Prednisone taper for sudden sensorineural hearing loss,oil for ringing in the ears remedies,tinnitus best medicine jokes - You Shoud Know

See Introduction by guest-editor Maurice Miller, PhD, for other articles in this special issue. Sudden Sensorineural Hearing Loss (SSNHL) is one of the few sensorineural losses known to be reversible. Sudden Sensorineural Hearing Loss (SSNHL) is one of the few sensorineural losses known to be reversible in some cases. In a recent 10-year retrospective study2 of 318 patients, 88% had little or no pre-existing hearing loss on the contralateral side and, as a result, were not previously under the care of an audiologist or otolaryngologist. Once referred to an otolaryngologist, such cases may benefit from the application of steroids (typically Prednisone) for several weeks.
Even though outcome is variable, the 10-year study noted above showed a significant benefit to the use of steroids for SSNHL.2 Because of the possibility of improved outcome with steroids, and the narrow window of opportunity for initiating treatment, SSNHL should be considered an emergency of the ear. Vascular insufficiencies were proposed by several authors, based primarily on the brief time course of the onset, as if blood supply to the cochlea had been interrupted.
Several authors have shown an association of SSNHL with active viral upper respiratory illness. On the other hand, it is not necessary for infection of the cochlea itself to occur in order to provide a viral-based mechanism for SSNHL. Although corticosteroids are known to cause a host of side-effects, the vast majority of these are dose-related. A unilateral loss of practically any audiogram type can develop suddenly and present in the audiology clinic or practice.
The low frequency category was given special consideration since low frequency sensorineural loss can be a symptom of Meniere’s syndrome. On the other hand, when sudden, unilateral sensorineural loss first presents, it may be impossible to know if it is SSNHL or Meniere’s syndrome. Figure 1 shows the result of audiologic evaluations done when the patient first presented and then 1 month later after receiving a standard 3-week course of steroids. Some studies have been undertaken to evaluate the benefit of antiviral drugs in combination with steroids for treatment of SSNHL.
There is no question that early diagnosis and treatment are needed in order to get the best outcome for patients with SSNHL. Chris Halpin, PhD, is a clinical associate in audiology at the Massachusetts Eye and Ear Infirmary in Boston, and is assistant professor of Otology and Laryngology at Harvard Medical School. In cases where such an outcome is possible, there appears to be a time window of no more than 2-4 weeks from onset of deafness during which treatment must be started to be effective. The chance to improve hearing with the application of steroids can be very rewarding for an otolaryngologist and audiologist, and this depends upon early diagnosis of the cases where such an outcome is possible. In these cases, the initial symptoms were often a combination of hearing loss and a pronounced “blocked” sensation that frequently led primary care physicians to a mistaken preliminary diagnosis of otitis media.
Patients with SSNHL have also been shown to have antibodies to certain viruses.7 Postmortem examination of SSNHL temporal bones have shown atrophy of the organ of Corti, spiral ganglion, and tectorial membrane, with relatively good preservation of spiral ganglion cells. Adams9 has shown that bio-molecules known as inflammatory cytokines are produced in the cochlea as a response to viral disease in the upper respiratory tract.
Therefore, they are unlikely to occur during the relatively short “burst and taper” treatment used for SSNHL. In Meniere’s syndrome, fluctuations in low frequency hearing can occur in the same timeframe as in SSNHL.
It is prudent to err on the side of treating the potential emergency condition, SSNHL, with a tapering course of oral steroids. Audiograms taken one month apart showing the reversal of SSNHL after a course of steroid medication. Nearly 40% of steroid-treated cases did not recover at all, or the hearing worsened over the treatment period and these hearing losses remained permanent. In the retrospective study of Chen et al,2 52 patients declined treatment or had medical contraindications to the steroid therapy. To date, none have shown efficacy above steroid treatment alone.11,12 While steroids themselves are likely to remain the medication of choice for SSNHL, there is an emerging new delivery system which may prove to be beneficial. Every effort must be made to spread the word about this condition to primary care physicians and other primary care providers so they will make prompt referrals to audiologists and otolaryngologists who can initiate appropriate evaluation and treatment.
Further, there is a range of outcomes, including some untreated cases where spontaneous recovery is seen and some treated cases that do not respond at all. SSNHL is characterized by new-onset unilateral sensorineural hearing loss that develops within 72 hours.
Ultimately audiologic evaluation demonstrating elevated bone conduction thresholds and normal tympanometry is needed to establish the correct diagnosis. First, there appears to be a time window of no more than 2-4 weeks from onset of deafness during which treatment must be started to be effective. In the retrospective study by Chen et al.,2 a large number of flat losses were found (37%), but both high (6%) and low frequency (12%) steeply sloping losses were also seen.
In the Chen et al.2 study, low frequency cases were excluded in order to prevent any mixing of the SSNHL and Meniere’s etiologies.
If the the ear goes on to fluctuate and cause vertigo attacks, the Meniere’s diagnosis will eventually become apparent. Most authorities advocate testing hearing again at 6 months and 1 year after treatment to confirm that recovery is stable and assure that no other problems have arisen in the contralateral ear. In the other 60% of cases, the steroid-treated group improved by an average of 29 dB PTA (500 Hz, 1000 Hz, 2000 Hz and 4000 Hz).
This cohort of subjects provides an opportunity to study the natural history of the disorder. Instead of tablets taken orally, the medication can be injected through the anesthetized tympanic membrane and will diffuse through the round window directly into the cochlea. Rauch, MD, is a surgeon in otolaryngology at Massachusetts Eye and Ear Infirmary and is associate professor of Otology and Laryngology at Harvard Medical School. Oral steroid treatment for sudden sensorineural hearing loss: a ten year retrospective analysis. The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review. Hearing loss in experimental cytomegalovirus infection of the guinea pig inner ear: prevention by systemic immunity.
Dexamethazone inner ear perfusion for the treatment of Meniere’s disease: a prospective, double blind crossover trial. Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial.
It is very often accompanied by a feeling of fullness and, occasionally, by tinnitus and vertigo.1 Audiologic evaluation establishing a sensory rather than a conductive pathology is critical to the diagnosis. Second, there is a range of outcomes, including some untreated cases where spontaneous recovery is seen and some treated cases that do not respond at all.
Gap junctions function as gates between the supporting cells in the cochlea, allowing the proper ions to be transported to maintain the fluid “battery” necessary for normal hearing. In clinical practice, a similar caution is in order, requiring careful follow-up by an otolaryngologist and audiologist to establish a clearer picture of the disease. Bone conduction with masking and word recognition testing are essential in order to evaluate the sensorineural nature of the disorder and the improvement, if any. This was a better outcome than seen in the untreated cases, where a spontaneous improvement mean of 11 dB PTA was seen.
Besides this function, gap junctions transport other necessary chemicals and so, if this system is stopped, the result is expected to be a sudden decrease of sensorineural function, and eventual death of hair cells.
Stomach problems are generally only seen during the early phase of treatment when steroid dose is higher, and it can often be avoided by giving the medication with a meal. As is usually the case, there was also a good number of audiograms (22%) which did not neatly fall into a single category. These losses are not associated with any middle ear involvement and so tympanometry and clinical otologic examination should be normal. Of those who did improve, a large range was seen, with a few cases even showing a large spontaneous recovery.
The possible advantage of IT administration is that it delivers a relatively high drug dose directly to the ear, thereby lowering the risk of systemic side-effects associated with oral steroids.
Adams has also shown that early introduction of steroids will effectively reverse this process. Stomach problems can also be prevented by antacids and other over-the-counter drugs used for ulcers and reflux. As can be seen in the case in Figure 1, both initial decreases and then improvements are expected for speech discrimination as well. Speech intelligibility improved in both treated and untreated groups, but a significantly larger number of patients improved among those receiving steroids. Overall, however, the steroid-treated group showed larger improvements than the spontaneous improvements in the untreated group.
Research is underway to study whether IT steroids are as good or better than oral steroids, and whether the side effects are actually reduced. As always, a full 50-item standard list (ie, CID W-22), presented via compact disk is the minimum for effective assessment of changes in speech intelligibility over time. The retrospective study showed that, while about 40% of each group failed to improve, in those cases where some recovery did occur, steroids seemed to assist the natural healing process resulting in larger hearing improvements. Until this research is complete, a tapering course of oral steroids remains the standard of care for SSNHL.



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23.12.2014 admin



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