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      Sudden sensorineural hearing loss – A contemporary review of management issues

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          Abstract

          Sudden sensorineural hearing loss (SSNHL) is an enigmatic entity, with obscure pathophysiology and debatable efficacy of the treatment agents used. An underlying cause is identified in only 10–15% of cases. The management of the remaining patients, classified as ‘idiopathic’, is empirical, and is conventionally with systemic steroids, vasodilator therapy, rheological agents, and antioxidants, to list a few amongst the host of the agents employed for the treatment. The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols. In the present review, we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL. The current review aims to present a narrative outlook of the updated evidence base available from PUBMED, augmented with relevant designated publications.

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          Sudden hearing loss: eight years' experience and suggested prognostic table.

          F M Byl (1984)
          The etiology, incidence, acute and late prognosis, and treatment of sudden hearing loss (SHL) are described variously in the literature. In an 8-year prospective study of 225 SHL patients, initiated in July 1973, overall, normal, or complete recovery occurred in 45% of patients and late otologic complications in 28%. Important prognostic indicators were severity of initial hearing loss and vertigo, time to initial audiogram, and elevated erythrocyte sedimentation rate; other indicators were age greater than 60 and less than 15 years, midfrequency audiogram configuration, and hearing status of the opposite ear. A common inflammatory cause is suggested for all degrees of severity in SHL, and a prognostic table is provided to aid the practitioner in predicting recovery. There is still no evidence that treatment achieves a result better than expected with spontaneous recovery.
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            The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study.

            W R Wilson, F M Byl, N Laird (1980)
            Double-blind studies were conducted for the treatment of idiopathic sudden hearing loss (ISHL) with oral steroids. The condition was defined as not less than a 30-dB loss over three contiguous frequencies in three days or less. Follow-up audiograms were obtained four weeks and three months later. Specific audiologic guidelines for the assessment of hearing recovery were used to ensure objectivity. Steroids had a statistically significant effect on the recovery of hearing in patients with moderate hearing losses. The nature of the hearing loss and its susceptibility to improvement with steroid therapy lend support to the hypothesis that viral cochlitis is the primary cause of ISHL.
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              Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial.

              Steven D Rauch, Christopher F Halpin, Patrick J Antonelli … (2011)
              Idiopathic sudden sensorineural hearing loss has been treated with oral corticosteroids for more than 30 years. Recently, many patients' symptoms have been managed with intratympanic steroid therapy. No satisfactory comparative effectiveness study to support this practice exists. To compare the effectiveness of oral vs intratympanic steroid to treat sudden sensorineural hearing loss. Prospective, randomized, noninferiority trial involving 250 patients with unilateral sensorineural hearing loss presenting within 14 days of onset of 50 dB or higher of pure tone average (PTA) hearing threshold. The study was conducted from December 2004 through October 2009 at 16 academic community-based otology practices. Participants were followed up for 6 months. One hundred twenty-one patients received either 60 mg/d of oral prednisone for 14 days with a 5-day taper and 129 patients received 4 doses over 14 days of 40 mg/mL of methylprednisolone injected into the middle ear. Primary end point was change in hearing at 2 months after treatment. Noninferiority was defined as less than a 10-dB difference in hearing outcome between treatments. In the oral prednisone group, PTA improved by 30.7 dB compared with a 28.7-dB improvement in the intratympanic treatment group. Mean pure tone average at 2 months was 56.0 for the oral steroid treatment group and 57.6 dB for the intratympanic treatment group. Recovery of hearing on oral treatment at 2 months by intention-to-treat analysis was 2.0 dB greater than intratympanic treatment (95.21% upper confidence interval, 6.6 dB). Per-protocol analysis confirmed the intention-to-treat result. Thus, the hypothesis of inferiority of intratympanic methylprednisolone to oral prednisone for primary treatment of sudden sensorineural hearing loss was rejected. Among patients with idiopathic sudden sensorineural hearing loss, hearing level 2 months after treatment showed that intratympanic treatment was not inferior to oral prednisone treatment. clinicaltrials.gov Identifier: NCT00097448.
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                Author and article information

                Contributors
                Anup Singh
                Journal
                Journal ID (nlm-ta): J Otol
                Journal ID (iso-abbrev): J Otol
                Title: Journal of Otology
                Publisher: Chinese PLA General Hospital
                ISSN (Print): 1672-2930
                ISSN (Electronic): 2524-1753
                Publication date PMC-release: 30 July 2019
                Publication date (Print): June 2020
                Publication date (Electronic): 30 July 2019
                Volume: 15
                Issue: 2
                Pages: 67-73
                Affiliations
                [a ]Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- the Medicity, Gurugram, Haryana, India
                [b ]Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                [∗ ]Corresponding author.8th floor, Dept. of Otorhinolaryngology and Head and Neck Surgery, Medanta- The Medicity, Sector- 38, Gurugram, Haryana, 122001, India. anoop.aiims1@ 123456gmail.com
                Article
                Publisher ID: S1672-2930(19)30102-3
                DOI: 10.1016/j.joto.2019.07.001
                PMC ID: 7231990
                PubMed ID: 32440269
                SO-VID: 3ccd8c36-b2ce-45be-bfb7-b29a2dfbef78
                Copyright © © 2019 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 17 July 2019
                Date accepted : 26 July 2019
                Categories
                Subject: Review Article

                Keywords: hearing loss,sudden,sensorineural,instillation,drug,dexamethasone,prognosis
                Data availability:
                Keywords: hearing loss, sudden, sensorineural, instillation, drug, dexamethasone, prognosis

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