Contribution of Audiogram Classification in Evaluating Vestibular Dysfunction in Sudden Sensorineural Hearing Loss With Vertigo

Jiang, Zhixin; Zhang, Jiajia; Wang, Ying; Hu, Xuan; Yao, Qinke; Feng, Yuanming; Huang, Shaoguang; Wang, Hui; Yin, Shankai

doi:10.3389/fneur.2021.667804

Cited by 11 publications

(14 citation statements)

References 37 publications

(56 reference statements)

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“…In fact, the higher vulnerability to various disorders of caloric responses might lead to biased topographic data on inner ear damage, as well as the different recovery behavior of different hair-cell populations might affect prognostic data. In recent years, since when the vHIT replaced the scleral search-coil system in the measurements of ampullary reflexes in the high frequency domain ( 52 ), the vestibular test battery in clinical setting has been extended to the evaluation of vertical SCs ( 29 , 32 , 34 , 37 , 49 , 50 , 57 ). According to the vast majority of the most recent investigations, PSC represents the most frequently involved SC in SSNHL, in particular when acute vertigo accompanies hearing symptoms ( 29 , 32 , 34 , 37 , 50 , 57 ).…”

Section: Discussionmentioning

confidence: 99%

“…Patient's age, configuration and degree of HL, comorbidities and time between onset of symptoms and treatment have been widely accepted as the most influencing factors on hearing outcome ( 5 , 6 , 26 ). Additionally, the presence of vestibular symptoms and the involvement of the vestibular end-organs have been considered supplementary poor prognostic factors, as they are usually associated with a greater inner ear damage, deeper HL and worse hearing recovery ( 27 – 37 ). Several studies investigating the clinical significance of vertigo and data obtained from vestibular tests have been conducted, yielding some conflicting results ( 26 – 51 ).…”

Section: Introductionmentioning

confidence: 99%

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Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms

et al. 2023

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IntroductionPredicting hearing outcome in sudden sensorineural hearing loss (SSNHL) is challenging, as well as detecting the underlying pathomechanisms. SSNHL could be associated with vestibular damage since cochleo-vestibular structures share the same vascularization, along with being in close anatomical proximity. Whereas viral inflammations and autoimmune/vascular disorders most likely represent the involved aetiologies, early-stage Menière's disease (MD) can also present with SSNHL. Since an early treatment could beneficially influence hearing outcome, understanding the possible etiology plays a pivotal role in orienting the most appropriate treatment. We aimed to evaluate the extent of vestibular damage in patients presenting with SSNHL with or without vertigo, investigate the prognostic role of vestibular dysfunctions on hearing recovery and detect specific lesion patterns related to the underlying pathomechanisms.MethodsWe prospectively evaluated 86 patients with SSNHL. Audio-vestibular investigation included pure-tone/speech/impedance audiometry, cervical/ocular-VEMPs, vHIT and video-Frenzel examination. White matter lesions (WML) were evaluated on brain-MRI. Patients were followed-up and divided into “SSNHL-no-vertigo,” “SSNHL+vertigo” and “MD” subgroups.ResultsHearing was more impaired in “SSNHL+vertigo” patients who exhibited either down-sloping or flat-type audiograms, and was less impaired in “MD” where low frequencies were mostly impaired (p < 0.001). Otolith receptors were more frequently involved than semicircular canals (SCs). Although the “SSNHL-no-vertigo” subgroup exhibited the lowest vestibular impairment (p < 0.001), 52% of patients developed otolith dysfunctions and 72% developed nystagmus. Only “MD” subjects showed anterior SC impairment and upbeating spontaneous/positional nystagmus. They more frequently exhibited cervical-VEMPs frequency tuning (p = 0.036) and ipsilesional spontaneous nystagmus (p < 0.001). “SSNHL+vertigo” subjects presented with more frequently impaired cervical-VEMPs and posterior SC and with higher number of impaired receptors (p < 0.001). They mainly exhibited contralesional spontaneous and vibration-induced nystagmus (p < 0.05) and only they showed the highest WML score and “vascular” lesion patterns (p < 0.001). Concerning the outcomes, hearing was better in “MD” and worse in “SSNHL+vertigo” (p < 0.001). Hearing recovery was mostly affected by cervical-VEMPs impairment and the number of involved receptors (p < 0.05). Patients with “vascular” lesion patterns presented with the highest HL degree and WML score (p ≤ 0.001), while none of them exhibited a complete hearing recovery (p = 0.026).ConclusionsOur data suggest that vestibular evaluation in SSNHL can provide useful information on hearing recovery and underlying aetiologies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms

et al. 2023

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“…As far as diagnostics of moderate to profound sensorineural hearing loss (MPSHL), the use of cVEMPs (cervical vestibular-evoked myogenic potentials) to identify and intervene promptly in cases of vestibular disorders, which could endanger the process of integration of the critical sensory stimuli for correct posture and locomotion [24,25]. Additionally, the evidence for viral involvement in SSNHL, Ménière's disease, and vestibular neuritis is indirect and equivocal [26,27].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Various Treatments for Sudden Sensorineural Hearing Loss—A Retrospective Study

Skarżyńska

Kołodziejak

Gos

et al. 2022

Life

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(1) Background: A retrospective clinical study was conducted to compare the effectiveness of different pharmacological and non-pharmacological regimens for treating sudden sensorineural hearing loss (SSNHL). (2) Methods: Adult patients (n = 130) diagnosed with sudden sensorineural hearing loss (SSNHL) and hospitalized between 2015 and 2020 were enrolled in this study. Depending on the treatment regimen applied, patients were divided into five groups. Inclusion criteria were as follows: (i) hearing loss of sudden onset; (ii) hearing loss of at least 30 dB at three consecutive frequencies; (iii) unilateral hearing loss; (iv) age above 18 years. Exclusion criteria were as follows: (i) no follow-up audiogram; (ii) bilateral hearing loss; (iii) recognized alternative diagnosis such as tumor, disorder of inner ear fluids, infection or inflammation, autoimmune disease, malformation, hematological disease, dialysis-dependent renal failure, postdural puncture syndrome, gene-related syndrome, mitochondrial disease; and (iv) age below 18 years. (3) Results: Complete recovery was found in 14% of patients (18/130) and marked improvement was found in 6% (8/130), giving an overall success rate of 20%. The best results were obtained in the second group (i.e., patients given intratympanic glucocorticoid + prolonged orally administered glucocorticoid) where the success rate was 28%. In general, the older the patient, the smaller the improvement in hearing, a correlation that was statistically significant. (4) Conclusions: In treating SSNHL, the highest rate of hearing recovery—28%—was in the group of patients given intratympanic corticoid plus prolonged treatment with orally administered glucocorticoid.

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“…The amplitude asymmetry ratio (AR) was calculated as the ratio of the absolute value of the difference between the amplitudes of the two sides to the sum of the wave amplitudes of the two sides. Abnormal VEMP was defined as a waveform not elicited or an AR of >29% ( 14 ).…”

Section: Methodsmentioning

confidence: 99%

Abnormal posterior semicircular canal function may predict poor prognosis in patients with severe and profound ISSNHL

Yang

Gao

et al. 2023

Front. Neurol.

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BackgroundSevere and profound idiopathic sudden sensorineural hearing loss (ISSNHL) generally leads to unfavorable prognosis, and has a considerable impact on patient quality of life. However, related prognostic factors remain controversial.ObjectiveTo elaborate the relationship between vestibular function impairment and the prognosis of patients with severe and profound ISSNHL, and investigated the relevant factors affecting prognosis.MethodsForty-nine patients with severe and profound ISSNHL were divided into good outcome group [GO group, pure tone average (PTA) improvement > 30 dB] and poor outcome group (PO group, PTA improvement ≤ 30 dB) according to hearing outcomes. The clinical characteristics and the proportion of abnormal vestibular function tests in these two groups were analyzed by univariate analysis, and multivariable logistic regression analysis was performed for parameters with significant differences.ResultsForty-six patients had abnormal vestibular function test results (46/49, 93.88%). The number of vestibular organ injuries was 1.82 ± 1.29 in all patients, with higher mean numbers in PO group (2.22 ± 1.37) than in GO group (1.32 ± 0.99). Univariate analysis revealed no statistical differences between the GO and PO groups in terms of gender, age, side of the affected ear, vestibular symptoms, delayed treatment, instantaneous gain value of horizontal semicircular canal, regression gain value of vertical semicircular canal, abnormal rates of oVEMP, cVEMP, caloric test and vHIT in anterior and horizontal semicircular canal, however, significant differences were found in the initial hearing loss and abnormal vHIT of posterior semicircular canal (PSC). Multivariable analysis revealed that only PSC injury was an independent risk factor for predicting the prognosis of patients with severe and profound ISSNHL. Patients with abnormal PSC function had worse initial hearing impairment and prognosis than patients with normal PSC function. The sensitivity of abnormal PSC function in predicting poor prognosis in patients with severe and profound ISSNHL was 66.67%, specificity was 95.45%, and positive and negative likelihood ratios were 14.65 and 0.35, respectively.ConclusionAbnormal PSC function is an independent risk factor for poor prognosis in patients with severe and profound ISSNHL. Ischemia in the branches of the internal auditory artery supplying the cochlea and PSC may be the underlying mechanism.

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Contribution of Audiogram Classification in Evaluating Vestibular Dysfunction in Sudden Sensorineural Hearing Loss With Vertigo

Cited by 11 publications

References 37 publications

Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms

Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms

Effectiveness of Various Treatments for Sudden Sensorineural Hearing Loss—A Retrospective Study

Abnormal posterior semicircular canal function may predict poor prognosis in patients with severe and profound ISSNHL

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