucci et al [2005]. However, it should be noted that the selection criteria and screening of non-idiopathic causes of iSSNHL in the paper by Marcucci et al [2005] are unclear.…”

“…Unfortunately, the lack of certain specific data does not enable full comparisons between these series [Capaccio et al, 2005;Marcucci et al, 2005;Rudack et al, 2006;Lin et al, 2008;Cadoni et al, 2010;Uchida et al, 2010;Mosnier et al, 2011]. Analogous data were observed in other studies for the cardiovascular and neurovascular risk profiles [Capaccio et al, 2005;Marcucci et al, 2005;Rudack et al, 2006;Lin et al, 2008;Cadoni et al, 2010;Uchida et al, 2010;Mosnier et al, 2011]. Lin et al [2008] compared the presence of stroke in cohorts of appendectomy and iSSNHL patients.…”

Sudden sensorineural hearing loss: is there a relationship between routine haematological parameters and audiogram shapes?

“…Impaired cochlear perfusion remains the most supported hypothesis due to the characteristics of inner ear circulation, constituted by a terminal capillary bed without collateral blood supply; vasospasm, thrombosis or vascular haemorrhage may be responsible of a reduced cochlear blood flow with consequent hypoxia, decrease of metabolic activity and damage of cochlear hair cells (Mosnier et al, 2010;Martines et al, 2011). Additionally, rheological and thrombophilic factors like high plasma viscosity, elevated fibrinogen levels, inherited prothrombotic conditions (e.g.…”

The Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers for Prognosis in Idiopathic Sudden Sensorineural Hearing Loss

“…A higher blood viscosity may determine damage in ear microcirculation that can produce hearing loss [16,17]. Ciccone et al showed that ISSHL seemed to be associated with vascular endothelial dysfunction and preclinical atherosclerosis by calculating the carotid intima-media thickness [18].…”