Risk of sudden sensorineural hearing loss in stroke patients

Hong

JAMA Otolaryngol Head Neck Surg

2018

Section: Introductionmentioning

confidence: 99%

Association of Sudden Sensorineural Hearing Loss With Risk of Cardiocerebrovascular Disease

Hong

JAMA Otolaryngol Head Neck Surg

2018

“…mumps virus), intralabyrinthine hemorrhage and rupture of the labyrinthine window have been reported as causes of SSNHL 7 , 18 – 20 . Previous studies have suggested that risk factors for cerebrovascular and cardiovascular disease can also be considered risk factors for idiopathic SSNHL 21 , 22 . Although previous studies have provided evidence for the hypothesis that idiopathic SSNHL is caused by a circulatory disturbance 2 – 4 , like cochlear infarction, no definitive conclusions have been reached.…”

Section: Discussionmentioning

confidence: 99%

Severe sudden sensorineural hearing loss related to risk of stroke and atherosclerosis

Tsuzuki

Wasano

Oishi

et al. 2021

Sci Rep

The cause of idiopathic sudden sensorineural hearing loss (idiopathic SSNHL)—diagnosed after excluding other causes of hearing loss, such as SSNHL associated with vestibular schwannoma (VS)—is unknown. The presumed pathogenesis of idiopathic SSNHL includes circulatory disorders (e.g., cochlear infarction). We tested the hypothesis that patients with SSNHL who are at high stroke risk will have a lower rate of VS compared to those with low stroke risk. The rationale is that the primary cause of SSNHL in patients with high stroke risk might be a circulatory disturbance. We conducted a retrospective study in six hospitals. Our sampling of SSNHL patients included those diagnosed with idiopathic SSNHL and VS-associated SSNHL. SSNHL patients who had a head MRI were stratified by severity of hearing loss and evaluated for differences in the detection rate of VS between the high-scoring CHADS2 (CHADS2-H-), an index of stroke risk, and low-scoring CHADS2 (CHADS2-L-) groups. We identified 916 patients who met the inclusion criteria. For severe hearing loss, the CHADS2-H group had a significantly lower rate of VS than the CHADS2-L group (OR 0 [95% CI 0.00–0.612]; P = 0.007). These results indirectly support the hypothesis that a primary cause of severe idiopathic SSNHL in those at high risk of stroke might be a circulatory disorder.

Journal of Stroke and Cerebrovascular Diseases

“…Some experts favor viral infection as the main cause of SHL on the basis of viral polymerase chain reaction 23 and pathological findings. 24 However, other lines of evidence suggest a vascular etiology, including mechanisms (increase of prothrombin factors in patients with SHL 25 ) and an epidemiological association with stroke (history of stroke as a risk factor for SHL 26 and increased risk of stroke during 5-year follow-up [HR = 1.64] 11 ). Case reports and case series data suggest SHL can be a prodromal warning sign for a large-vessel disease (AICA infarction, 27 basilar artery occlusion, 28 or, rarely, even posterior inferior cerebellar artery [PICA] infarction 29 ).…”

Section: Discussionmentioning

confidence: 99%

Sudden Hearing Loss with Vertigo Portends Greater Stroke Risk Than Sudden Hearing Loss or Vertigo Alone

Chang

Wang

Winnick

et al. 2018

Background Because it is unknown whether sudden hearing loss (SHL) in acute vertigo is a “benign” sign (reflecting ear disease) or a “dangerous” sign (reflecting stroke), we sought to compare long-term stroke risk among patients with (1) “SHL with vertigo,” (2) “SHL alone,” and (3) “vertigo alone” using a large national health-care database. Methods Patients with first-incident SHL (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] 388.2) or vertigo (ICD-9-CM 386.x, 780.4) were identified from the National Health Insurance Research Database of Taiwan (2002-2009). We defined SHL with vertigo as a vertigo-related diagnosis ±30 days from the index SHL event. SHL without a temporally proximate vertigo diagnosis was considered SHL alone. The vertigo-alone group had no SHL diagnosis. All the patients were followed up until stroke, death, withdrawal from the database, or current end of the database (December 31, 2012) for a minimum period of 3 years. The hazards of stroke were compared across groups. Results We studied 218,656 patients (678 SHL with vertigo, 1998 with SHL alone, and 215,980 with vertigo alone). Stroke rates at study end were 5.5% (SHL with vertigo), 3.0% (SHL alone), and 3.9% (vertigo alone). Stroke hazards were higher in SHL with vertigo than in SHL alone (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.28-2.91) and in vertigo alone (HR, 1.63; 95% CI, 1.18-2.25). Defining a narrower window between SHL and vertigo (±3 days) increased the hazards. Conclusions The combination of SHL plus vertigo in close temporal proximity is associated with increased subsequent stroke risk over SHL alone and vertigo alone. This suggests that SHL in patients with vertigo is not necessarily a benign peripheral vestibular sign.