Cerebral Small Vessel Disease in Elderly Patients with Sudden Sensorineural Hearing Loss

Abstract

Background The cause of sudden sensorineural hearing loss (SSNHL) is uncertain in a significant number of patients. A vascular etiology has been proposed because SSNHL increases the risk of developing a stroke. Cardiovascular risk factors can cause cerebral small vessel disease (CSVD). The presence of CSVD in turn raises the risk of stroke. Aim The aim of this study was to compare the presence of CSVD and cardiovascular risk factors in elderly patients with idiopathic SSNHL (iSSNHL) to a control cohort. Method Patients with iSSNHL of 50 years and older were compared with a control cohort with patients suspected of trigeminal neuralgia or vestibular paroxysmia. The primary outcome was the difference in the number of white matter hyperintensities using the ordinal Fazekas scale. Secondary outcomes were the presence of brain infarctions on MRI and the difference in cardiovascular risk factors. Results In the SSNHL cohort, Fazekas score 2 was most frequently seen compared with Fazekas 1 in the control cohort. The distribution of Fazekas scores did not differ significantly. The sum of the Fazekas scores were 13,925 and 14,042 for iSSNHL and controls, respectively ( p = 0.908). Brain infarctions were seen in 8 patients with iSSNHL (n = 118) and in 13 patients in the control cohort (n = 118) ( p = 0.361). None of the cardiovascular risk factors were more frequently seen in the iSSNHL cohort. Conclusion Patients with iSSNHL did not exhibit more CSVD on MRI than controls. This result is in contrast with previous literature demonstrating a higher risk of stroke in patients with iSSNHL than in controls. A prospective analysis with a larger study population is therefore warranted.

Cardiovascular Risk Factors, Cerebral Small Vessel Disease, and Subsequent Risk of Stroke in Patients with Idiopathic Sudden Sensorineural Hearing Loss: Systematic Review and Meta-Analyses of the Current Literature

“…Data on the total Fazekas score of each included patient could not be distilled from the article by Ciorba et al, and therefore, it was also excluded from the meta-analysis. We included two articles with a total study population of 456 patients, of whom 231 were diagnosed with iSSNHL [Dicuonzo et al, 2019;Oussoren et al, 2023].…”

“…Ciorba et al additionally reported the Wahlund scale for white matter hyperintensities [Ciorba et al, 2019]. Oussoren et al also identified silent brain infarctions, though the incidence thereof was low in both cohorts [Oussoren et al, 2023]. Three articles provided the total Fazekas scores, the sum of the white matter hyperintensities both periventricular and in the deep white matter, while Dicuonzo et al compared the incidence of hyperintensities in the periventricular white matter (PVWM) and deep white matter (DWM) separately [Dicuonzo et al, 2019].…”

“…Three articles provided the total Fazekas scores, the sum of the white matter hyperintensities both periventricular and in the deep white matter, while Dicuonzo et al compared the incidence of hyperintensities in the periventricular white matter (PVWM) and deep white matter (DWM) separately [Dicuonzo et al, 2019]. Three studies used a (ordinal) logistic regression model to adjust for potential confounders like age, gender, and MRI sequence [Dicuonzo et al, 2019;Fusconi et al, 2019;Oussoren et al, 2023].…”