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Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
Karolinska University Hospital.
Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
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.

Place, publisher, year, edition, pages
2010. Vol. 130, no 3, 384-391 p.
Keyword [en]
Sudden deafness, acoustic neuroma, Borrelia infection
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54412DOI: 10.3109/00016480903161541ISI: 000274884500013OAI: oai:DiVA.org:liu-54412DiVA: diva2:303509
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
In thesis
1. Idiopathic Sudden Sensorineural Hearing Loss in Sweden: Diagnostic Protocol and Treatment in Relation to Outcome
Open this publication in new window or tab >>Idiopathic Sudden Sensorineural Hearing Loss in Sweden: Diagnostic Protocol and Treatment in Relation to Outcome
2009 (English)Licentiate thesis, comprehensive summary (Other academic)
Alternative title[sv]
Idiopatisk Plötslig Sensorineural hörselnedsättning i Sverige : Diagnostiskt protokoll och behandling i relation till resultat
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:nbn:se:liu:diva-19023 (URN)978-91-7393-600-2 (ISBN)
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
2. Idiopathic Sudden Sensorineural Hearing Loss: Corticosteroid Treatment, the Diagnostic Protocol and Outcome
Open this publication in new window or tab >>Idiopathic Sudden Sensorineural Hearing Loss: Corticosteroid Treatment, the Diagnostic Protocol and Outcome
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a rapid loss of hearing caused by damage to the cochlea 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 (vascular catastrophes, immunologic damage, infections 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: 1) to investigate the current management and treatment of ISSNHL patients in Sweden with regard to outcome, 2) to evaluate whether, in comparison to placebo, the most common drug given in the treatment of ISSNHL in any way influences the outcome, and 3) to analyze which variables such as background data, concomitant disease, audiogram shape and laboratory tests, best can predict the outcome of ISSNHL.

A national database was developed with half of all ENT clinics in Sweden participating by submitting a questionnaire for each patient with SSNHL (I-II). 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.

A randomized placebo controlled multicenter trial (RCT) was performed (III) using a modified version of the questionnaire used in the national database. Prednisolone in high tapering dosage, or placebo was given with a total treatment period of eight days. If recovery was complete, treatment stopped, otherwise medication was continued at 10 mg daily to a total of 30 days from beginning. After an initial pure tone audiogram, new audiograms were taken at three follow-up visits: day eight of treatment, after one month, and after three months.

Meta-analysis (IV) was used in order to strengthen the analysis from the RCT by increasing the material with corresponding data drawn from the Swedish national database for ISSNHL.

Results from the national database showed that out of 400 patients included in the study with ISSNHL, almost 60% were medically treated, of which nearly 90% were given corticosteroids. Hearing improvement was not statistically associated with receipt of medication. 40% of all patients had an MRI or CT, where 3–4% had acoustic neuroma. 24% of the patients with ISSNHL who had hematological tests taken, had one or more pathological findings.

In the RCT, 47 patients were randomized to Prednisolone and 46 to placebo. No significant difference of hearing recovery was observed between the Prednisolone group and placebo group at either first or final follow-up regarding the effect of treatment. Presence of vertigo had significant negative effect on hearing improvement in both groups. Inflammatory signs in laboratory work-up had a positive prognostic effect, irrespective of treatment.

The meta-analysis showed no significant difference between the Prednisolone group and placebo/no treatment group (p>0.05). Vertigo at the onset of hearing loss and age had a negative prognostic value equally in all groups and signs of inflammation had a positive.

Conclusion: Regardless of diagnostic protocol, treatment of ISSNHL in Sweden is mainly limited to corticosteroids (50%) or to no medical treatment. In a randomized placebo-controlled clinical trial no positive effect of Prednisolone on ISSNHL could be demonstrated. A Meta-analysis of patient data from the Swedish national database for SSNHL and the RCT for ISSNHL demonstrated no effect of Prednisolone on ISSNHL. Is it time to change the focus of research to find new ways to treat ISSNHL?

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1229
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67609 (URN)978-91-7393-220-2 (ISBN)
Public defence
2011-05-12, Elsa Brändströmsalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-19 Created: 2011-04-19 Last updated: 2011-05-10Bibliographically approved

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