Vestibular Dysfunctions in Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

Abstract

BackgroundSudden sensorineural hearing loss (SSHL) not only involves cochlear function but might also be accompanied by vestibular disturbances. The assessment of vestibular function could be of great relevance in SSHL.ObjectiveTo investigate the prevalence of vestibulocochlear lesions in SSHL and the correlation of specific vestibular organs with hearing prognosis.Data sourcesA complete literature search of eligible studies in the PubMed and EMBASE databases was performed.Study selectionFor our aim, studies that focused on vestibular examination in the case of SSHL were retrieved, including caloric tests, cervical vestibular-evoked myogenic potential (cVEMP) tests, or ocular vestibular-evoked myogenic potential (oVEMP) tests.ResultsOf the 18 studies included, a caloric test was performed in 16 studies, cVEMP in 13 studies, and oVEMP in 5 studies, and together the studies included a total population of 1,468 subjects. The scores on the Agency for Healthcare Research and Quality (AHRQ) questionnaire ranged from 6 to 11. These results indicated that the most commonly damaged vestibular organ in SSHL was the utricle and superior vestibular pathway (U + S) followed by the lateral semicircular canal and superior vestibular pathway (LSC + S), the saccule and inferior vestibular pathway (S + I), and the cochlea only (C only). The meta-analysis indicated that SSHL patients with vertigo have a statistically increased risk of vestibular organ lesions compared with those without vertigo, including the LSC + S subgroup (OR = 4.89, 95% CI = 1.20–19.93, I2 = 80%, p = 0.03) and the S + I subgroup (OR = 3.58, 95% CI = 1.61–7.95, I2 = 0%, p = 0.002). The pooled possibility of hearing recovery within the LSC + S lesion group was less than half that of the non-LSC + S lesion group (OR = 0.24, 95% CI = 0.11–0.52, I2 = 68%, p = 0.0003).ConclusionThis study shows the relevance of vestibular damage concomitant with SSHL and that SSHL patients with vertigo are at an increased risk of vestibular organ lesions compared with patients without vertigo. LSC + S lesions thus appear to be a critical variable that influence the possibility of hearing improvement in SSHL.

Analysis of Clinical and Laboratory Findings of Idiopathic Sudden Sensorineural Hearing Loss

“…There are no previous reports which explain this phenomenon yet. Current evidence however shows that ISSNHL patients with vertigo had a higher risk of vestibular organ lesions 30 and that this may be negatively associated with hearing recovery 31 . Therefore, ISSNHL patients with vertigo have a worse prognosis and we emphasize the importance of immediate and comprehensive treatments, such as medical treatments and vestibular rehabilitation.…”

Comparisons among Vestibular Examinations and Symptoms of Vertigo in Sudden Sensorineural Hearing Loss Patients

“…In a meta-analysis evaluating vestibular function in SSNHL, vestibular organs were found to be involved in SSNHL regardless of the presence of vertigo, indicating that vertigo might not be an independent and determining factor. Vestibulocochlear lesion patterns showed that the utricle, followed by the LSCC, was the most susceptible to damage in SSNHL, and abnormal caloric response was a negative prognostic marker [7].…”

“…Vestibular involvement in SSNHL is hypothesized as an extension of the disease caused by the anatomical proximity and correlation of the cochlea and vestibule [6]. Recently, vestibular diagnostic methods have been included in the general evaluation of SSNHL patients, such as the caloric test, cervical vestibular-evoked myogenic potential (c-VEMP), and ocular VEMP (o-VEMP) [7]. The caloric test is a method for investigating lateral semicircular canal (LSCC) function and superior vestibular integrity, the c-VEMP can be used for assessing saccular function and the inferior vestibular pathway, and the o-VEMP can be used for evaluating utricular function and the superior vestibular pathway [8][9][10][11].…”

Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

“…Vestibular dysfunction, commonly complained by patients as vertigo, dizziness, or lateropulsion, has been considered as a risk factor of profound hearing loss and poor prognosis [30][31][32][33][34]. Recently, researchers made their efforts to specify the lesion patterns of the vestibular system in ISSNHL and proposed that the utricle and superior vestibular pathway is the most vulnerable vestibular site in ISSNHL, followed by the lateral semicircular canal and superior vestibular pathway [30].…”