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Stay up to date with the latest news on treatments for sudden hearing loss and tinnitus by visiting frequently. Having my story out there will hopefully help others fight the battle against sudden hearing loss, or at least help them learn to cope. Losing your hearing is very common in people these days, so I think it`s important to have information like this one!
Sudden hearing loss, also known as sudden sensorineural hearing loss, is a medical emergency that is extremely frightening for the person experiencing it. There have been ongoing debates as to whether Intra-Tympanic Steroid Injections would be the most effective medical intervention in treating Sudden Hearing Loss or if the widely practiced evidence-based medical management of oral steroids would be a safer choice. When seeking the different options for tinnitus treatment, there are a couple of options that one can consider. Sudden hearing loss is associated with vertigo in between 20 to 60% of patients (Rambold et al, 2005).
There is presently no convincing evidence that any oral or intravenous treatment for idiopathic SHL is better than placebo.
According to Zhang et al (2015), in China, in a study of about 250 people, SHL is commonly seen in middle aged people. In our medical practice in Chicago, of the 54 SHL patients in our database, the median age was 60. Some authors maintain that vascular disease is the most likely cause (Rambold et al, 2005). Also supporting the idea that vascular causes are important, is the observation that SHL following surgery outside the inner ear, is most commonly associated with cardiopulmonary bypass surgery (Page and Peters, 2015). It is better to have a minor hearing loss, no vertigo, and rapid treatment (within 1 week).
If you have experienced a SHL, you might be able to follow your hearing loss using a cell-phone hearing app. Occasionally, unfortunate persons experience hearing loss on the opposite ear, a year or more later. Bottom line: At this writing (2016) almost everything looks either ineffective or slightly effective.
We presently suggest that most people start on oral steroids quickly (preferably same day), check and follow their hearing with a cell-phone hearing app, and if the hearing loss is severe, consider the more aggressive steroid regimens outlined below. Ng et al (2014) performed a metaanalysis of intratympanic steroids and reviewed 187 randomized trials, but found only 5 that met their inclusion criteria.
A slightly better recent double-blinded study of only 60 patients split into 3 groups (Battaglia et al, 2008) indicated that patients treated with a combination of intratympanic dexamethasone and high dose steroids are more likely to recover hearing than those treated with high dose steroids alone. Dallan et al (2011) reported that intratympanic steroids had identical results to a mixture of oral steroids, pentoxifylinne, low molecular weight heparin and vitamin E.
Kim et al (2015) compared use of both IT and oral steroids to patients with either one alone -- this was an unblinded retrospective study -- thus the level of evidence is low. Steroid injections through the ear drum are more costly (in the USA) than the alternatives of no-treatment or oral steroid treatment. Steroid injections through the ear drum are prone to produce long lasting perforations of the ear drum. SHL is a very disturbing experience and there have been many unusual protocols and drugs advocated. There are several protocols involving increasing blood flow or oxygenation: We think that the oxygen part of these treatments is a placebo.
These studies are implausible -- , is is difficult to see why this treatment should work and we would not suggest anyone go forward with this until it confirmed with a placebo-controlled and adequately powered study. Haberkamp and Tanyeri (1999) noted that while numerous treatments have been studied aiming to improve blood flow, such as carbogen inhalation or stellate ganglion block, all remain controversial or simply lack convincing evidence of efficacy. Recently, Kim et al (2011) compared steroids +carbogen+lipoprostaglandin E1 to several other variants including steroids alone, but not including placebo, They found a small advantage for the combination group. At the University of Freiburg, exploration of the middle ear and patching is recommended for patients with SHL.
Similar results are reported in another German Otolaryngology Dept, in Cologne (Kampfner et al, 2013). Lipo-prostaglandin E1 in combination with steroid therapy is effective for treatment of sudden sensorineural hearing loss in Korean patients with Type 2 diabetes.
Coelho DH, Thacker LR, Hsu DW.Variability in the Management of Idiopathic Sudden Sensorineural Hearing Loss.
Ng JH1, Ho RC, Cheong CS, Ng A, Yuen HW, Ngo RY.Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss?
Kampfner D, Anagiotos A, Luers JC, Hüttenbrink KB, Preuss SF Analysis of 101 patients with severe to profound sudden unilateral hearing loss treated with explorative tympanotomy and sealing of the round window membrane. Khan AS, Sheikh Z, Khan S, Dwivedi R, Benjamin E.Viagra deafness-Sensorineural hearing loss and phosphodiesterase-5 inhibitors. Linthicum FH Jr, Doherty J, Berliner KI.Idiopathic Sudden Sensorineural Hearing Loss: Vascular or Viral? Niu X and many others.The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss. Samuelsson AK, Hyden D, Roberg M, Skogh T.Evaluation of Anti-hsp70 Antibody Screening in Sudden Deafness. Wang Y1, Zhang L1, Zhang J1, Zhang X1, Zhang W1, Chen X1, Tang S2.The clinical analysis of bilateral successive sudden sensorineural hearing loss.
Zhang X, Xu X, Ma W, Zhang Q, Tong B, Yu H, Xu M, Ren T, Rosenhall U, Anniko M, Duan M.Acta Otolaryngol. Sensorineural hearing loss is the most common type of hearing loss, occurring in 23% of population older than 65 years of age. Infections, such as meningitis, are a common cause of hearing loss in children where it occurs in approximately 20% of those with streptococcus pneumoniae meningitis (Heckenberg et al 2011). Noise induced hearing loss is a permanent hearing impairment resulting from prolonged exposure to high levels of noise. Children who are born prematurely or contract certain infections in utero are at a higher risk of hearing loss (Hille et al 2007, Roizen 2003). While very unusual, acoustic neuromas or metastatic cancer (particularly breast) can be a source of hearing loss. Sudden hearing loss (SHL) is defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over 72 hours or less. Sensory presbyacusis is caused by loss of sensory elements in the basal (high-frequency) end of the cochlea with preservation of neurons. Cochlear conductive presbyacusis is caused by thickening of the basilar membrane caused by deposition of basophilic substance.
Because presbycusis occurs in some individuals as they age but not in others, genetic or environmental factors must also play a role in its development (Liu & Yan 2007). In conductive hearing loss, the second most common form of hearing loss, sound is not transmitted into the inner ear. Images marked as copyright Northwestern University were developed with the support of a National Institutes of Health (NIH) grant to Northwestern University Dept. The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear and is also committed to educating the public about these health issues.
Come in for a free hearing evaluation and receive a FREEcaption call phone (restrictions apply).
Recurring dizziness or chronic dizziness is usually described as light-headedness, a sensation of losing one's balance, or a feeling of being unsteady. 20% to 30% of the general population experience this sometimes debilitating dizziness, and it's one of the top reasons that adults seek medical help.


Your general physician should be able to rule out any serious medical conditions that could be causing dizziness. Aside from more obvious medical conditions, dizziness and balance issues could stem from the inner ear or other ear problems, which is why audiologists also specialize in giving balance evaluations. An audiologist can either diagnose or rule out possible inner ear issues, or other reasons for dizziness.
Balance rehabilitation is an ongoing therapy that can help some people to minimize or relieve symptoms of dizziness, as well as partially or fully resolve balance problems.
Most audiologists can perform VNG (videonystagmography) testing, which can determine if your dizziness is peripheral (ear level), central (brain), or unknown. All of these tests give the audiologist valuable information as to what is causing your dizziness.
As you can see, an audiologist can be a good addition to your medical team in figuring out what is causing your dizziness or balance problems.
They can work with your regular doctor to discover if your dizziness is caused by other medical conditions or by problems with the inner ear or brain. It is ideal for people who need a device that is not visible and one that can facilitate their hearing. It is very rare that hearing loss occurs in both ears within 72 hours, so generally the timing definition of SHL alone leaves this situation out.
The wide spread probably depends on what you define as vertigo -- a little bit of dizziness, or a profound sensation of rotation. Thus people who already have ear damage -- are more likely to have more hearing loss documented going forward.
Migraine is very common (15% of the population), far more so than SHL, and even occasional SHL due to migraine could be very significant. This is surprising as pregnancy is a risk factor for another cranial nerve syndrome -- Bell's palsy. MRI testing is not always ordered -- in fact, only about half the time (Coelho et al, 2011). Two meta-analysis studies of steroid treatment (Conlin and Parnes, 2007; Labus et al, 2010) suggested there was no benefit. Hearing outcome is not altered differentially by IV steroids administered in the first day vs. This doesn't happen very often, and there is an obvious fallacy in that if hearing tends to improve anyway, improvements cannot necessarily be attributed to steroids. This involved 10, 90-minute sessions of breathing pure oxygen at 2.2 atmospheric pressure in a chamber.
Very few placebo controlled studies have performed of treatment of SHL and for this reason, there is presently a limited ability to determine what is the optimal treatment of SHL.
Rather, there are a few unusual institutions that perform surgery in spite of the general opinion that surgery is not indicated. First, it is difficult to follow the logic described by the authors that led them to designated fistula or no-fistula. Even if there is an additional effect of adding prostaglandin, this is a very narrow population and it seems doubtful that this experience generalizes to others. Uramoto, et al, in a paper entitled Vitamin E and vitamin C in the treatment of idiopathic sudden sensorineural hearing loss.
This study from China suggests that intravenous administration of a mushroom extract improves hearing in SHL. Practically, the US drug industry has priced these drugs in the nose-bleed range, and it seems unlikely that this information will do anyone much good until these drugs become generic and cheap.
Combinatin therapy (intratympanic dexamethosone + high-dose predisone taper) for the treatment of idiopathic sudden sensorineural hearing loss. Prognostic model for predicting hearing recoery in idiopathic sudden sensorineural hearing lossl. Experimental otoacoustic emission and auditory brainstem response changes by stellate ganglion blockage in rat.
Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Potential Benefits of Combination Therapy as Primary Treatment for Sudden Sensorineural Hearing Loss.
Results of exploratory tympanotomy following sudden unilateral deafness and its effects on hearing restoration. Association between the V Leiden G1691A mutation and sudden sensorineural hearing loss in Italian population: a meta-analysis. The outer ear includes the auricle, the external auditory canal, and the lateral surface of the tympanic membrane (TM). Postmeningitic hearing loss can be due to lesions of the cochlea, brainstem and higher auditory pathways, but usually is related to suppurative labyrinthitis (cochlear damage).
One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech.
Much research has focused on the detection of genetic causes of hearing loss, and many of them can now be diagnosed at an early age (Blanchard et al 2012, Dror & Avraham 2009, Kochhar et al 2007, Kokotas et al 2007, Robin et al 2005, Xing et al 2007). Risk factors that correlate with hearing loss in premature infants include hypoxia, mechanical ventilation, hyperbilirubinemia, very low birth weight, and the use of ototoxic medications.
It occurs most frequently in the 30- to 60-year age group and affects males and females equally.
These patients have symmetrical, high-frequency sensorineural hearing loss (as shown in Figure 3). Medical conditions that are common in the elderly, such as diabetes and stroke, may also increase the risk of hearing loss with aging (Bainbridge et al 2010, Helzner et al 2005, Maia & Campos 2005, Schreiber et al 2010). Causes include a buildup of ear wax, a foreign body in the ear canal, otosclerosis, tympanosclerosis (as shown in Figure 4), external or middle ear infections (otitis externa or media), allergy with serous otitis media, trauma to the ossicular chain such as temporal bone fracture, tumors of the middle ear, erosion of the ossicular chain (cholesteatoma) and perforation of the tympanic membrane. Because it could be a sign of a serious condition, it's important that you visit your doctor if you experience sudden dizziness or balance problems. Dizziness is certainly nothing new to your doctor, so don't fee embarrassed to be seen for this troublesome symptom. If your doctor has ruled out other medical conditions, he or she may refer you to an audiologist for further examination.
After obtaining a diagnosis, an audiologist can provide some balance rehabilitation (vestibular rehabilitation), or may refer you to a physical therapist or occupational therapist for ongoing rehabilitation.
This therapy works especially well for individuals whose dizziness is caused by head movement, motion sensitivity, or certain positions.
Saccade Test – this test evaluates rapid eye movements by tracking eye movement as they follow a target visually. Positional Test – Tests the dizziness associated with movment of the head into different positions. Caloric Test – Checks for the response of your eye movements as warm andcold water are circulated through a small tube within your ear canal. They can even refer you to physical or occupational therapists to help rehabilitate you and allow you to live a more normal life. However, sometimes it is difficult to know -- such as someone with a preexisting unilateral hearing loss, who loses hearing in the other ear. And probably people who care enough about their hearing to get it tested in the past, are more likely to keep caring about it when they have a change.
An additional study of 11 more temporal bones in 2013 (Linthicum et al), was suggestive of a viral etiology. The author's opinion is that migraine is a much more common cause of SHL than is generally appreciated in the otolaryngologic community.


However, perhaps it relates to the fact that pregnancy is often reduces Migraine substantially. These apps might also be useful for following ones response to treatment (or no treatment as it may be). In our opinion, MRI is not always necessary as one must consider availability, severity of the situation, and followup. They suggested that the hearing impairment in this select group is more severe and outcome of treatment is worse. In a more recent evidence based review, Lawrence and Thevasagayam (2015) suggested that either oral or intratympanic steroids should generally be offered. As of 2016, the best approach appears to be more steroids - -both systemic and intratympanic.
The steroid regimen involved prescribing 66 tablets of prednsone (10 mg) given in a dose of 6 tablets for 7 days, then 5 capsules for 2 days, then 1 less capsule per day until finished.
It seems to us that the injections themselves might have an adverse effect on hearing (compared to oral steroids given without a placebo injection). We do not recommend IT steroids otherwise -- for example, in persons with minor hearing loss. In a more recent evidenced based review, Lawrence and Thevasagayam (2015) suggested that antivirals should not generally be offered routinely. Horn et al (2005) also reported some good responses to hyperbaric treatment in an uncontrolled study of 9 patients. In a recent evidenced based review, Lawrence and Thevasagayam (2015) suggested that "Due to the variability in the vasodilator and vasoactive agents used, there is insufficient evidence to support the routine use of these agents. At this writing we do not feel that there is enough evidence for either treatment to advocate for its use.
According to their article on their experience in 97 patients, surgery can be beneficial if performed within 7 days (Maier et al, 2008). The middle ear includes the medial surface of the TM, the ossicular chain, the eustachian tube, and the tympanic segment of the facial nerve. These conditions are relatively common in premature infants, and the majority do not go on to develop hearing deficits.
Hearing loss in adults surviving pneumococcal meningitis is associated with otitis and pneumococcal serotype. Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study. Considering this unlikely but devastating possibility, we think it is prudent to take the more aggressive approach in treating SHL (see below).
Even more recently, Gao and Liu (2016), in another meta-analysis, suggested that combined intratympanic and systemic steroids provide better outcomes than systemic steroids alone. Another recent meta-analysis concluded that there was no significant effect (Labus et al, 2010).
There is an obvious trend for an increasing number of positive reports, albeit nearly all uncontrolled, over time. Or perhaps this is because controlled studies show no effect, and studies that show no effect are hard to publish.
We are not sure ourselves whether oral or IT steroids are superior in terms of hearing results to doing nothing, but we are certain that large amounts of oral steroids can cause significant side effects. We are very unenthused about this treatment suggestion deriving from this uncontrolled trial.
Second, the natural history of SHL is such that improvement cannot be necessarily attributed to surgical exploration and patching. It is puzzling that these patients were operated, and even more puzzling that they got better. The inner ear includes the auditory-vestibular nerve, the cochlea and the vestibular system (semicircular canals). The National Institute of Health reports that about 15 percent of Americans aged 20 to 69 have high frequency hearing loss related to occupational or leisure activities.
If the loss is minor, then avoidance of noise and ototoxic medications may be an appropriate treatment. High levels of cholesteral and low levels of Coenzyme Q are associated with SHL (Cadoni et al, 2007). Another recent trial comparing oral steroids to intratympanic injections suggested that there was no difference (Nakache et al, 2015).
This study suggested a powerful treatment effect where the combination group did far better than groups with either IT dexamethasone alone or high dose steroids + placebo injections. Concerning intravenous steroids, they are likely superior to oral steroids, but they are far more difficult to administer. Their method of judging whether or not a fistula was present was direct observation of the round window while displacing the stapes footplate. Trauma is more likely to affect hearing in patients who suffer a temporal bone fracture or are older in age (Bergemalm, 2003).
Because of occupational risk of noise induced hearing loss, there are government standards regulating allowable noise exposure. This will be used to determine whether the hearing loss is truly a sensorineural hearing loss or whether it is due to another cause such as wax build-up or otitis media. Of course, most of the processes that they noticed were either disorders that affected spinal fluid (such as meningitis or superficial siderosis), the body as a whole (a variety of autoimmune inner ear disease), and bilateral forms of unilateral ear disorders. They reported a statistically better effect in the IT patients, with no change in the controls.
This protocol also would be expected to have numerous steroid side effects due to the prolonged use of high-dose prednisone. People working before the mid 1960s may have been exposed to higher levels of noise where there were no laws mandating use of devices to protect hearing.
Occasionally, persons with acquired deafness can be treated surgically with a surgically implanted device, a cochlear implant. The hearing evaluation will also be used to determine the degree of impairment and monitor any change during the course of treatment.An otolaryngologist may also recommend further tests to determine the underlying cause of the hearing loss. Lets be clear however -- these are not big effects, and one should be careful to judge whether the risk of steroids is warranted by the small effect.
For example, one would generally not want to use high dose systemic steroids in a diabetic, as the risk from steroid effects on diabetes might easily outweigh the small average effect on hearing.
The problem with this study is that it is not a protocol likely to be helpful clinically, as it is not presently common to give 10 days of intravenous steroids in the treatment of SHL.
Another concern with this study is that it is implausible in that conventional thought is that treatments provided after 10 days of illness are intrinsically unlikely to work.
The obvious problem here that makes interpretation impossible, is the lack of definition of what was done as well as the lack of controls. The younger the patient, the greater likelihood of full recovery.If a sudden sensorineural hearing loss does not improve with medical treatment, the effects of the hearing loss can be managed with the use of hearing technology. Hearing technology and rehabilitation can be used to help alleviate some of these long-term issues.



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