Sensorineural Loss in Chronic Otitis Media: Is It Clinically Significant?

Abstract

\s=b\Charts of 161 patients with unilateral chronic otitis media were reviewed for evidence of sensorineural hearing loss, defined as the difference in preoperative bone conduction thresholds between diseased and normal contralateral ears. Mean bone conduction differences were small but statistically significant, ranging from 5.6 to 12.8 dB across the frequencies. Approximately 45% of the subjects had differences greater than 10 dB for high frequencies, but less than 12% had a difference greater than 20 dB for the pure-tone average. Significant relationships were found between sensorineural hearing loss and the presence of acquired cholesteatoma in the middle ear, diseased mucosa of the promontory and hypotympanum, and diseased ossicles. These findings suggest that more severe middle ear disease may result in sensorineural hearing loss. However, for the majority of subjects, the amount of sensorineural hearing loss was judged not to be clinically significant.(Arch Otolarygol Head Neck Surg. 1989;115:814-816) Chronic otitis media (COM) is asso¬ ciated with various sequelae, including a mixed hearing loss. The conductive component of this hearing loss is acknowledged. Several investi¬ gators have collected data in support of a significant sensorineural compo¬ nent with both experimental animals and clinical studies.18 These investiga¬ tors have emphasized the necessity for prompt clinical action in light of the possibility of sensorineural hear¬ ing loss (SNHL).Other investigators, although find¬ ing evidence of SNHL in patients with COM, have questioned the clinical sig¬ nificance of the degree of hearing loss.9 The clinical impression of two of us (C.S. and J.L.S.) has also been that significant SNHL as a result of COM is not typical. Few studies have direct¬ ly compared the amount of SNHL in COM and control ears. Most studies have compared the percentage of patients meeting specified criteria for SNHL, but have not reported the actual difference in amount of hear¬ ing loss between the diseased and control ears. Those studies that have, report only small average differ¬ ences.9This retrospective study quantified the amount of relative SNHL by com¬ paring COM ears with the normal contralateral ears in patients with unilateral COM, using a matchedpairs approach. In addition, we exam¬ ined the relationship between this rel¬ ative amount of SNHL and other important patient characteristics that reflect the extent of disease. SUBJECTS AND METHODS SubjectsThe subjects included those patients of the Otologie Medical Group, Los Angeles, Calif, who were diagnosed with unilateral COM and who ultimately underwent sur¬ gery. The normal contralateral ear served as the control. The diagnosis of COM was based on a physical examination showing a tympanic membrane perforation, choles¬ teatoma, or ossicular destruction. Subjects were excluded for the following reasons: prior otologie surgery; bilateral disease; history of head trauma; posttraumatic tympanic membrane perforation; labyrin¬ thine fistula; congenital cholesteatoma...

Sensorineural hearing loss in patients with chronic suppurative otitis media: Is there a significant correlation?

“…There was a greater difference in the high frequencies than in the low frequencies (7.00 dB at 500 Hz increasing to 9.71 dB at 4000 Hz). Our findings comply with those found by Noordzij et al (13) and Levine et al (14). In a similar study, MacAndie and O’Reilly (6) found a significant degree of SNHL in the diseased ear, which tended to be increased in higher frequencies.…”

“…Although the number and proportion of CSOM patients with cholesteatoma in their studies was greater than our study, they found no difference in SNHL between patients with or without cholesteatoma. The present study did not demonstrate a significant relation between ossicular erosion and severity of SNHL (p > 0.05), but Levine et al (14) found significant association with the presence of ossicular erosion and SNHL. We used a strict criterion to decrease the effect of confounding factors, but we could not exclude patients using topical ototoxic antibiotics.…”

Mucosal Type of Chronic Suppurative Otitis Media and the Long-Term Impact on Hearing Loss

“…Similar results were also reported by several other studies [ 19 , 20 ]. These findings support the hypothesis that put forward inflammation in the middle ear may alter the permeability of round window membrane (RWM); therefore the bacteria and their remnants, for example, endotoxins, may perhaps pass through and adversely affect the inner ear functions, especially the high-frequency region which is anatomically located next to the round window [ 21 , 22 ].…”

Pneumococcal Toxins Reversibly Affect Cochlear Electrophysiology

“…SNHL was observed in high-frequency areas (14,16,20 and 31.5 kHz) thus being in agreement with one previous report [9]. We found that the mean of the threshold changes was approximately 10 dB at 31.5 kHz, 5 dB at 20 kHz and below 5 dB at 16 and 14 kHz.…”