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Idiopathic Sudden Sensorineural Hearing Loss in Sweden: Diagnostic Protocol and Treatment in Relation to Outcome
Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
2009 (English)Licentiate thesis, comprehensive summary (Other academic)Alternative title
Idiopatisk Plötslig Sensorineural hörselnedsättning i Sverige : Diagnostiskt protokoll och behandling i relation till resultat (Swedish)
Abstract [en]

Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a rapid loss of hearing caused by damage to the cochlea (inner ear) or auditory nerve. Spontaneous recovery has been seen in 32% - 81%. The incidence of the ISSNHL has been estimated to be between 5 and 20 per 100,000 per year. Different theories (infections, vascular catastrophes, immunologic damage or intracochlear membrane break) about the etiology have resulted in different treatment policies. The effect of therapy is difficult to evaluate for a single physician who sees just a few patients annually.

The aim of the present thesis was to analyze the management and treatment of ISSNHL patients in Sweden with regard to outcome.

A national database was developed for Sweden with half of all ENT clinics in Sweden participating by submitting a questionnaire for each patient with SSNHL. The questionnaire covered the patient’s background, current disorder, past and family history of different diseases, examinations and treatment. Audiograms at the onset of SSNHL and after three months were requested.

All results were analyzed using ordinal logistic regression looking for interactions with hearing recovery and remaining hearing loss as dependent variables. Independent of treatment or no therapy heredity for hearing loss (I, II), older age (I, II) and presence of vertigo (II) was significantly associated with negative outcome. 40% of all patients had an MRI or CT, where 3 – 4% had acoustic neuroma. 24% of patients with ISSNHL who had hematological tests taken had one or more pathological findings. Blood screening varied from simple routine tests to a complete analysis with such tests as HSP70, Anti-Neutrophilic Cytoplasmic Antibodies (ANCA) and Borrelia tests. There was no association between any of these laboratory tests and either hearing improvement or remaining hearing loss evaluating the tests separately (I, II) or after categorization in comparison with those who had normal laboratory findings (II). Patients with hearing loss in the mid-frequency region had significantly better odds for hearing improvement compared to the other three frequency regions (low, high and “flat loss”). Almost 60% of patients with ISSNHL were medically treated, of which nearly 90% got corticosteroids. The medication had no association with either hearing improvement or remaining hearing loss. However, patients who were prescribed rest or sick leave had higher odds for hearing improvement regardless of other treatment. Those patients who did not receive any treatment at all also came significantly later to the ENT clinics than those treated medically and consequently had worse prognosis.

Conclusion: There is no standard program for management or treatment of ISSNHL in Sweden. The diagnostic protocol varies. MRI is an underused resource to get specific diagnoses for the condition especially acoustic neuromas. Regardless of pathological findings, treatment is mainly limited to corticosteroids or no medication with no difference in outcome. A randomized placebo controlled study is necessary to evaluate whether there is an effect of corticosteroids on ISSNHL.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 61 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 101
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:liu:diva-19023ISBN: 978-91-7393-600-2 (print)OAI: oai:DiVA.org:liu-19023DiVA: diva2:222401
Presentation
2009-06-04, Conradsalen, Huvudblocket, plan 11, ingång 7, Campus US, Linköpings Universitet, Linköping, 00:00 (English)
Opponent
Supervisors
Available from: 2009-06-12 Created: 2009-06-08 Last updated: 2010-03-22Bibliographically approved
List of papers
1. Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
Open this publication in new window or tab >>Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
2007 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 11, 1168-1175 p.Article in journal (Refereed) Published
Abstract [en]

A national database was developed in Linköping by the authors to gather data from patients with Sudden Sensorineural Hearing Loss (SSNHL). A form was used for data collection covering background, current disease, examinations and treatment. Audiograms at the onset of SSNHL and after three months are analyzed. The aim of the study was to investigate the treatment policy of SSNHL in Sweden, the effect of treatments on outcome, and which variables are of value in predicting the outcome.

Out of the first 300 patients reported to the database 208 patients were considered to have idiopathic SSNHL. 50% were treated with corticosteroids, 44% did not receive any treatment. The treated patients had the same outcome as the non-treated patients. The time interval from onset of SSNHL to start of treatment was of importance for the outcome irrespective of type of audiogram or results from laboratory tests. Higher age and heredity for hearing loss gave significant lower chance for improvement.

The first results from 300 patients in the national database demonstrate that corticosteroids or “no treatment at all” are the treatment options in use today. No significant difference in outcome was seen between treated and non-treated patients. Since spontaneous recovery might be the cause, a placebo-controlled randomized study is required before a positive effect of corticosteroids can be asserted.

Keyword
Sudden Hearing Loss, Hearing Loss, Idiopathic, Corticosteroid treatment
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-19020 (URN)10.1080/00016480701242477 (DOI)
Available from: 2009-06-08 Created: 2009-06-08 Last updated: 2017-12-13Bibliographically approved
2. Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
Open this publication in new window or tab >>Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
2010 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 3, 384-391 p.Article in journal (Refereed) Published
Abstract [en]

Conclusion: Results from a database for sudden sensorineural hearing loss (SSNHL) demonstrate no correlation between laboratory findings, treatment, and outcome in 400 patients. The patients with pathological test results were not treated differently from those with normal test results. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. Objectives: To investigate diagnostic test batteries for SSNHL and evaluate their value in the management of idiopathic SSNHL. Methods: A total of 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected about the patients past medical history, potential precipitating events, trauma, medical history, hearing loss, current disease, diagnostic protocol, and treatment, using questionnaires as well as two audiograms, one at the first ENT clinic visit and another 3 months later. Results: In all, 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT scan. Twenty-two of 160 MRI investigated had pathological findings including 5 acoustic neuromas. Also, 300 of these 400 patients were evaluated as having idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological test results. No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL.

Keyword
Sudden deafness, acoustic neuroma, Borrelia infection
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54412 (URN)10.3109/00016480903161541 (DOI)000274884500013 ()
Note

This is an electronic version of an article published in: Ramesh Zarenoe, Magnus Hansson and Elisabeth Hultcrantz, Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome, 2010, ACTA OTO-LARYNGOLOGICA, (130), 3, 384-391. ACTA OTO-LARYNGOLOGICA is available online at informaworldTM: http://dx.doi.org/10.3109/00016480903161541 Copyright: Taylor & Francis http://www.tandf.co.uk/journals/default.asp

Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2017-12-12

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