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INTRODUCTION: Sudden deafness is characterized by an abrupt onset, often idiopathic and tinnitus is present, and becomes the main complaint in up to 80% of patients. OBJECTIVE: To review carefully all studies of the past 10 years on sudden deafness and tinnitus and analyze the effectiveness of oral and intratympanic steroids for tinnitus control in eight patients with sudden deafness and severe disabling tinnitus. METHOD: An analytical prospective in which 64 patients after sudden deafness with tinnitus were monitored and 08 of these suffering with severe disabling tinnitus underwent hearing evaluation and application of the Tinnitus Handicap Inventory and Visual Analogue Scale before, during and after sudden deafness treated with oral and intratympanic steroids. Sudden sensorineural hearing loss (SSHL) was first described by De Kleyn in 1944 and defined as a hearing loss of at least 30 dB in three sequential frequencies in the standard pure-tone audiogram over 3 days or less1. Population studies of SSHL show a wide distribution, ranging from 5 to 30 cases per 100.000 per year, with an average of 50-60 years and no sex preference. Hypotheses are proposed to explain the pathogenesis of sudden hearing loss as the vascular, the viral, the autoimmune and the rupture of membranes one. Patients with tinnitus and SSHL are very frustrated by residual tinnitus even after accomplishment of the treatment for SSHNL. All patients received information about the risks and expectations of therapy and signed a free informed consent form.
Next, salvage therapy with intratympanic methyl-prednisolone was offered to XX patients with a diagnosis of SHL, after systemic therapy failed and no improvements were demonstrated audiometrically. All patients underwent tonal and vocal audiometry and speech recognition rate analysis done by audiologists before and after treatment. Prior to any procedure, patients were oriented as to the risks and expectations about the procedure and signed a free informed consent form. After intratympanic application of the steroid, the patient remained in the supine position and cervical rotation at 45? for 30 minutes to maximize exposure of the round window membrane to the solution. The criteria for defining successful recovery after therapy vary in the literature on intratympanic therapy. All patients underwent Questionnaire Tinnitus Handicap Inventory (THI)5 and the Visual Analogue Scale (VAS) to assess quantitatively and qualitatively the therapeutic response in relation to tinnitus. The search strategy employed in the literature review was guided by the combination of two descriptors indexed in MeSH (Medical Subject Headings): sudden deafness and tinnitus. Most of the patients had vertigo associated with sudden deafness, being classified as mild in 75% of cases and severe in 12.5%.
We performed a literature search with the following aliases: sudden hearing loss and tinnitus.
Their ages ranged from 26-73 years with a mean of 39,5 years and the ear most affected was the left ear (n = 5).
In this study, we chose to intratympanic corticosteroid associated with oral corticosteroids and showed that this association was particularly effective in relation to tinnitus, from the eight cases analyzed, seven of these showed a significant improvement verified by THI and EVA. Several factors may affect the prognosis of the PANSS (eg, hearing loss severity, symptoms duration before treatment, vertigo, type of audiogram, and the patients ages).
Regarding hearing improvement, only two patients had good responses to therapeutic intervention. Given the results, we note that in addition to the proposed intervention, especially those cases where there were no improvement or even where there were worsening of symptoms over time, there are other recommended therapies such as cognitive-behavioral and Tinnitus Retraining Therapy.
Some therapies for tinnitus tend to focus on the impact of noise on the quality of life and humor, and include antidepressants, anticonvulsants and benzodiazepines, or attempt to mask their own noise with white noise generators.
In 2005, a review of published randomized clinical trials addressing the correlation between sudden sensorineural hearing loss and tinnitus and treatment by hyperbaric oxygen therapy (HBOT).
The sudden sensorineural hearing loss (SSHL) is a considerable diagnostic challenge because it can be caused by many different diseases and there is still no definitive treatment for PANSS universally accepted.
In search of a therapeutic approach, the efficacy of enoxaparin sodium associated with venous hemofiltration was studied. In 2008, Ishida et al.15 investigated how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) varied over the course of recovery thresholds in pure tone audiometry in SSHL.
Kleinjung et al.16, in 2009, described the case of a man of 55 years who suffered from tinnitus in the right ear as a result of a SSHL. Hikita-Watanabe et al.17, in 2010, in an article entitled "Tinnitus as a prognostic factor of sudden deafness", rebound that in the group "buzzing rare" there was a worst prognosis to hear than in the group "buzz often". In 2012, Fioretti et al.18 described the case of a 67 years-old women with severe and disabling tinnitus in the right ear, hyperacusis and mild headache. In 2012, a research was also conducted by Ramos et al.10, in which the authors assessed the effectiveness of cochlear implants in patients with SSHL and disabling tinnitus. The tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI) and the Visual Analogue Scale (VAS) before and after deployment. Given the results, it can be concluded that the reduction of tinnitus after cochlear implantation may be due to several mechanisms such as habituation, acoustic masking, direct stimulation of the cochlear nerve and reorganization of cortical areas. Michiba et al.19, in 2013, highlighted the fact that many patients are frustrated with the SSHL residual buzz, even after complete SSHL treatment. The hearing improvement rate was determined by comparing the thresholds before and 6 months after initiation of treatment. The improvement of hearing thresholds were significantly correlated with improvement in the score of tinnitus 6 months after initiation of treatment compared with before treatment. Generally, subjective feelings for the ringing residual 6 months after initiation of SSHL treatment are almost the same as 24 months after treatment. Patients that carriers sudden deafness and severe disabling tinnitus, and underwent intratympanic and oral corticosteroids showed, in this study, significant reduction or remission of tinnitus. Paper submitted to the ITJ-SGP (Publishing Management System) on September 4, 2013; and accepted on October 4, 2013.
As a registered pharmacist, Hammond is definitely well-versed in medical issues, but in this book she approaches her own sudden sensorineural hearing loss and balance problems as a layman.
In What Did You Say?, Hammond weaves her own first-hand account of suddenly losing a significant amount of her hearing, as well as an attack of horrifying balance issues and tinnitus (ringing or sounds of the ears).
Let me first make the disclaimer that as a licensed hearing instrument specialist, I have studied all of the disorders and situations described in this book. In addition to being a hearing care professional, though, I am also a person with hearing loss. Because of my lifelong exposure to relatives with profound hearing loss, I didn’t view it as the devastating diagnosis that many people do. Because of my own experience, reading about Hammond’s situation was very interesting to me. In the informational section, Hammond explains the basics of audiology, the elements of an audiogram and what causes hearing loss. She rounds out her book with some good information about the emotions that often surround a hearing loss diagnosis and some exceptional checklists to help people who are purchasing hearing aids. As a whole, the information in What Did You Say? could be more than what an individual might need, but all of it is well-written, factual and someone could easily pick and choose which sections they need to read. For anyone in the hearing care field, this book would be a great resource for ideas about how to communicate information about hearing loss in ways that are easy for people to understand. As a hearing care practitioner, I seriously wish that every person with hearing loss had all of the information in this book readily available to them. The final verdict was that I had suffered a sudden sensorineural hearing loss (SSHL), which is considered a medical emergency. Going back to work only reinforced the realization that my job was eroding right from under me: I simply could not function safely and effectively anymore in the noise-confused environment of the hospital pharmacy that was my place of work. Of all the hearing-related issues that I have come across, I have chosen noise-induced hearing loss (NIHL) as the focus for any of my training, education, and advocacy efforts. All my life I have been a big believer in prevention and education and from that aspect nothing has changed. These days I am kept busy working with support groups, leading training sessions, doing public speaking, and writing articles and a blog. Yes, the journey into the world of hearing loss has been a long and often thorny road paved with fears and tears but also with plenty of revelations and amazement. Eight patients treated with intratympanic and oral corticosteroids were selected, just two patients showed improvement over the hearing but seven of them showed big improvement in their tinnitus, which was demonstrated by an improvement in the values of the degrees of severity of tinnitus.

In most cases, there is a unilateral hearing loss, with bilateral involvement reported en less than 5%1. However, the current trend is to consider the sudden deafness as a disease of multifactorial etiology2. In idiopathic cases, the oral corticosteroids are widely used, although the supporting evidence is weak. However, there are few theories trying to explain its mechanism, one of than associates this symptom with a maladaptive attempts of a cortical reorganization process due to peripheral deafferentation4.
The majority ask doctors about the prognosis of residual tinnitus at the final day of medical treatment for SSNHL. From June 2011 to July 2013, 64 patients with a diagnosis of sudden sensorineural hearing loss were seen at the otorhinolaryngology outpatient and emergency unit of our Center, Eight was suffering from severe disabling tinnitus.
A detailed clinical history was taken, followed by an otoneurological examination, and an initial audiological assessment by tonal and vocal audiometry, impedance testing, speech recognition rate (SRR), laboratory tests, and an image exam (magnetic resonance imaging with contrast of the inner auditory canal).
Eight patients suffering from severe disabling tinnitus agreed to undergo rescue therapy and signed the free informed consent form to be included in this study.
All patients with fluctuating hearing loss or suspected Meniere's disease were also excluded from this study. A second injection was done if there was any possibility that the first injection was not adequate.
A 20 dB improvement at 0.5, 1 and 2KHz, or a 20% improvement in discrimination was enough to consider the intervention as successful. In the Visual Analogue Scale (VAS) score ranges from 1 to 10, where 10 represents the highest degree of tinnitus severity. However, corticosteroids seem to have universal acceptance and are the ones with proven effectiveness. Such treatments aim to improve inner ear oxygenation and include vasodilators, plasma expanders, steroids and anticoagulants11. In the EVA, it is observed that 100% of patients had a score greater than or equal to 7 and a significant reduction in scores of patients 1, 2, 3, 4, 7 and 8, in order to reduce at least two points on score and the same was observed in the degree of severity in THI (Table 1). Patient 2, despite their age, presents a clinical STD (sexually transmitted disease) that could prevent or reduce the effectiveness of the proposed treatment.
The administration of hyperbaric oxygen is based on the argument that both the hearing loss and the tinnitus may result from a hypoxic event in the cochlea, and that hyperbaric oxygen therapy may be able to reverse the oxygen deficit. Eight patients were followed with improvement in SSHL auditory thresholds (Group A) and eight patients with poor hearing improvement (Group B), to elucidate the behavior of these symptoms in your ongoing recovery. Several therapeutic efforts including intravenous steroids and graft in the round window showed no positive responses. All subjects had SSHL, although the group "short" had a better prognosis than the group "longer duration" when restricted to SSHL accompanied by tinnitus.
Ten patients with sudden hearing loss and severe-profound unilateral tinnitus associates were implanted with a mean age of 42.7 years deployment.
It was conducted a prospective study that analyzed gender, laterality and age of patients, along with changes in the level of hearing and tinnitus, after scoring early SSHL to determine the prognostic factors of residual tinnitus after the last day of treatment for SSHL.
The tinnitus was assessed subjectively by a questionnaire before, 6 and 24 months after initiation of treatment. The scores of tinnitus in all three items were significantly better 6 months after initiation of treatment comparing with the last treatment. Especially younger patients with hearing improvement achieve an improvement of tinnitus in the period between 6 and 24 months after initiation of treatment.
Specialist in Otology and Neurotology by Harvard Medical School, Boston, MA, USA, PhD in Medical Sciences from the University of Brasilia, Professor at Health Sciences School - University of Brasilia - Brasilia - DF - Brazil.
El jugador del Real Madrid con tres goles le gano el duelo a Zlatan Ibrahimovic que convirtio dos.
Los primeros empataron 1-1 como visitante con Rumania, y su victoria 3-1 como local les dio el pasaje. Her writing is clear and easy to understand even for those who aren’t familiar with hearing loss. Unfortunately, her journey was fraught with frustrations, dead ends and unanswered questions, both asked and unasked.
It was difficult for me to imagine how terrifying it must be to experience sudden hearing loss. There is also extensive information about Meniere’s disease, tinnitus and hyperacusis. In some ways, the latter portion of the book is much like a textbook of hearing loss information, but written in a manner that is easy for anyone to understand. As a person with adult-onset hearing loss, I would have liked to have had all of this information when I first began to struggle with my own loss.
I recommend it for anyone interested in communication disorders, hearing loss, balance issues or tinnitus. The doctors suspected the cause to be a viral infection complicated by an excessively loud noise exposure from a church fundraiser the day before. Although hearing aids have helped many people beyond their wildest dreams, they have not been tremendously effective for me. In many cases, the etiology remains unknown and constitutes a major challenge, even after complete otologic evaluation, and these cases are classified as idiopathic sudden deafness3. Intratympanic dexamethasone has been trialled in patients with sudden sensorineural hearing loss, because it provides a high concentration of steroids in the labyrinth in animal models1, although its evidence are conflicting.
This study was approved by the institutional review board of the Medical School and the University Hospital in which it was carried out. Below are the details of inclusion criteria, the audiometric assessment, application technique, analysis of The Tinnitus Handicap Inventory and Analogue Visual Scale for Tinnitus and outcome of recovery of Hearing Loss and Tinnitus. The speech recognition rate (SRR) was based on the percentage of correct answers for monosyllables. EMLA cream was placed in the outer ear canal and the tympanic membrane and left for 30 to 45 minutes, after which it was removed. Failure of oral prednisolone therapy was absence of improvement, as just described, after 14 days of treatment.
In relation to the mean-tone, obtained as a result of the following classifications: mild (25%), moderate (25%), severe (25%) and deep (25%). Sudden hearing loss can occur mainly in the age group 43-53 years7, with equal gender distribution. Already Patient 4 also showed no change in auditory thresholds, showed a significant change in their tinnitus. Significant increase of 25% was found in the hearing threshold of patients undergoing this type of therapy, but in relation to tinnitus, the study was not conclusive13. Seven patients (70%) treated with enoxaparin sodium and venous hemofiltration (group A) had reduced subjective tinnitus and four patients (40%) showed a complete hearing recovery after the first procedure. Given the failure of the rapies performed, it was suggested the cochlear implant that, according to the authors, is a routine procedure for patients with profound bilateral sensorineural hearing loss, and succeeded, some reports showed a suppression of tinnitus as a side effect after implantation.
This indicates that the tinnitus by itself cannot be a problem sign in the prognosis of hearing, but may be an essential sound for the early recovery of the damaged auditory system.
Shortly after the standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and the headache disappeared completely in the follow-up of 3, 6 and 12 months. Seven patients experienced an improvement inTHI in different degrees and in only one patient there was no change. 44 patients with SSHL were followed, all treated with systemic steroids administration for 2 weeks and oral ingestion of vasoactive drugs and B12 vitamin for 6 months. Among the comparison between 6 and 24 months after initiation of treatment, there was no significant change. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial.

Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work? Cochlear implant in patients with sudden unilateral sensorineural hearing loss and associated tinnitus. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: a systematic review of randomized controlled trials. Sodium enoxaparin and venovenous hemofiltration in treating sudden sensorineural hearing loss and tinnitus. Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness. Curing tinnitus with a Cochlear Implant in a patient with unilateral sudden deafness: a case report. En tanto, los croatas, a pesar de jugar gran parte del partido con 10 jugadores superaron 2-0 a Islandia. Susanne Jones is the customer support specialist for Healthy Hearing and wrote the following review.
The story Monique Hammond tells in her 2012 book, What Did You Say?, is both a compelling personal narrative and powerful resource about hearing loss for people who are ready to accept their own hearing loss or that of a loved one, and get solid information.
There are several books out there offering first-hand accounts of hearing loss, and countless textbooks too technical for the average person without specialized audiology training to enjoy. The book also has both a broad overview of hearing loss causes and types, as well as detailed information about specific disorders of hearing and balance. So while I couldn’t read this book as someone with no knowledge of hearing loss, I can confidently say that Hammond does a great job of explaining things in a way that people can understand and her information is solid. I began to lose my hearing gradually in my late twenties and was wearing hearing aids a few years later. In fact, in some ways it has enhanced my life because it helped me to make the choice to go a different direction with my career, which has been extremely rewarding. Her personal narrative covers everything from the moment her hearing loss occurred, to her long and frustrating journey to find answers, getting a hearing aid, reclaiming her balance and making peace with her tinnitus. Along the way, Hammond learned a tremendous amount about hearing loss and how it is diagnosed and treated.
Hammond gives very comprehensive information about hearing aid types and styles, as well as the process of buying hearing aids. My only real criticism of this entire book was I found myself wishing that Hammond had talked a bit more about her own personal experience. I largely credit the treatment of oral steroids and antiviral medication that I received at the very start for being able to regain limited hearing. Over time, they have come to appreciate the varied challenges that hearing loss bestows on those affected.
It is an ideal tool to keep up with news and research and to communicate information about a myriad of hearing loss topics to my followers. Only 2 patients had improvement of hearing (from severe to normal, mild to normal), keeping unchanged all other results and no worsening (Table 2 and Figure 2). Patient 8, 73 years, has hypertension and diabetes, as well as probable hearing loss due to presbycusis before the episode of sudden deafness. In group B, eight patients (80%) treated with conventional therapy showed a reduction of subjective tinnitus and hearing score also improved in eight patients (80%) - the hearing remained unchanged in two patients (20%).
All patients in both groups had ear fullness and tinnitus in association with the onset of the SSHL. One year after the onset of symptoms on the right side, the cochlear implant was performed, and resulted in a complete suppression of tinnitus after activating the implant. It was concluded that, according to the survey of tinnitus, the time factor is the most reliable item for subjective tinnitus. This book is an easy-to-read option for those who want both a memoir of life with hearing loss, as well as hard facts and good advice. My own experience was not nearly as frustrating as what she went through; however, it was my own experience with lack of information and compassion from hearing care professionals that made me decide to pursue additional education and change careers to become a hearing care practitioner.
It gives me empathy for the patients and practitioners around me and makes me really good at test-driving and programming hearing aids. The book also touches on assistive listening devices, sign language and implants including middle ear implants, cochlear implants and bone anchored hearing aids.
I recognize that I am biased, though, because I already knew the factual information about hearing loss. The procedure is well tolerated and relatively easy to perform as outpatient procedure performed under local anesthesia (topical), general anesthesia can be avoided, most patients understand the concept of intratympanic therapy and easily accepts the proposed therapy. Regarding the THI scores, it ranged from 58 to 96, prior to initiation of therapy, 8-82 and 30 days after.
Such comorbidities could not justify the improvement in hearing thresholds after the proposed therapy. None of the patients experienced side effects from this treatment, and the authors concluded that this option can be beneficial as adjuvant therapy for hearing improvement in patients with PANSS, but cost factors are the main obstacles to the use of this therapy14.
However, these symptoms improved only in Group A, showing a significant relationship between recovery of hearing thresholds and improvement of aural fullness. Clinical improvement was also reflected by a decrease in the scores of questionnaires THI and VAS.
The hearing recovery was determined by comparing the hearing levels before and after treatment and tinnitus was subjectively evaluated by using a questionnaire. In the hearing care field, we see this every day and it leads me to wonder how many more people with hearing loss could be helped by hearing aids if only their medical doctors would get on board with recommending them.
I think that the average reader picking this up is going to feel like there’s good balance of information about hearing loss and first-person narrative. As yet there is no cure for any kind of hearing loss, and organized public education on this timely topic as well as on hearing loss in general is greatly lacking. However, it should be emphasized again that in relation to complaints of tinnitus, it has undergone a significant change, in which catastrophic change of the degree to mild (Table 1). Given this, the authors suggested the use of cochlear implants as a possible therapy for tinnitus persisted after sudden deafness.
We obtained an average difference of 38.6 points among patients who reported an improvement in tinnitus before and after the course of oral steroids and intratympanic. In group A, the OAE responses appeared simultaneously with the improvement in hearing levels in five patients (63%). However, I can honestly say that it does not have a significant negative impact on my day-to-day life.
Referring to EVA, there was a change from 7 to 10 points before therapy and from 1 to 8 points after it, in relation to intensity.
It was concluded that patients with hearing improvement PANSS (Group A) tend to have OAE responses and sensations of fullness in the ear and tinnitus improved almost simultaneously with the hearing improvement. Most people who meet me for the first time are surprised to find out that I have hearing loss and am wearing hearing aids. In relation to the nuisance, there was a change from 7 to 10 points before and 0-08 points after therapy. The authors concluded that patients with poor hearing improvement tend to have absent OAE and ear fullness and tinnitus persisted.

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