Critical Evaluation of Round Window Membrane Sealing in the Treatment of Idiopathic Sudden Unilateral Hearing Loss

Abstract

ObjectivesRupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL.MethodsThe clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature.ResultsIntraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery.ConclusionThe results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.

Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula – retrospective analysis and review of the literature

“…Other symptoms such as tinnitus and vertigo do not seem to correlate with the degree of hearing loss. 28 This was also reflected in our results (Figure 1). To conclude, no predictive factors for the success of surgical sealing of the membranes for treating idiopathic sudden SNHL can be identified based on the presented results.…”

“…investigated a time period of seven years and included 51 patients in their analysis. 28 The lower numbers in the study by Hoch et al . may partly be due to the inclusion criteria of a threshold shift of at least 60 dB over five contiguous frequencies.…”

Diagnostics and therapy of sudden hearing loss

“…In summary, the hypothesis of the efficacy of tympanoscopy with sealing of the round window membrane for treatment of idiopathic sudden hearing loss (in contrast to barotrauma, stapes surgery, or temporal bone trauma) can neither be confirmed nor rebutted on the basis of currently available data [ 40 ], [ 41 ].…”

Diagnostik und Therapie des Hörsturzes

“…Zusammenfassend konnte die Hypothese der Wirksamkeit der Tympanoskopie mit Abdichten der Rundfenstermembran beim Hörsturz (anders als beim Barotrauma, Stapesoperationen oder Traumata) auf der Basis der gegenwärtig vorliegenden Daten bisher nicht bestätigt werden [44,45].…”