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Abstract
Objective
To analyze the etiologies, treatments, and outcomes of sensorineural hearing loss
(SSNHL) during pregnancy.
Study design
Retrospective chart review of 25 pregnant patients treated for SSNHL between January
2012 and September 2019. Forty-nine age matched non-pregnant women with severe and
profound hearing loss diagnosed with SSNHL during the same period served as controls.
Data were recorded on age, symptoms, onset of hearing loss, audiometric results, treatments,
and outcomes.
Results
The mean age was 29.6 years (range 23–38 years). Intratympanic steroids (ITS) were
administered in 15 (60.0%) pregnant women with SSNHL. Three women were treated with
postauricular steroids only, while another woman was treated with intravenous ginkgo
leaf extract and dipyridamole. The remaining six women received no medications. More
than half (8/15, 53.3%) of pregnant women with SSNHL receiving ITS experienced hearing
improvement. Pregnant women with profound hearing loss who received no medication
had no hearing improvement. Most pregnant women with SSNHL (12/15, 80.0%) had higher
fibrinogen levels than controls (mean values 3.77±0.71 g/L and 2.54±0.48 g/L, respectively).
Conclusion
Fibrinogen could be a risk factor for SSNHL during pregnancy. ITS may benefit pregnant
women with severe and profound SSNHL.
Sudden sensorineural hearing loss is usually unilateral and can be associated with tinnitus and vertigo. In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. A careful examination is needed to exclude life threatening or treatable causes such as vascular events and malignant diseases, and patients should be referred urgently for further assessment. About half of patients completely recover, usually in about 2 weeks. Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management. Copyright 2010 Elsevier Ltd. All rights reserved.
Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.
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.
Title:
The Journal of International Medical Research
Publisher:
SAGE Publications
(Sage UK: London, England
)
ISSN
(Print):
0300-0605
ISSN
(Electronic):
1473-2300
Publication date
(Electronic):
25
February
2021
Publication date Collection:
February
2021
Volume: 49
Issue: 2
Electronic Location Identifier: 0300060521990983
Affiliations
[1-0300060521990983]Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical
University, Chongqing City, China
Author notes
[*]Houyong Kang, Department of Otorhinolaryngology, The First Affiliated Hospital of
Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing City 400042,
China. Emails:
526883773@
123456qq.com
;
zyj@
123456solton.com.cn
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms
of the Creative Commons Attribution-NonCommercial 4.0 License (
https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without
further permission provided the original work is attributed as specified on the SAGE
and Open Access pages (
https://us.sagepub.com/en-us/nam/open-access-at-sage).
History
Date
received
: 22
July
2020
Date
accepted
: 6
January
2021
Funding
Funded by: Chongqing Association for Science and Technology,China;
Award ID: cstc2015jcsf10012-4
Award ID: cstc2018jscx-msybX0006
Funded by: Youth Program of National Natural Science Foundation of China;
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