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Author: admin | 30.01.2016 | Category: Ginkgo Biloba Tinnitus

Idiopathic sudden sensorineural hearing loss is a medical emergency that requires urgent diagnosis and treatment, and the adaptation of a proper protocol for management is a priority. Idiopathic sudden sensorineural hearing loss (ISSNHL) [1] is a well-known clinical condition characterized by a sudden occurrence in one or both ears of sensorineural hearing loss of more than 30 dB in at least three contiguous audiometric frequencies over a time course of no more than 72 hours.
Hearing impairment is a common problem worldwide and even more problematic in developing countries. Sensorineural hearing loss [4-9] (or nerve-related deafness) involves damage to the ear caused by aging, prenatal and birth-related problems, viral and bacterial infections, heredity, trauma, exposure to loud noise, fluid backup, or tumor in the inner ear. This retrospective study was conducted from January 2002 to December 2003 to identify patients with ISSNHL. We found no age relation or significant side predilection, and the duration of improvement was variable, extending from less than 1 week to up to 6 weeks. The prognosis of tinnitus involved full recovery in all but one of the grade 4 patients; the unrecovered patient had at 8 kHz a dip that did not improve.
All but three patients who developed dizziness (those with very severe hearing loss) had fully recovered in a few days; the unrecovered group had dizzy spells that lasted more than a few days. ISSNHL is a symptom of cochlear injury and is characterized by sudden onset; within a few hours, it reaches its maximum peak.
Although called sudden, hearing loss seems unlikely to be abrupt but rather probably evolves over a few hours [6].
Research conducted by the Institute of Audiology in Turin documented that 5,925 cases were diagnosed over a 5-year period (1990-1995) [7]. Many causes can trigger sudden hearing loss [6-10] but, despite extensive evaluation, the majority of cases elude definitive diagnosis and, therefore, remain idiopathic.
Our study revealed that the treatment protocol involving steroid therapy in Qatar resulted in hearing improvement in 57.4% of patients with ISSNHL.
Idiopathic sudden deafness is defined as sudden sensorineural hearing loss of undetermined etiology. Hearing is one of our most important senses, and its sudden loss is likely to frighten affected individuals owing to the speed of its evolution, bringing feelings of frustration to such patient and to their physicians.
According to Caldas and Caldas Neto [1] and Snow and Telian [2], the definition of sudden deafness (SD) is "a sensorineural hearing loss whose quick installation can last minutes, hours or a few days. Shaia and Sheehy [3] found a 2% incidence of SD in all otological cases, with no significant difference related to gender.
In 2000, Loughran [6] undertook an SD survey of 100 otolaryngologists, checking the specialists' answers regarding the examinations they requested and the treatments they adopted for this condition.
The confirmation of deafness with sensorineural characteristics and knowledge of the depth of the lesion are obtained through pure-tone audiometry, speech audiometry (speech reception threshold and speech discrimination score [SDS]), and tympanometry curve and acoustic reflex. Our sample was composed of patients who reported to the otolaryngology emergency room of the Federal University of Sao Paulo-Paulista Medical School (UNIFESP-EPM), all of whom had received care during the entire year of 2001.
The pure-tone audiometry (air tone at frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz and bone tone at frequencies of 500, 1,000, 2,000,3,000, and 4,000 Hz), speech reception threshold, and SDS examinations were carried out at the audiometer (MAICO MA 41, Maico Hearing Instruments, Inc., Minneapolis, MN). Our sample included 20 patients with unilateral SD (20 ears), of whom 12 were men and 8 were women (right side, 11; left side, 9).
In our analysis, we used as factors for hearing improvement the definition of improvement of hearing loss in terms of change of thresholds, as provided by the American Academy of Otolaryngology-Head and Neck Surgery: improvement of 10 dB or more at frequencies of 500, 1,000, 2,000, and 3,000 Hz and improvement of 15% or more in SDSs. At its beginning, SD is usually associated with other symptoms that may appear before, at the same time as, or a little after the loss of hearing. Owing to the prospective aspect of our study,it is possible to fail to monitor some patients' progress. All 12 patients (60%) who recovered total hearing showed improvement on the SDS, some associated to tonal thresholds. The five patients (25%) whose hearing did not normalize did not show a good SDS at the outset.
Of the three (15%) patients who abandoned treatment, two did not show any improvement until the third and fourth weeks of treatment.
Of the patients with totally recovered hearing,11 (55%) started treatment before 10 days had elapsed from the onset of SD, and 1 (5%) started treatment after 31 days had passed. Those researchers observed the correlation between hearing and final hearing result through threedimensional audiograms aiming to evaluate prognostic factors.
In their 1998 retrospective study of 132 SD cases that were monitored for 10 years, Molini et al. In our work, we observed that of the six patients (30%) with a light or moderate level of hearing loss at the beginning of the SD, five (25%) had normalized hearing in the second week of treatment, and one did not have total recovery in 2 months but started to improve in the second week. Our preliminary results suggest that the degree of hearing loss may not be very important in determining the prognosis for patients who experience SD. Management of Idiopathic Sudden Sensorineural Hearing Loss: Experience in Newly Developing Qatar.
A report prepared by the Department of Otolaryngology [3] at University of Texas Medical Branch documented approximately 15,000 reported cases of ISSNHL per year worldwide, with 4,000 of those cases occurring in the United States.
Therefore, we have a pressing need to study the causes of ISSNHL and suggest a treatment protocol for ISSNHL.
Of the studied subjects, 81% were male and 19% were female (median age, 43 years; range, 24-67 years).
Of the seven patients (33.3%) who showed no improvement in their hearing both audiologically and clinically (grade 1), six patients had dizzy spells when first seen, four had audiometric HTLs of 65 dB or no response at 8 kHz, five had high-frequency sloping audiometric curves, and all showed no improvement at 6 weeks' duration.
Incidentally that patient developed recurrence of hearing loss 12 week later but in the opposite ear, which was also treated with steroid therapy and showed remarkable improvement.
ISSNHL is the most intractable of hearing loss types, because its fundamental cause is hair cell death. The researchers concluded that sudden idiopathic hearing loss, often attributed to general vascular causes, was one of the most frequent reasons for monolateral hearing loss. Furthermore, we concluded that results can be improved if the disorder is diagnosed early in patients using proper protocols and if early treatment is undertaken. Department of Medical Statistics and Epidemiology, Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar. Audiological Evaluation of Twenty Patients Receiving Pentoxifylline and Prednisone After Sudden Deafness: Prospective Study. Loss of hearing impairs understanding of words and interactions between individuals and their environment, creating several emotional problems that may lead to a series of difficulties and changes in their lives. The severity of the hearing loss may vary from mild to total loss of perception of the most intense sound. Several etiological theories have been proposed to explain SD, such as infection, vascular involvement, and perilymphatic fistulas.


He did not find a consensus, but most of the doctors surveyed (98.5%) used steroids in the treatment, alone or combined with other drugs.
Our objective was to analyze the evolution of a hearing loss in patients with SD through puretone audiometry and speech audiometry (SDS). All patients were subjected to a complete otolaryngological evaluation with magnetic resonance imaging, pure-tone audiometry, speech audiometry (speech reception threshold and SDS), and tympanometry curve and acoustic reflex.
For impedance audiometry, the tympanometry curve and acoustic reflexes were obtained using the Interacoustics AZ 7 (Interacoustics, Assens, Denmark) at frequencies of 500, 1,000, 2,000, and 4,000 Hz. Usually, owing to sudden loss of hearing, affected individuals look for professional aid as soon as possible, as shown in our protocol wherein 16 of the 20 patients (80%) began the medical treatment and were subjected to the first audiometry examination before the tenth day of SD.
Duration of sudden deafness and level of hearing loss at the beginning of treatment (20 patients). Of four patients (20%) whose hearing normalized in the fourth week, two (l 0%) started with severe loss, and two (10%) started with profound loss.
Of these, two (10%) improved on the SDS only in the fourth week, and one of them already showed a good SDS from the outset.
Two (10%) began to improve only in the pure-tone thresholds, one in the third week after the beginning of treatment and the other in the fifth week.
In one case (5%), the complete improvement began to occur, but the patient abandoned treatment after the second week.
Of those whose hearing improved but did not normalize after 2 months, three (15%) started treatment before 10 days had elapsed, one (5%) started between 11 and 20 days,and one (5%) started between 21 and 30 days. All patients were analyzed before the ninth day from onset of SD, and all received the same treatment. As a criterion for improvement, those authors used 15 dB or more in average frequencies and classified the groups according to loss configuration, besides classifying them into categories of total deafness (absence of answers in all frequencies) or deafness. Nevertheless, we also observed a significant index of improvement in six patients (30%) with deep and severe levels of hearing loss.
Intracranial vascular lesion can cause sudden onset tinnitus if there is an aneurism or deformity that results in arterial blood entering straight into the vein without going through the capillaries. Ia€?m googling everything, nutrition, vitamins, Please let me know if you have had sudden onset tinnitus that has gone away! The aim of this study was to determine and identify as early as possible those factors that play the important role in the prognosis of the condition, to describe the experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Because of its various etiological possibilities and its prognostic characteristics, urgent attention and treatment are required, and the condition may be considered as an emergency.
One in every 10,000- 15,000 people experience this condition, with the highest incidence occurring between 50 and 60 years of age.
The prevalence of hearing loss increases with age; most hearing losses develop over a period of 25-30 years.
The aim of this study was to identify patients with ISSNHL as early as possible, to describe their experience, and to suggest a treatment protocol that can be adopted in a tertiary hospital, such as Hamad General Hospital. Tympanometry showed a type-A curve in all patients, and acoustic reflex results were negative in the affected ear in 13 patients. Spectacular advances have recently been made in our understanding of hair cell physiology and molecular biology, offering new hope of alleviating ISSNHL [10].
Also, we observed in our study that most patients who had ISSNHL ranged in age from 40 to 60 years, although the highest rate was found among men.
Monolateral sensorineural hearing loss, which is not seriously disabling, represents a handicap from the social point of view. The degree of hearing loss may vary from mild to severe and may involve different parts of the hearing frequency range. Suggested causes of ISSNHL include viral infections, immunologic vascular compromise, and intracochlear membrane breaks. Samson, Department of Epidemiology and Medical Statistics, Hamad Medical Cor poration, for her kind help in preparing and typing the manuscript.
Sudden hearing loss due to large vestibular aqueduct syndrome in a child: Should exploratory tympanotomy be performed? The loss of hearing may be permanent, or the hearing may spontaneously return to normal or near normal. Besides these, metabolic disorders, drug toxicity, and several other diseases may contribute to the appearance of SD.
Owing to the difficulty in establishing an etiology for SD, several treatments have been suggested. The heari ng loss of these patients was monitored through successive audiometric examinations for a minimum period of 2 months, excluding cases of abandonment of treatment.
Of the sample, two patients (10%) showed a mild level of initial loss, four (20%) showed a moderate level, four (20%) showed a severe level, and six (30%) showed a profound level of hearing loss. Given these results, the most common symptom associated with the hearing loss was tinnitus, which appeared in 16 patients (80%). Of the other two (10%) whose hearing normalized in the seventh week, one (5%) had a moderate level of hearing loss, and the other (5%) had a severe level of hearing loss at the beginning of the treatment (Table 2). Of these, one (5%) who began with a moderate level of hearing loss showed initial improvement in the second week of treatment. Of the patients who experienced complete improvement, six (30%) improved in the second week, and four already had a good SDS: two (10%) in the fourth week and two (10%) in the seventh week (Table 5). Of those who began to improve on the SDS as well as in pure-tone thresholds, one began in the second week, another in the third week, and the last in the seventh week (Table 6). Of those who abandoned treatment, two (10%) began treatment before 10 days from the onset of SD, and one (5%) began after 31 days. The analysis was conducted within 2 weeks from the onset of SD, and the conclusion was that gender and age had no influence on the index of hearing improvement. For this reason, in our work we did not analyze those factors as variables that could have some influence on the prognosis of SD. Of these, one (5%) had hearing that normalized in the second week, four (20%) in the fourth week, and one (5%) in the seventh week.
The level of hearing loss was investigated through audiometry at the beginning and at the recovery of hearing. Vasoactive therapy versus placebo in the treatment of sudden hearing loss: A double-blind clinical study. However, because of controversies regarding etiology and the need for urgent treatment, various diagnosis and treatment protocols were advocated by different centers.
Many hypotheses have been advanced to explain its etiology: viral inflammation, vascular diseases, allergic reaction, rupture of intralabyrinthine membranes, and autoimmune diseases.


Audiological evaluation, including pure-tone audiometry, tympanometry, speech audiometry, and auditory brainstem-evoked response testing results were included.
All patients except one had unilateral ear involvement and revealed almost equal frequency of involvement for both left and right ears.
Only three patients had speech audiometry and, for auditory brainstem response, results in nine patients were normal except for decreased HTL. Six patients of the grade 4 group had flat, basin-shaped or up-turning audiometric curves (Fig.
We observed in our study that some of the causes of sudden or fluctuating sensorineural hearing loss were meningitis, multiple sclerosis, or Friedreich's ataxia. We analyzed this treatment's results in our patients through conventional audiograms, and speech audiometry was performed in the acute stage and during the treatment. Although sudden deafness is usually unilateral, it may be bilateral." Many times, it is accompanied by other symptoms, such as tinnitus and vertigo. In 1991, Shikowitz [5] pointed out that although several studies on SD have been carried out, researchers do not have a definition that is universally accepted.
For years,many treatment protocols have appeared in the medical literature, each associated with varying success rates. In our study, we used pentoxifylline and prednisone, after we eliminated through magnetic resonance imaging the possibility of neoplastic processes or demyelinating diseases.
For these authors, when the loss was of 60 dB NA or more, the prognosis was less favorable than when the loss was lower, showing that the intensity of the initial hearing damage is an important prognostic factor. In their study, these authors noted that recovery was less probable after 9 days had elapsed since onset of SD. End Your Tinnitus: 42% of Ringing in ears patients could hyperlink no direct trigger to their signs or symptoms 51% of victims observed their Ringing in the ears coming on gradually 39% reported a sudden onset of signs or symptoms.
It was conducted in the ear, nose, and throat outpatient clinics at Hamad General Hospital and the ear, nose, and throat wards at Rumailah Hospital. Recently, increasing interest is centered on the means of diagnosis and treatment, leading to the emergence of quite a variety of protocols adopted by different treatment centers.
With respect to laboratory investigations, results of complete blood cell count, erythrocyte sedimentation rate, blood film for abnormal cells, and coagulation screening were normal in all patients. However, they are usually based on emotional and nonscientific considerations, because the exact etiology is unknown. These drugs were chosen for their action in the inner ear cells, independent of the etiology.
Of the three patients (15%) who showed profound loss at the outset of SD, two (10%) showed some improvement at the third week, and one (5%) showed some improvement at the fifth week (Table 3). In our work, of the 12 patients (60%) whose hearing normalized, 11 (55%) presented with SD before 10 days had passed and obtained total recovery at different times: 5 (25%) in the second week after beginning treatment, 4 (20%) in the fourth week after beginning treatment, and 2 (10%) in the seventh week after beginning treatment. As many as one in ten close relationships break down as a result of one partner becoming unexpectedly deaf2, because the onset of sudden deafness imposes. Many studies have been carried out to assess the histopathology of the labyrinth in cases of ISSNHL and to provide a better understanding of the etiopathogenesis [10]. In ten of the twelve patients who showed improvement, the duration of onset was less than 14 days and was less than 7 days in six of eight patients in grade 4. The incidence of tinnitus compares well with that in the literature [11,12]; however, tinnitus did not assist well in determining which patients would suffer hearing loss. In all the studied cases, patients had an intact tympanic membrane and revealed no other ear, nose, and throat abnormality. The global incidence of this disease seems to be low but, in reality, it may be higher because patients who spontaneously recover hearing may never look for medical aid.
Hearing in one patient (5%) showing SD for more than 1 month improved in the second week after the beginning of treatment. The sudden onset tinnitus is thought to be due to a€?excessa€? and the ringing is low, like screaming or thunder, and is not relieved by.
The treatment protocol that was adopted-consisting of high-dose steroid therapy, full-dose antiviral drug (acyclovir), and a histamine analog, betahistine-resulted in hearing improvement in 57.4% of cases. Finally, most causes of ISSNHL remain unknown; thus the term idiopathic is applied to these cases. In respect to the duration of illness, 33.3% of the studied patients had the complaint for 2 weeks, and 19% had it for more than 4 weeks. However, a high incidence of associated dizziness may be responsible for poor recovery incidence in our series, so it can be considered to indicate a poor prognosis [13-15]. Of those who began treatment before 10 days, two (10%) did not show improvement until the fourth week and abandoned treatment.
End Your Tinnitus: 42% of Ringing in the ears victims could website link no direct lead to to their symptoms 51% of patients noticed their Ringing in the ears coming on little by little 39% noted a sudden onset of indicators. We compared the hearing threshold results in the different periods in this prospective study.
Thus, the relation between time of SD onset and beginning of recovery showed great diversification and was not significant.
Five patients (25%), among them some with moderate hearing loss, began a slow improvement in only the pure-tone thresholds or in the complete aspect and showed a low SDS at the beginning. Traumatic Head Injuries: Some automobile crash victims have reported a sudden onset of tinnitus. The noise can arrive either from the inner ear, outer ear, middle ear or inside the sufferer's head. The results of our study revealed that the steroid therapy protocol practiced in Qatar resulted in hearing improvement in patients with idiopathic sudden sensorineural hearing loss. These patients have been monitored by us for more than 2 months but have not obtained normalization of hearing.
Good prognostic factors include early diagnosis, marked reduction of symptoms, and improved shape of the audiometric curve.
The onset of total deafness, coupled with severe tinnitus completely ended life as I knew it.



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