Hearing impairment after subarachnoid hemorrhage

Abstract

Background Subarachnoid hemorrhage (SAH) survivors experience significant neurological disability, some of which is under‐recognized by neurovascular clinical teams. We set out to objectively determine the occurrence of hearing impairment after SAH, characterize its peripheral and/or central origin, and investigate likely pathological correlates. Methods In a case‐control study (n = 41), participants were asked about new onset hearing difficulty 3 months post‐SAH, compared with pre‐SAH. Formal audiological assessment included otoscopy, pure tone audiometry, a questionnaire identifying symptoms of peripheral hearing loss and/or auditory processing disorder, and a test of speech understanding in noise. A separate cohort (n = 21) underwent quantitative susceptibility mapping (QSM) of the auditory cortex 6 months after SAH, for correlation with hearing difficulty. Results Twenty three percent of SAH patients reported hearing difficulty that was new in onset post‐SAH. SAH patients had poorer pure tone thresholds compared to controls. The proportion of patients with peripheral hearing loss as defined by the World Health Organization and British Audiological Society was however not increased, compared to controls. All SAH patients experienced symptoms of auditory processing disorder post‐SAH, with speech‐in‐noise test scores significantly worse versus controls. Iron deposition in the auditory cortex was higher in patients reporting hearing difficulty versus those who did not. Conclusion This study firmly establishes hearing impairment as a frequent clinical feature after SAH. It primarily consists of an auditory processing disorder, mechanistically linked to iron deposition in the auditory cortex. Neurovascular teams should inquire about hearing, and refer SAH patients for audiological assessment and management.

Long‐term fatigue following aneurysmal subarachnoid haemorrhage and the impact on employment

“…It affects younger people than other stroke types, resulting in a disproportionately high socio-economic impact due to loss of productive employment and the long-term healthcare burden [1]. Survivors of aSAH can suffer a wide range of neurological deficits ranging from physical disability to less obvious, yet life changing, sequelae including cognitive [2], psychological [3] and auditory deficits [4,5]. These disabilities contribute to unemployment following aSAH, with up to 50% of previously employed individuals not returning to work at 1 year following haemorrhage [6].Fatigue is another common consequence of aSAH with one analysis reporting a weighted mean fatigue frequency of 73.6% in the first year, falling to 50.7% thereafter, based on five published studies [7].…”

An assistive listening device improves hearing following aneurysmal subarachnoid haemorrhage

“…Although new onset hearing difficulty is common following aSAH, affecting up to 23% of survivors [10], impairing quality of life [28] and leading to unemployment [29], it is not routinely assessed and there are currently no recommendations for its management.…”

“…It has previously been demonstrated that APD underlies hearing difficulty following aSAH [3,10] and this understanding of the pathology is essential to guide ongoing management. There is no gold standard for the management of APD but a number of strategies can be considered including modification of the listening environment, technology (such as WRM, low-gain hearing aids or a combination), auditory training and compensatory strategies [11].…”

“…Auditory complaints are common following aSAH with 20%-23% of patients reporting new onset hearing difficulty following haemorrhage [8][9][10]. Despite this they are clinically under-recognised and are rarely formally diagnosed and treated.…”

Study protocol for SFX-01 after subarachnoid haemorrhage (SAS): a multicentre randomised double-blinded, placebo controlled trial

“…Brain volume on T1 sequences will be measured, since this has been shown to correlate with outcome 55. Cortical iron content will be assessed using quantitative susceptibility mapping after susceptibility weighted MR imaging, which predominantly measures siderotic iron deposits 56. Iron is a major component of Hb, and it is unknown what effects SFX-01, SFN or increased Hp binding of Hb may have on the downstream iron pathway.…”