Sudden sensorineural hearing loss: when is it idiopathic?

Wilson, Helena; Alderson, David

doi:10.1017/s0022215109992064

Cited by 9 publications

(5 citation statements)

References 11 publications

(18 reference statements)

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“…The occurrence of audiovestibular dysfunction is more frequent in GCA cases than in PMR [ 19 ]. Elderly patients and patients with isolated PMR who present with new onset of audiovestibular symptoms, particularly SNHL, have a high-indexed of suspicion of underlying GCA and should be considered for treatment with glucocorticoids which should be started promptly [ 20 , 21 ]; treatment need not to be withheld while awaiting the performance or the results of the biopsy. If the temporal or other artery biopsies prove insignificant for any evidence of inflammatory vasculitis but the clinical suspicion of GCA still remains high, the glucocorticoid treatment should be continued [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss – A Likely Consequence of Delayed Institution of Glucocorticoid Therapy

2017

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Patient: Male, 66Final Diagnosis: Giant cell arteritisSymptoms: Hearing lossMedication: —Clinical Procedure: —Specialty: RheumatologyObjective:Unusual clinical courseBackground:The classical picture of giant cell (temporal) arteritis (GCA) is not always evident. A wide variety of unusual presentations have been increasingly reported. Sensorineural hearing loss (SNHL) as an initial manifestation of GCA is a rare, yet important entity. Similar to blindness, SNHL also deserves serious attention as timely intervention may play a key role in overall prognosis. Only a few cases of SNHL associated with GCA have been reported in the literature, the majority of them were diagnosed early and responded well to glucocorticoid therapy. Our report focuses on a case of persistent audiometry-proven SNHL despite optimal doses and duration of glucocorticoids required in GCA patients with ischemic complications.Case Report:We present the case of a 66-year-old male with severe bi-temporal headache, left jaw claudication, and progressively worsening hearing loss, the latter symptom reported over the preceding year. Examination of his temporal artery remained insignificant, but the laboratory data showed raised erythrocyte sedimentation rate (ESR) of 52 mm/hour. Audiometry performed and the interpretations were coincided with the bilateral high frequency mild to moderately-severe SNHL. Prompt administration of IV methylprednisolone started at high-optimum doses that were gradually tapered over the subsequent six months. On biopsy of the left temporal artery, the findings were consistent with the GCA. The patient responded well in terms of headache and general condition improvement, but results of repeat audiometry at follow-up visits proved disappointing and the interpretations were that there was no change in the audiometry results based on first presentation.Conclusions:This case is purposefully reported to draw the attention of practicing physicians, and encourage them not only to better understand atypical presentations of GCA but also to intervene in a timely fashion. This case should encourage literature to reset recommendations and encourage have high-indexed suspicion when elderly patients present with deafness since early diagnosis and treatment may have profound effects on overall long-term prognosis of other cranial ischemic complications as well.

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Section: Discussionmentioning

confidence: 99%

Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss – A Likely Consequence of Delayed Institution of Glucocorticoid Therapy

2017

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“…[3] ile Hoffman ve ark. 'nın [4] yaptığı çalış-malarda AİK'nın başlangıcından itibaren 10 gün içinde başvuran hastalar çalışma programına alındıkları halde, bizim çalışmamızda AİK'nın başlangıcından itibaren 15 gün süre geçmiş olan olgular çalışma programı-na alındı.…”

Section: Discussionunclassified

“…Bu arada destekleyici tedavi olarak yatak istirahati, sedatifler, trankilizanlar, vitaminler (özellikle B vitamini), ayrıca fistül şüphe-si varsa başın elevasyonu tavsiye edilmektedir. [2][3][4] İdiopatik AİK'da etkinliği kanıtlanmış tek ilaç steroidlerdir. İdiopatik AİK tedavisinde kullanılan oral steroidlerin yan etkileri sebebiyle zaman zaman tedavide kullanımı kısıtlanmaktadır.…”

Section: Introductionunclassified

Comparison of intratympanic steroid treatment versus hemodilution and vasoactive treatment combination in sudden hearing loss

Aydın¹,

Şanlı²,

Altın³

et al. 2011

J Kartal TR

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ÖzetAmaç: Ani işitme kaybı ardışık 3 veya daha fazla frekansta en az 30 dB kaybın olduğu son 3 gün içinde ortaya çıkmış sensörinöral işitme kaybı olarak tanımlanabilir. Bu çalışma-daki amacımız, intratimpanik steroid tedavisi ile hemodilüs-yon ve vazoaktif kombinasyon tedavisinin etkinliklerini karşılaştırmaktır. Gereç ve Yöntem:Bu prospektif çalışmaya, 2005 ile 2010 yıl-ları arasında kliniğimize ani işitme kaybı şikayeti ile başvu-ran 49 hasta dahil edildi. Bu hastalardan 25'i intratimpanik steroid grubuna, 24'ü hemodilüsyon ve vazoaktif kombinasyon tedavi grubuna dahil edildi. İntratimpanik steroid grubuna toplam 5 kez 20 mg/ml dozunda metilprednizolon enjeksiyonu uygulandı. Kombinasyon grubuna ise primer tedavi olarak intravenöz dekstran ve oral pentoksifilin verildi. Tedaviden sonra hastaların saf ses ortalamaları, her iki grup için istatistiksel olarak karşılaştırıldı. Bulgular:Tedaviden sonra saf ses ortalamasındaki iyileşme intratimpanik steroid grubunda 32.22 dB iken, kombinasyon grubunda 22.13 dB idi. İntratimpanik steroid terapisi alan hastalarda iyileşmedeki düzelme diğer gruba göre daha iyi bulundu (p<0.05).Sonuç: İntratimpanik steroid tedavisi kombinasyon (hemodilüsyon ve vazoaktif ) tedavisine göre işitme kazancı yönün-den daha iyi sonuçları, steroidlerin sistemik yan etkilerini oluşturmadan vermektedir. Örnek sayısı daha fazla olan ça-lışmalarla, verilecek steroidin cinsi, uygulama dozu, sıklığı ve süresi gibi faktörlerin aydınlatılmasına ihtiyaç vardır.

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“…Similarly, in the literature, accompanying autoimmune diseases have been reported in many patients with sudden hearing loss (7,8). The treatment and prognosis of sudden hearing loss depends on the accuracy of the diagnosis of the disease (9). Diagnosis is made by audiometry and clinical criteria in these patients, but it cannot be supported by biochemical and serological tests.…”

Section: Introductionmentioning

confidence: 99%

Age-related Differences in Homocysteine and Serological Markers in Patients with Sudden Sensorineural Hearing Loss

Aşık¹,

Kılıç²,

Bınar³

2019

eamr

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Objective: Sudden hearing loss is mostly a unilateral sensorineural hypoacusis with the highest incidence in young adults. The aim of this study was to determine the differences in homocysteine and serological marker levels in sudden sensorineural hearing loss and to define the importance of these markers in diagnosis. Methods: After audiological examination, 52 patients were considered as having sudden hearing loss. Serological markers (C3, C4, anti-streptolysin-O, C-reactive protein, rheumatoid factor) and homocysteine were examined. The patients were divided into two groups, as patients above and below 40 years of age. Statistical analysis was performed using SPSS version 15 software. P values less than 0.05 were considered statistically significant. Results: Fifty-two patients were included in the study, and the study group consisted of 33 men and 19 women. The mean age was 43.5 years and the age range was 14-82 years. According to the survey results, 63% of the patients had higher than normal homocysteine levels. It was observed that 60.8% of homocysteine levels were increased in patients below 40 years of age and 69% in patients over 40 years of age. There was no statistically significant difference between the two groups (p=0.49). In the evaluation of immunological serological markers, no parameter was observed except for C3c. Fifty-four percent of all patients were considered to have a C3c parameter below normal limits. C3c levels were decreased in 52% of patients below 40 years of age and 55% of patients over 40 years of age. There was no statistically significant difference between the two groups (p=0.31). Conclusion: It is thought that microvascular and immunological pathogenesis develops in sudden hearing loss. Homocysteine and C3 levels are valuable but agerelated parameters following diagnosis and treatment.

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Sudden sensorineural hearing loss: when is it idiopathic?

Cited by 9 publications

References 11 publications

Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss – A Likely Consequence of Delayed Institution of Glucocorticoid Therapy

Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss – A Likely Consequence of Delayed Institution of Glucocorticoid Therapy

Comparison of intratympanic steroid treatment versus hemodilution and vasoactive treatment combination in sudden hearing loss

Age-related Differences in Homocysteine and Serological Markers in Patients with Sudden Sensorineural Hearing Loss

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