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Imagine waking up one morning to discover that you had spontaneously lost most of your hearing in one or both ears, with no warning or explanation.
If you or a loved one experiences a sudden hearing loss, please call your doctor or visit an ER or urgent care center immediately! Forty hospitalized patients with sudden hearing loss and tinnitus were compared to a control group (N = 28) of inpatients of an ear-nose-throat ward. Certain single-case studies have reported the association between stress and SHL [9], as have some group studies that used qualitative interviews as assessment instruments [10,11]. From a physiological point of view, the assumption of the contribution of stress to the onset of SHL and TIN has some plausibility.
The main objective of the current study is to examine the association between stress SHL and TIN in a control group design, using a comprehensive and methodologically refined assessment strategy. Our study, therefore, tested the following assumptions: Onset of SHL and TIN is associated with a high level of stress defined by life events and daily hassles, habitual dysfunctional coping strategies, a high level of worrying, and a low level of social support.
Because a prospective design relating to the stress hypothesis with hundreds of non symptomatic subjects was beyond our research capacities, a control group design was used. Daily hassles (DH) were assessed by the German questionnaire Alltagssorgen-Skala [33] (Cronbach's alpha = 0.96), which is based on the Daily Hassles Scale by Kanner et al. To determine the level of worrying (W), the German version of the Penn State Worry Questionnaire [36] (16 items; a 5-point rating scale) was presented to the subjects. The experimental subjects were contacted by telephone 3 months after they had been assessed for the first time.
Patients with SHL and TIN show significantly higher scores on both measures of stress, on the life event scale, and on the daily hassles scale than those in the clinical control group.
As expected, significantly more negative coping strategies (COPneg) were found in the experimental group.
The prospective part of our study examined the connection of psychological test variables (LOCint, LOCpow, LOCfat and LE, DH, W, and social support), sociodemographic variables (age, gender, family status, number of children), and characteristics associated with the disorder (TIN in the past, acute TIN, disability due to TIN and SHL, and WB at the onset of the disorder), all measured at onset of the hearing disorder, to the chronicity of TIN and hearing loss 3 months later. The chronicity of TIN is correlated most closely to WB at disorder onset, COPneg, and LOCfat (Table 5). In a discriminant analysis, the six variables of all three categories (WB, COPneg, LOCfat, acute TIN, age, disability due to TIN) associated most highly with chronicity of TIN were used to separate the group of patients with TIN from recovered patients. Chronicity of SHL (n = 18 of 35 subjects) is associated most closely with WB at the onset of the disorder, with disability due to TIN and SHL, and with the degree of anxiousness concerning SHL and LOCfat. The six variables-WB, disability due to acute TIN, SHL, LOCfat, anxiety concerning SHL, and number of SHL-correlated most highly to the chronicity of hearing loss were entered into a discriminant analysis at the same time. The hypothesis regarding the stress differences expected between SHL and TIN patients and the control group before the onset of the disorder was confirmed fully. The affective state of certain persons often has been shown to influence memory; in a negative state, more negative memory contents are activated and retrieved. At first glance, the data about worrying confirm our hypothesis that it is more intense in SHLITIN patients. The discrimination analysis fully supported the foregoing conclusions, selecting daily hassles as the strongest variable in the prediction of group membership and coping as a further relevant aspect. The second part of our study was concerned with the prediction of chronicity of SHL or TIN 3 months after onset. Though the validity of these predictions cannot be guaranteed and has to be cross-checked, an interesting note is that the supposedly predisposing stress factors that seem important for the onset of the studied hearing disorders do not contribute to its chronicity. All in all, our study suggests that psychological variables related to stress and its processing are predisposing for TIN and SHL and that the actual subjective state of well-being shortly after onset of the di sorder is a relevant predictor of chronicity of both disorders.
Though our data support the hypothesis of psychological influences on disease etiology and prognosis in SHL and TIN, some methodological limitations of the study have to be taken into account. The intent of our study was to sample similar groups maximally except for the disorder itself. Furthermore, the conclusions drawn from the prospecti ve part of the study, especially regarding the importance of psychological variables, are somewhat uncertain. An acoustic neuroma (also called a vestibular schwannoma) is a benign (non-cancerous) tissue growth that arises from the balance nerve.
The most accurate imaging technique for acoustic neuroma identification is a magnetic resonance imaging (MRI). Since acoustic neuromas are benign, often slow-growing tumors, careful observation over a period of time may be appropriate for some patients. The aim of this study was to determine the effects of various treatment modalities employed for patients with sudden sensorineural hearing loss (SHL).
Sudden sensorineural hearing loss (SHL) is defined as hearing loss equal to or greater than 30 dB at three or more consecutive frequencies, the onset of which takes place over a period of 3 days or fewer [1]. Treatment is controversial and can involve anti-inflammatory drugs (steroids), vasodilators, antiviral agents, plasma expanders, diuretics, calcium channel antagonists, hyperbaric chamber use, carbogen, anticoagulants and, more recently, intratympanic corticosteroids [6-11]. The aim of this study was to observe the progression of SHL in patients who underwent different treatments at the SHL outpatient facility of our institution and to describe clinical and epidemiological aspects.
This retrospective study analyzed the records of patients treated in the sudden hearing loss section of the Otolaryngology Department, Clinic Hospital School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006. All patients underwent imaging tests (temporal bone magnetic resonance imaging or computed tomography) and complete blood cell counts. The patients underwent serial audiometric testing at baseline and after 30, 90, 120, and 180 days of treatment.
Considering all the cases, we observed significant posttreatment reductions in low- and high-frequency PTA (Table 3). Estimates have shown that among patients with SHL, the mean age ranges from 43 to 53 years, the gender distribution is equivalent, and the hearing loss is unilateral in more than 95% of cases [2,4,11,13,14], similar to what we observed in our study. Approximately 25-40% of patients with SHL present with concomitant upper-airway infection [11]. According to Rauch [11], vestibular symptoms were identified in 28-57% of cases, as compared with 32-40% reported by Nakashima et al. The most common etiological factors identified for SHL were those that are not the most frequent but can be directly identified through clinical history, blood samples, or imaging studies, including autoimmune diseases, acoustic trauma, ototoxic drugs, Lyme disease, and ear malformations. Theoretically, this anatomical presentation predisposes to hypoxia, spasms, thrombi, and hemorrhage, especially at the cochlear apex, primarily affecting the response to low frequencies [23]. When we analyzed the cases in which PTA normalized, we observed that in most cases baseline PTA was moderate and the etiology was unknown. Among the five treatment groups, the differences in ΔPTA were not statistically significant at any frequency. For low-frequency and high-frequency PTA, we observed an inverse linear correlation between time from onset to treatment and audiometric response presented by the patients. On the basis of our analysis, we can infer that plasma expanders do not improve the efficacy of the corticosteroidacyclovir combination used in managing SHL in patients.
Dossier Cuisine La vague "Healthy Food" s'est greffee au continent Europeen apres avoir converti les Americains. Dossier Lifestyle Apres Lyon, Nantes, Toulouse, ou encore Marseille, on continue notre tour de France des bons restos. Neurosensory is an accredited provider of the Royal Australian College of General Practitioners’ Quality Improvement and Continuing Professional Development program.
Under these conditions, your lungs can gather up to three times more oxygen than would be possible breathing pure oxygen at normal air pressure.
Many insurance carriers are approving this costly procedure without question for victims of sudden hearing loss.
Most studies dealing with chronic TIN focus on its symptomatology, consequences, and treatment [13-21].
One presently prominent theory postulates that both disorders result from a diminished supply of blood to the inner ear, which impairs the inner and outer hair cells by lack of oxygen [1,5,10,22].
Stress is assessed by psychometrically validated inventories of life events and daily hassles. The study examines whether psychological predictors exist for maintenance of hearing loss and TIN 3 months after onset. The main guideline for the selection of the control group was to assess patients with maximal similarity to those in the experimental group of patients with SHL and TIN so as to rule out threats to internal validity, as addressed by Kazdin [29]. At the time of the assessment, all patients selected for the study were hospitalized in the ear-nose-throat ward. Patients were on the average approximately 40 years old, and nearly one-half (48.5%) were female. The first questionnaire asked for sociodemographic data (age, gender, family status, number of children, profession), information regarding the circumstances of the disorder (both groups), and a detailed description of SHL and TIN (experimental group only). Stober [37] found a Cronbach's alpha of 0.86 for the German version of the Penn State Worry Questionnaire, which is similar to the Cronbach's alpha found by Molina and Borkovec [38]. This outcome is true for both aspects, the number and stressfulness of events (Table 3), though subjective strain differentiates more clearly between the groups. However, in contrast to expectation, they also showed significantly more positive strategies (COPpos, see Table 3). This finding indicates that the lower the state of wellbeing, the higher is the probability of TIN maintenance.
The number of predictors is limited to six, as the number of subjects should not be less than the number of predictors multiplied by five.
Chronicity of hearing loss is not correlated to the other sociodemographic variables or characteristics attributed to the disorder (Table 6).
Life events and daily hassles before the onset of the disorder were significantly more frequent, and their stressfulness was more distinct in the experimental group. As a marked difference in well-being was found between the two groups (worse mood in the experimental subjects), the variance between groups attributed to differences in well-being was eliminated by partial correlation. The hypothesis of more COPneg strategies in the experimental group was supported, but the level of positive coping endeavors also is much higher in the SHLITIN group, a finding contrary to expectation. However, after controlling for well-being, this effect vanished, which demonstrates that the process of worrying is intensified markedly by an individual's negative state.
The general assumption is that the probability of remission of these special hearing disorders at that time is rather low, so that a chronic state can be assumed. The only psychological trait variable with some predictive power for TIN is negative coping. Only habitual processing variables (coping, fatalistic LOC) show some influence on chronicity, but the best predictor is well-being, probably an indicator of the subjective evaluation of the biopsychosocial state of an individual. Habitual psychological trait characteristics (coping, LOC) exhibit some, but not a strong, influence. The experimental group exists of patients suffering predominantly from both types of hearing disorders; very few persons were afflicted with TIN or SHL only. This was successful in nearly all assessed variables, with the exception of well-being, which turned out to be an important variable. The first step in identifying a possible tumor is a thorough history and physical examination by a physician. When a small tumor is discovered in an older patient, observation to study the growth rate of the tumor may be indicated if acute symptoms are not present. The type of approach is individualized depending on the patient's wishes, hearing level, other neurological symptoms, as well as the location and size of the tumor. We retrospectively evaluated the records of patients treated in the sudden hearing loss section of the Otolaryngology Department at Clinic Hospital, School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006. Approximately one-third of affected patients improve spontaneously, most within the first 2 weeks of disease progression [1,3]. The inclusion criterion was SHL of sudden onset over a 72-hour period, equal to or greater than 30 dB at three or more consecutive frequencies. Group II included patients who had a 0- to 15-day history of SHL and in whom the use of plasma expanders was contraindicated owing to systemic hypertension, cardiopathy, coagulation disorder, or renal failure. The laboratory exams included erythrocyte sedimentation rate, fasting glucose, cholesterol, triglycerides, free thyroxine and thyroid-stimulating hormone, circulating immunocomplex, complement, rheumatoid factor, and antinuclear factor.

The only epidemiological study of SHL published to date was performed in Japan in three different years and different decades [13]. However, other authors [2] observed that, unlike our finding, only 11% of their SHL patients presented with concomitant upper-airway infection. The autoimmune diseases that can lead to SHL are autoimmune inner-ear disease and immunemediated systemic disease leading to a secondary innerear injury.
One piece of evidence supporting this hypothesis is the fact that various authors have reported among patients with SHL seropositivity for a number of viruses, including herpes simplex, varicella zoster, cytomegalovirus, influenza, parainfluenza, rubella, and mumps [9, 18-20].
Studies involving patients with SHL have shown evidence of sudden-onset cochlear ischemia and an association between SHL and systemic vascular diseases [23]. In fact, vascular etiology is a very promising theory, but confirming and explaining it is difficult. Despite the lack of a control group, the findings of our study can be compared with those presented in the literature. Among the remaining cases, the most common etiology was diabetes mellitus, followed by viral causes.
The improvement in PTA was less pronounced in patients in groups IV and V (who started treatment at least 15 days after the onset of SHL) than in the other patients, although the difference was not statistically significant. This finding is in agreement with those of other studies showing that earlier initiation of treatment improves prognosis [1,4,25]. The main feature is intermittent attacks of vertigo which can last from a few minutes to hours.
Les marches de Noel permettent de s'organiser un veritable tour de France a l'occasion des fetes de fin d'annee. On a mis le sapin sur le trottoir (ou dans le placard), on a range les guirlandes et decroche la couronne de la porte. Human blood carries this oxygen throughout the body, stimulating the release of substances called growth factors and stem cells, which promote healing.
The main objective of our study was to test the hypothesis of stress as a predisposing risk factor in the development of sudden hearing loss and tinnitus. Their pathophysiological features, the assumptions concerning their pathogenesis, and their medical treatment are rather similar [5-8]. Patients suffering from SHL (N = 98) reported more stress than did 13 patients with morbus Meniere who were used as control subjects. Vascular processes, mainly responsible for blood flow, are regulated by the sympathetic nervous system and the hypothalamic pituitary adrenal axis, the main systems activating cardiovascular stress responses. Because external stressors have no direct influence on health but are mediated by subjective evaluation and processing of the stressful situation [23], habitual coping strategies also are studied. The variables examined as possible predictors are the same as those mentioned earlier as assessed at the time of the onset of the disorder. Additionally to the disorder itself being different in the control group, the disease should not be associated conceptually with stress in its etiology.
Furthermore, patients rated their actual well-being (WB) on a 5-point scale from very good (5) to very bad (0).
The 56 items reflect a variety of everyday hassles concerning work, household, marriage, money, friends, and family.
The Streβverarbeitungsbogen assesses the likelihood of various habitual coping behaviors in situations leading to discomfort, arousal, or tension. The contacted subjects were interviewed about the status of their hearing disorder, especially whether their TIN or hearing deficit still were present.
Also, the more negative coping strategies individuals exhibit and the stronger a fatalistic locus of control in individual patients, the more probable is the maintenance of TIN.
Interestingly, the reported strain due to the stressful events differentiates more clearly between groups than does their number. Otherwise, the reported higher amount of stress could be ascribed to the negative state of those in the hearing loss and TIN group at time of assessment. One can assume that the classification of coping behaviors into "bad" or "good" regarding their problemsolving or palliative capacity may be invalid, as some often have argued that the effectiveness of coping also depends on the kind of stressor and other characteristics of the situation. The discrimination between groups was well above chance but, with an error rate of 25%, was not really very satisfactory.
Interestingly, this global self-evaluation is more important than is the rating of disability due to TIN and SHL and variables related to the history of the disorder.
The definitely worse state of well-being in the experimental group points to the fact that the comorbidity of SHL and TIN probably is very stressing and annoying. Nevertheless, our data support the hypothetical role played by stress and related psychological factors in the etiology of SHL and TIN. Verhaltensmedizinische Untersuchungen zum HOrsturz [The behavioral medicine of sudden hearing loss]. Plotzliche doppelseitige Ertaubung durch psychische Konfliktsituation [SHL in both ears as a consequence of psychological conflict]. General and specific coping strategies used by middle aged males with noise induced hearing loss, with or without tinnitus.
Structure of perceived handicap in middleaged males with noise-induced hearing loss, with and without tinnitus.
The management of chronic tinnitus-comparison of a cognitive-behavioral group training with yoga.
Psychologische Behandlung des chronischen Tinnitus [Psychological treatment of chronic tinnitus]. Multidimensional health locus of control as partial predictor of serum phosphorus in chronic hemodialysis.
Zur interund intraindividuellen Reliabilitat einer modifizierten deutschen Fassung der Social Readjustment Rating Scale [Inter- and intraindividual reliability of the modified Social Readjustment Rating Scale]. Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. Fragebogen zur Erhebung von Kontrolluberzeugungen zur Krankheit und Gesundheit (KKG) [Questionnaire to assess locus of control regarding illness and health (KKG)]. MRI uses magnetic pulses and radio frequency waves to produce an image of a portion of the body being studied. A MRI scan of the tumor and surrounding region must be performed periodically to determine if there is significant change in the size of the tumor.
The Ear Institute of Chicago is well versed in all surgical approaches for acoustic neuroma management. Our study included patients with SHL of sudden onset (occurring over a 72-hour period) at equal to or greater than 30 dB at three consecutive frequencies. Approximately one-third of cases are accompanied by complaints of tinnitus, dizziness, and ear fullness [2,3].
Risk factors associated with poor prognosis include time of disease progression prior to the initiation of treatment, extreme age (being very young or very old), severe initial hearing loss, concomitant vestibular symptoms, and a descending pure-tone audiometry curve [1,4,12].
The treatment regimen was the same as that used in group I patients, minus dextran or minus dextran and acyclovir if the SHL onset was greater than 5 days. Serological tests were also conducted for herpes simplex virus type I, cytomegalovirus, syphilis, rubella, measles, Lyme disease, and the human immunodeficiency virus. Nevertheless, none of those authors compared their results with the prevalence observed in epidemiological studies of upper-airway infection in the corresponding populations.
However, those authors found that prevalence of these disorders among patients with SHL was lower than that reported for patients with dizziness [15], which is in agreement with the findings by Cadoni et al. In our study, the etiology was vascular in 4.3% of the cases of SHL, one of which was very severe. We cannot state with confidence that the likelihood of complete recovery is greater in such cases of SHL, as other factors such as gender and age at SHL onset might exert some influence. In groups I, II, and III, treatment was initiated within the first 15 days after the onset of SHL.
We observed a genderbased difference in ΔPTA, with a tendency toward statistical significance, suggesting that the SHL prognosis is poorer for men. Oral steroid treatment of sudden sensorineural hearing loss: A ten year retrospective analysis. Sudden complete or partial loss of function of the octavus system in apparently normal persons. Antiviral treatment of idiopathic sudden sensorineural hearing loss: A prospective, randomized, double-blind clinical trial. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: A prospective, randomized, double-blind clinical trial. Prognosis for sudden sensorineural hearing loss: A retrospective study using logistical regression analysis. Clinicoepidemiologic features of sudden deafness diagnosed and treated at university hospitals in Japan. The implication of viruses in idiopathic sudden hearing loss: Primary infection or reactivation of latent viruses? The relationship of the herpesvirus family to sudden hearing loss: A prospective clinical study and literature review.
There are periods of remission between the attack, which vary in each person making M ni re s disease an unpredictable and distressing illness.
Une escapade a travers les beaux paysages du Vieux Continent pour vous donner des belles idees de vacances ou de depaysement le temps d’un week-end en solo, en amoureux ou entre amis ! L'esprit de Noel s'est petit a petit estompe, mais ne soyons pas triste, c'est pour mieux le retrouver l'annee prochaine !
In the past, sudden onset hearing loss (occurring within 72 hours) has had very limited treatment options. Thus, differences in life events and daily "hassles" were expected between groups, as were differences in coping styles, habitual worrying, and social support. Quite a number of experts and laymen believe that the onset of SHL and TIN is mediated by stress. However, no standardized measures were applied, and no quantitative statistical analysis of the data was conducted. What must be borne in mind, however, is the existence of various theories of pathogenesis and etiology of these hearing disorders; in general, all lack sound empirical support and somehow differ in their views of the functional role attributed to stress. Furthermore, worrying [24] is an important factor related to the processing of stressful information, a trait variable that has not yet been considered in regard to the onset of hearing disorders. Additionally, locus of control assessed at the same time is included as a psychological trait variable, which has been studied often in the context of chronic disease [25-28]. For the control group, inpatients suffering from different conservatively treated illnesses of throat, ear, and nose were selected. Life events (LE) were assessed by the German version of the Social Readjustment Rating Scale (retest-reliability after 10 weeks, Pearson's coefficient, r = 0.71) [31,32].
Number and stressfulness of hassles during the last 4 weeks before the onset of the illness were assessed. Wellbeing showing a significant difference between groups can be considered as a potentially confounding variable. Worrying had a significantly higher level in the experimental group, but this difference was lost after statistical control for well-being.
Thus, the subjective evaluation of stressful events is more important than is the sum of events. However, the difference in stressfulness of life events and daily hassles were shown to be maintained at a significant level.
Regardless, the fact remains that different coping behaviors, whether positive or negative, are used much more frequently by the experimental group.
All subjects reported an extraordinary high degree of social support (high above the average of the norm group). The most powerful predictor both for chronic TIN and for SHL is the state of subjective wellbeing at time of first assessment immediately after the onset of the disorders.

Furthermore, what should be mentioned is that the explained variance is higher in the prediction of chronicity than in the discrimination of the different clinical groups. The search for prognostic factors of chronicity must be continued, after this first attempt offering some challenging data.
In Bradley WG, Deroff RB, Fenichel GM, Marsden CD (eds), Neurology in Clinical Practice, Vol. The balance nerves are thin cords that stars at the base of the brain and travel through a small, bony canal (internal auditory canal) of the skull to the inner ear. Therefore, hearing loss is the first symptom in over 90% of patients with acoustic neuroma. An auditory brainstem response test (abbreviated ABR, BAER, or BSER) is ordered if there are any asymmetries in hearing testing between the right and left ears. We divided patients into five groups by profile and treated them with dextran, dexamethasone, acyclovir, nicotinic acid, and papaverine hydrochloride (with or without vitamin A).
Group III included patients who had a 6- to 15-day history of SHL and who were hospitalized and treated with the same treatment used in group I minus acyclovir. If no improvement occurred in the auditory threshold after 3 days, treatment was discontinued and the patient was discharged. No statistically significant difference was noted among the treatment groups in terms of audiometric progression determined by calculating the difference between the low- and high-frequency PTAs seen at baseline and after 180 days (Table 7). Owing to differences in design and population, we cannot directly compare our sample with theirs. However, despite advances, serological diagnosis remains difficult, as most tests are nonspecific and have a low accuracy rate [17]. Blood circulation in the inner ear is of the terminal type, the cochlear artery running from the base to the apex of the cochlea. In that case, SHL was detected after an episode of aplastic anemia (severe erythrocytopenia and thrombocytopenia) resulting from prolonged use of a nonsteroidal antiinflammatory drug (potassium diclofenac used daily for more than 1 year to treat acne). To our knowledge, no previous studies have attempted to identify the etiologies that are most often associated with audiometric normalization in patients with SHL. However, the greatest improvement in PTA was observed in group II patients, who were the only ones not treated by dextran.
A recent study demonstrated a statistically significant association between less recovery of hearing loss and male gender [16]. At one time, it was theorized that a viral componenet was involved, however, treatment with antivirals has shown no benefit. The hypothesis of more frequent and more stressful life events and daily hassles was supported empirically. Because of the abundant clinical evidence for the importance of stress, the simplified model illustrated in Figure 1 and derived from Hoffmeister [1] is used for the conceptualization of the presumed interplay of stressrelated somatic and psychological factors.
Patients were asked whether any of the 42 given life events took place within the last year.
It consists of three scales: internality (LOCint), powerful others-externality (LOCpow), and fatalistic externality (LOCfat). The group differences in both aspects of LE and DH, however, remain significant after statistically controlling for well-being (see Table 3). No difference was registered in the level of social support; both groups showed very high scores (Table 3). Our data show, as is found often in other studies, that life events and daily hassles are not independent of each other but correlate to a large degree. Thus, well-being had some effect on remembering and reporting negative events, especially on the number, but the difference between experimental and control group cannot be explained totally by their different state of well-being.
What might be posited is that the experimental group uses more coping strategies because they meet more life problems, as shown.
Generally, social support may be very high in the special situation to which all subjects were exposed: being in the hospital for their first few days.
Also very influential is the degree of disability due to TIN experienced at first assessment.
One undesirable aspect of our study is the difference in the number of subjects in the experimental control group, due to the difficulty in recruiting control patients.
Two other nerves, the hearing nerve and the facial nerve (7th cranial nerve), travel directly alongside the balance nerves through the internal auditory canal to the inner ear. An ABR provides information on the passage of an electrical impulse along the hearing nerve from the ear to the brain. A contrast material, gadolinium, is given during the MRI to enhance the visibility of the tumor. Worldwide, SHL accounts for approximately 1% of all cases of deafness, and 15,000 new cases occur annually [1,4]. Patients were divided into five treatment groups on the basis of SHL duration and clinical profiles that indicated the use or absence of the current drugs prescribed. Group IV included patients with a 16- to 30-day history of SHL and who were treated with the group I regimen minus dextran and acyclovir. However, the fact that the time to first medical visit was longer in our study might be attributed to patients' lack of knowledge concerning the symptoms or difficulty in patients' gaining access to treatment. In our sample, tinnitus was much more prevalent (95% of cases) and was often the main reason for the disturbance, leading us to recommend that future clinical trials investigate therapeutic possibilities in preventing and managing this symptom in SHL patients. In our sample, diagnoses were made by determining erythrocyte sedimentation rates and levels of antinuclear factor and rheumatoid factor. Intracochlear hemorrhage can be revealed through the use of magnetic resonance imaging, showing the importance of this procedure in making the diagnosis [24].
The authors estimated that audiometric recovery resulting from treatment translated to an increase in mean PTA of approximately 25 dB, similar to what we observed for low-frequency PTA. However, we agree with Mattox and Simmons [25], who reported a fundamental difference between hearing losses at low frequencies and those affecting high frequencies, stating that low-frequency losses are more easily reversed. Although some underlying diseases can impair innerear microcirculation and hinder clinical improvement of SHL, the comorbidities presented by patients in group II were not indicators of poor prognosis. The better prognosis in women merits further analyses, given a possible bias that might be related to indicators of good prognosis. The dominant role of daily hassles, especially their stressfulness as a risk factor, was shown clearly. In a well-designed but unpublished study by Mtinzel and Sander (oral presentation), however, no differences in stress were found between a group of patients with SHL and those in a clinical control group.
Additionally, they had to rate the subjective stressfulness (or strain) of each event on a rating scale from 0 to 100. To assess the relative importance of LE and DH, controls were applied for their common variance. A further assumption might be that they are trying hard to cope with stress most of the time but are not successful, as the reported strain by the events is higher in the experimental group. In the prediction of chronic SHL, both disability due to SHL and TIN at onset are important.
The task of identification of patients for the study was allotted to the hospital staff, who then informed the psychologists of their potential subjects. We determined outcome as the difference between day-0 and day-180 pure-tone averages (PTAs).
Since SHL was first described 62 years ago [5], various etiologies have been proposed, including the infectious, traumatic, neoplastic, immune, ototoxic, vascular, ischemic, neurological, and metabolic. Group V included patients with more than a 30-day history of SHL who were treated with nicotinic acid, papaverine hydrochloride, and vitamin A.
If audiometric improvement occurred, the treatment regimen was maintained for up to 10 days. Possibly these discrepancies in the prevalence of upper-airway infection accompanying SHL are the result of geographical differences.
In two patients, the diagnoses were made based on a clinical history of vasculitis (Churg-Strauss syndrome) and thrombophilia, respectively.
This was also observed in our study in which low-frequency PTA normalized in 28 cases as compared with 15 cases of high-frequency PTA normalization.
In our study, dextran was not found to act as an adjuvant to dexamethasone or acyclovir in the treatment of SHL, as the patients presenting the best response to treatment were those in the group not treated by dextran. Patients with profound hearing loss often do not regain any hearing function with steroid treatment. This selection criterion was used to reduce bias effects of memory on self-report measures [30]. The groups did not differ significantly in any of the sociodemographic variables (Table 2). After controlling for the effect of DH, the difference in LE between groups no longer was significant; on the other hand, after controlling for the effect of LE, the difference in stressfulness of DH was maintained (see Table 4). After this procedure, the discriminating function of life events, be it number or strain, was lost. Thus, their potentially exhausting coping endeavors could also contribute to onset of the hearing disorders. Because the identification of potential control group patients was much more difficult than was the identification of SHLITIN patients and because of the fact that pending surgery excluded many patients from the control group, the recruitment of the control subjects was very time-consuming and less successful. Wellbeing is the only variable differing significantly, with control patients feeling better than did the experimental subjects. On the other hand, daily hassles (especially their stressfulness) retain their differentiating function. However, the number of subjects lies within the range of statistical demands (number of subjects = 5 × number of variables) [41].
We observed significant improvements in PTAs after 180 days of treatment and noted a significant linear correlation between time from SHL onset to initial visit and recovery. The low-frequency PTA was determined by averaging the pure tones of the 250-, 500-, and 1,000-Hz frequencies, and the high-frequency PTA was based on those of the 2,000-, 4,000-, and 8,000-Hz frequencies.
The prospective part of the study aimed at the prediction of chronicity of sudden hearing loss and tinnitus (3 months after onset) by sociodemographic, psychological, and disease-associated variables. Patients who fulfilled the established criteria were informed about the study and then were given the questionnaires, which they were supposed to complete within 2 days.
Thus, what can be concluded is that life events probably give rise to various stressful daily hassles that undermine health status. We determined audiometric evolution of the responses in the different treatment groups by subtracting baseline PTA from final PTA (after 180 days of treatment).
Pitkaranta and Julkunen [21] investigated the protein MxA (a specific marker of systemic viral infection) in patients with SHL and found evidence of viral etiology in 6.5% of the cases. The strongest predictor of chronicity was the degree of well-being at the time of first assessment (soon after disease onset). Consequently, our study applying psychological instruments of satisfying reliability and validity in a control group design confirms findings by Hoffmeister [1], Kropp and Rad [10], Stange [11], and Neuser and Knoop [12].
In the treatment of SHL, dextran provided no more benefit than did dexamethasone or acyclovir. We found mumps (paramyxovirus) to be the most common etiology, although we did not test for influenza or parainfluenza. Only one person contacted in the experimental group and three in the control group refused to participate (see Table 2). These discrepancies can be attributed to the difficulty of making the viral diagnosis, given that the time to the first medical visit (interval between the onset of SHL and blood collection) varied from study to study, which can influence seropositivity.
Of note in our study and in a previous study [22] is that some of the patients presented seropositivity for the bacterium that causes Lyme disease.

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