Sudden Deafness and Right-to-Left Shunts

Iguchi, Yasuyuki; Kimura, Kazumi; Kobayashi, Kazuto; Tachi, Toshihiro; Aihara, Teruhito; Harada, Tamotsu

doi:10.1159/000151682

Cited by 11 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A plausible physiopathological mechanism involved in the onset of SSNHL could be represented by the paradoxical thromboembolism through the PFO, because of the numerous Valsalva maneuvers to which the patient was exposed during regular sporting activity as revealed in the cerebral MRI. However, the angio-MRI showed a thin right vertebral artery and absence of the left posterior communicating artery, which had not been reported to be directly linked to the onset of SSNHL [6][7][8][9][10] , and neither influence the hypothesized thromboembolism mechanism nor represent a potential defect of the posterior circulation [10] . Furthermore, some characteristics of the patient disease are known factors associated with an increased risk of stroke occurrence in cases of PFO [8] .…”

Section: Discussionmentioning

confidence: 76%

Patent Foramen Ovale as Possible Cause of Sudden Sensorineural Hearing Loss: A Case Report

et al. 2017

View full text Add to dashboard Cite

Objective: To present a case of sudden sensorineural hearing loss (SSNHL) and the related diagnostic workup. Clinical Presentation and Intervention: A 54-year-old man presented with a unilateral SSNHL episode and vertigo. A severe patent foramen ovale (PFO) that included a complete ear nose and throat, audiological, and neurological examination was discovered during the diagnostic workup. Audiometry, blood, and serological tests were performed. Magnetic resonance imaging and color Doppler echography of the supra-aortic trunks and lower limbs were carried out. Finally, transthoracic followed by transesophageal echocardiography and transcranial Doppler were performed in order to confirm the diagnosis of PFO. Medical therapy with systemic steroid and antiplatelet drugs was administered. Conclusions: This case showed a small PFO associated with an aneurysmatic interatrial septum. The PFO and paradoxical thromboembolism could be involved in the pathogenesis of SSNHL.

show abstract

Section: Discussionmentioning

confidence: 76%

Patent Foramen Ovale as Possible Cause of Sudden Sensorineural Hearing Loss: A Case Report

et al. 2017

View full text Add to dashboard Cite

show abstract

“…We evaluated the pure-tone average (PTA) for each audiogram by calculating the mean of thresholds at 500; 1,000; 2,000 and 4,000 Hz. Hearing recovery was classiﬁed into three grades 3 , as follows: I Good: hearing returned within 15 dB of the unaffected contralateral ear; II Fair: hearing level improved by more than 10 dB, but did not return to within 15 dB of the unaffected ear; III Poor: no change in hearing level, improved ≤ 10 dB or even deteriorated after treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Researchers have suggested viral infection, vascular compromise, intracochlear membrane rupture and immune inner ear disease 2 . Right-to-left shunt (RLS) is one of the most important causes of ischaemic stroke in patients without vascular risk factors or other causes of embolism 3 .…”

Section: Introductionmentioning

confidence: 99%

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Capuano

Cavaliere

Lopardo

et al. 2019

Acta Otorhinolaryngol Ital

View full text Add to dashboard Cite

SUMMARY In the present retrospective cohort study, we investigated the association between idiopathic sudden sensorineural hearing loss (ISSNHL) and right-to-left shunt (RLS). For this study, we recruited 40 patients with ISSNHL treated in our department between January 2015 and January 2016. Inclusion criteria were: ≥ 18 years old, unilateral sensorineural hearing loss diagnosed within 2 weeks after onset, unknown cause, no previous surgery in the respective ear and no ﬂuctuation in hearing loss. All patients underwent a pure-tone audiogram and a trans-cranial Doppler ultrasonography (TCD) with contrast saline (c-TCD) and received hyperbaric oxygen (HBO) and concomitant steroid therapy. C-TCD examination detected the RLS in 20 patients (50%). ISSNHL patients with RLS were younger than those without RLS (p = 0.007). Vertigo was present mainly in the RLS group, while hypercholesterolaemia, arterial hypertension and hyperglycaemia were mainly seen in the “no RLS” group. The proportion of complete recovery was highest in the “No RLS” Group (40%), although it was not statistically significant. In conclusion, RLS is frequent in ISSNHL, particularly in young patients without comorbidities and with associated dizziness, who should routinely undergo TCD to exclude the presence of RLS. Unfortunately, TCD can only detect the RLS, and not the location of the shunt. This would be possible through transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE), which are much more invasive than TCD, and require further study.

show abstract

“…Systemic embolism in many forms has been linked with PFO. These include sudden onset deafness [67], monocular blindness [68–70], hemianopia [70] or peripheral embolism [71]. In general the reports and studies lack quality, hence these scenarios do not represent a rationale for PFO closure.…”

Section: Other Types Of Embolism and Pfomentioning

confidence: 99%

Patent Foramen Ovale—Assessment and Treatment

Irwin

Ray

2011

Cardiovascular Therapeutics

View full text Add to dashboard Cite

SUMMARYA Patent Foramen Ovale (PFO) is detectable in 20-25% of the population. Some, but not all, case control studies have found an increased incidence of PFO in patients with cryptogenic stroke. Prospective cohort studies have failed to convincingly demonstrate a link between PFO and first stroke, and evidence linking PFO to recurrent stroke is far from compelling. The rate of recurrent stroke in medically treated patients is low, but the development of devices for PFO closure has lead to enthusiasm in some quarters to pursue a strategy of device closure. Nonrandomized studies have suggested a lower risk of recurrent events with device closure but the data are heterogeneous, and potentially prone to bias. Device implantation is associated with a risk of major adverse events of between 1.5% and 2.3%, and there is a significant rate of failure to close shunts. The results of randomized trials of device closure are keenly awaited. Migraine with aura has been linked with PFO. A recent metanalysis suggested an association, but the one prospective population study did not. The well-publicized and controversial MIST Trial is the only randomized trial of device closure in migraineurs yet published, and failed to demonstrate a convincing benefit from device closure. Other conditions such as platypnea-orthodeoxia syndrome and prevention of decompression sickness in divers, may justify device closure. Evidence for a role of PFO in the etiology of cryptogenic stroke and migraine is contradictory. It is possible that some patients might benefit from PFO closure but there is scant evidence of sufficient quality to justify routine PFO closure in either group. It is essential that ongoing randomized trials of device closure are completed. Prevalence and DetectionA patent foramen ovale (PFO) is a slit or tunnel like passage in the interatrial septum (IAS) formed by failure of postnatal fusion of the septum primum and septum secundum. Persistent PFO occurs in around 20-25% of the adult population, the exact frequency dependent on the method of detection. An autopsy based study suggested that the prevalence of PFO decreased with age implying either spontaneous closure or, intriguingly, a significant early death rate in those with PFOs [1]. However recent evidence from a large surgical series suggests that this is not the case and prevalence does not relate to age [2].Transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), and transcranial Doppler (TCD) can all be used to detect . TOE has traditionally been regarded as the gold standard but has some significant disadvantages. Whilst in some individuals a PFO is obvious on 2D echo or color flow on TOE, injection of bubble contrast is needed in many to clearly demonstrate a right to left shunt (see Figure 1). Patient sedation, positioning in the left decubitus position and the inability to perform a complete Valsalva may make it more difficult to visualize a shunt with bubbles on TOE than on TTE where the patient is semiupright and able to perform a good Vals...

show abstract

Sudden Deafness and Right-to-Left Shunts

Cited by 11 publications

References 24 publications

Patent Foramen Ovale as Possible Cause of Sudden Sensorineural Hearing Loss: A Case Report

Patent Foramen Ovale as Possible Cause of Sudden Sensorineural Hearing Loss: A Case Report

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Patent Foramen Ovale—Assessment and Treatment

Contact Info

Product

Resources

About