The purpose of this retrospective study was to analyze the clinical
October 8, 2017
The purpose of this retrospective study was to analyze the clinical characteristics and document hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). produced a recovery rate in ISSNHL, which exceeds the spontaneous recovery rate. The current study results highlight the importance of medical treatment in the management of ISSNHL. Key words: Idiopathic, sudden hearing loss, sensorineural hearing loss, prognosis Competing interest statement Conflict of interest: the authors declare no potential conflict of interest. Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is an often under-recognized medical emergency that the Otolaryngologists and Audiologists come across frequently. It is defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies occurring over 72 hours.1,2 The loss of hearing has been associated with the damage to the cochlea or auditory nerve, which without prompt treatment can leave patients with permanent hearing deficits. Patient evaluation should proceed promptly and expeditiously. Early presentation to a physician and early initiation of treatment improves the prognosis for hearing recovery.3 The incidence of ISSNHL has been estimated to range between 5 and 20 cases per 100,000 people per year.4 There is no published data on incidence of ISSNHL in India. These figures are likely to be an underestimate since the symptoms are common and non-specific, spontaneous recovery of hearing may dissuade some patients from seeking medical attention and many people do not seek treatment immediately.1,5 The causes of ISSNHL are putative and often multifactorial. The term idiopathic is used frequently,6,7 because usually there is no definite or underlying cause that could be identified in (85-90%) of the patients at the time of presentation, and treatment decisions are generally made without knowledge of the etiology.3 Audiological evaluation provides a criterion PF-03394197 IC50 for the diagnosis of ISSNHL; in the case of retro-cochlear lesions, further investigations like imaging studies are necessary to rule out other causes like vestibular Schwannoma, cerebro-vascular accidents and the like. In case of sudden sensorineural hearing loss, treatment protocol as for ISSNHL can be initiated even without ruling out other causes, since early treatment is necessary for recovery. If periodic audiological evaluation shows improvement in hearing level across frequencies, further evaluation for cause of the hearing loss would not be required. Characteristics of pre-treatment audiogram will form the baseline for treatment protocol. Various theories have been proposed PF-03394197 IC50 for the cause of the disease, the treatment of ISSNHL is based on one or another underlying hypothesis of the etiology and always remains debatable. Despite extensive research, there is no strong evidence regarding the efficacy of treatment preferences. Therapeutic strategies may vary, though a short course of corticosteroids is often prescribed either systematically or by intra-tympanic injection in most cases,8,9 which reduces inflammation and edema in the inner ear. Vascular compromise is the most likely pathogenesis involved in ISSNHL. It is believed that pentoxifylline increases microvascular blood flow in the cochlea, although there is limited evidence supporting its effectiveness. PF-03394197 IC50 Although many studies have reported on the effectiveness of steroids, the state of clinical equipoise about the use of corticosteroids for ISSNHL still exists.10-12 Despite the lack of consistent data on treatment of ISSNHL, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines recommends that clinicians may PF-03394197 IC50 offer corticosteroids as initial therapy to patients with ISSNHL.4 Several prognostic factors have been investigated in various studies, including age of the patient, presence of concomitant vestibular symptoms, degree of hearing loss, audiometric configuration, and time between the onset of hearing RPS6KA5 loss and initiation of treatment.3,13 There is no consensus regarding the actual influence of these factors on the clinical outcome.14-18 Since ISSNHL is still a medical dilemma, in terms of its associated symptoms, prognostic indicators and hearing recovery following treatment, there is a need to study these characteristics, for better understanding and management of this condition. The aim of this retrospective study was to clinically characterize ISSNHL and document the hearing outcomes after a standardized combined systemic steroid and rheological therapy with pentoxifylline. Materials and Methods Study design and participants A retrospective study design was performed for patients who underwent PF-03394197 IC50 treatment for unilateral.