Idiopathic sudden sensorineural hearing loss issnhl involves a rapid loss of hearing that is caused by damage to the cochlea inner ear or auditory nerve. Neuroplasticitytargeted intervention for idiopathic. For sudden deafness without an obvious, identifiable cause upon examination, your doctor should perform a test called pure tone audiometry within a few days of onset of symptoms to identify any sensorineural hearing loss. Awakening with a hearing loss, hearing loss noted over a few days, selective low or highfrequency loss, and distortions in speech perception have all been classified as sudden hearing losses. Management of idiopathic sudden sensorineural hearing loss. Most cases are idiopathic, and the prognosis depends on the severity of the hearing loss.
Predictors of hearing recovery in patients with severe sudden. The described clinical case points to the validity of undertaking early hyperbaric oxygenation hbo therapy together with corticosteroids for full recovery of adult onset idiopathic sudden sensorineural hearing loss. Sudden sensorineural hearing loss is defined as acute hearing loss of the sensorineural type of at least 30 db over 3 contiguous frequencies that occurs within a 72hour period. Idiopathic sudden sensorineural hearing loss isshl is a frequent disease in adults and is estimated to occur with an incidence of 20100,000 in germany. Sudden sensorineural hearing loss pdf free download. It is characterized by sudden hearing impairment up to deafness within a short period of time and is possibly associated with vestibular dysfunction, tinnitus and pressure sensation in the. Idiopathic sudden sensorineural hearing loss in children.
Snhl accounts for about 90% of reported hearing loss. University of groningen the treatment of idiopathic sudden. We examined the temporal bone pathologies in 12 ears with idiopathic sudden sensorineural hearing loss, and found that the lesions present in these specimens and in 10 others reported in the literature are similar to lesions occurring in known cases of viral cochleitis. The majority of patients with sudden snhl have no identifiable cause for hearing loss and are classified as idiopathic byl, 1984. Sudden sensorineural hearing loss ssnhl is defined as a hearing loss of 30 db or more over at least three contiguous frequencies, over a period of 72 hours or less. This holds true for both acute acoustic trauma aat and idiopathic sudden sensorineural hearing loss isshl, two devastating conditions for which no highly effective treatment options exist 1, 2.
Sshl happens because there is something wrong with the sensory organs of the inner ear. Presentation is usually with asymmetrical hearing loss. The cause and pathogenesis of idiopathic sudden sensorineural hearing loss remain unknown. Prognostic value of labyrinthine 3dflair abnormalities in. Highdose corticosteroids are the standard treatment 1 and these might be even more effective when combined with hyperbaric oxygen. The pathology of idiopathic sudden sensorineural hearing loss. Sudden sensorineural inner ear hearing loss sshl, commonly known as sudden deafness, is an unexplained, rapid loss of hearing either all at once or over a few days. Idiopathic sudden sensorineural hearing loss did not increase stroke risk. Giant cell arteritis introduction the diagnosis and management of idiopathic sudden sensorineural hearing loss snhl are controversial and challenging.
If the perforation or hearing loss persists beyond two months, the patient. Experience in newly developing qatar ahmed harith salahaldin,l abdulbari bener,2 amr a. Mar 15, 20 the correlation between idiopathic sudden sensorineural hearing loss and subsequent stroke is unclear. To investigate the role of intratympanic it therapy in the treatment of idiopathic sudden sensorineural hearing loss issnhl. Modified intratympanic treatment for idiopathic sudden. In the us army over a 2year period, more than 882 hearing impairments were caused by aat, and the incidence of issnl. However, in the majority of cases of sudden sensorineural hearing loss ssnhl, no cause is identified and it is considered idiopathic ssnhl. This clinical practice guideline cpg, intended for all clinicians who diagnose or manage adult patients aged 18 years or older who present with sudden hearing loss shl and primarily those with idiopathic sudden sensorineural hearing loss, is an update of and replacement for the prior cpg published in 2012.
According to recent research, modern mr imaging can detect the presense of abnormalities on labyrinthine. Although many different causative factors have been proposed, sudden sensorineural hearing loss is still considered idiopathic in 71%85% of cases, and treatments are empiric, not based on etiology. Proposed theories include vascular occlusion, membrane breaks, and viral cochleitis. One of the most controversial topics in the otolaryngology literature is the treatment of sudden sensorineural hearing loss sshl. Regardless of the cause and degree of hearing loss, rapid. Nationwide epidemiological survey of idiopathic sudden. The effect of initial treatment on hearing prognosis in. Idiopathic sudden sensorineural hearing loss isshl involves sudden loss of hearing from cochlear or retrocochlear origin of unknown cause.
Sudden sensorineural hearing loss ssnhl involves an acute unexplained hearing loss, nearly always unilateral, that occurs over less than a 72hour period. Sudden sensorineural hearing loss ssnhl is defined as a subjective sensation of rapid onset hearing impairment i. Systemic corticosteroids may be considered in the management of issnhl. Oral and intratympanic steroid therapy for idiopathic sudden. Two weeks later, the patient experienced sudden sensorineural hearing loss in the left ear, and scalp tenderness. The data base contains results of basic otoneurological tests and clinical. The most common clinical presentation involves an individual experiencing a sudden unilateral hearing loss, tinnitus, a sensation of aural fullness and vertigo. An important, but poorly recognised, cause of sudden sensorineural hearing loss is immunemediated innerear disorders, including both organspecific innerear disease and systemic autoimmune disorders. An important, but poorly recognised, cause of sudden sensorineural hearing loss is immunemediated innerear disorders, including both organspecific inner.
I diopathic sensorineural hearing loss is a term applied to a hearing loss whose etiology is unknown. Sudden hearing loss shl means a sensorineural hearing loss of sudden onset or one that happens in minutes, hours or even in a few days. And this condition can be different from people to people. Prognostic factors of profound idiopathic sudden cliinco hearing loss. Pdf a healthy 58yearold woman answers the telephone and realizes that her hearing is diminished on the left side. Racgp sudden onset hearing loss causes, investigations. Outcomes of unilateral idiopathic sudden sensorineural.
Therapeutic effects of carbogen inhalation and lipoprostaglandin e1 in sudden hearing loss. A healthy 58yearold woman answers the telephone and realizes that her hearing is diminished on the left side. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss. The diagnosis and treatment of ssnhl are discussed here. Mar 25, 2018 to investigate the role of intratympanic it therapy in the treatment of idiopathic sudden sensorineural hearing loss issnhl. Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss. A standard definition of issnhl does not exist, nor is there a standard method for. This study comprised 1 patients who were diagnosed with unilateral.
To describe the temporal bone histopathology in 17 ears aged 4594 yr with idiopathic sudden sensorineural. The hearing impairment varies as far as intensity and sound frequency are concerned, and in general, it is unilateral 9899% of the cases1, 2. Aug 28, 2019 awakening with a hearing loss, hearing loss noted over a few days, selective low or highfrequency loss, and distortions in speech perception have all been classified as sudden hearing losses. The recurrence rate is heterogeneous, and the prognosis of relapses is uncertain. Patients were treated for issnhl from january 1, 2011 to april 12, 2015 with the following. The definition of the hearing loss includes abrupt hearing deterioration of 30 db or more in at least 3 consecutive frequencies that occur during no more than 3 days.
Efficacy of 3 different steroid treatments for sudden sensorineural hearing loss. The ssnhl definition used throughout this guideline is based on its consistent use in the. For those older than 75, that number is approximately 1 in 2. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. Pdf sudden sensorineural hearing loss researchgate. Idiopathic sudden sensorineural hearing loss is a devastating disease with limited effective treatment. Management of acute idiopathic sensorineural hearing loss. Idiopathic sudden sensorineural hearing loss in the only. The exact incidence of acute sensorineural hearing loss is not known, but is estimated to be between 5 and 20 per 100,000 personsyear and varies with age 1.
Sudden sensorineural hearing loss sshl is a disease, which severely affects the patients social and relational life. Eihakeem,t and khaled abdulhadp ldepartment of ear, nose, and throat and 2department of medical statistics and epidemiology, hamad general hospital and hamad medical corporation, doha, qatar. Request pdf idiopathic sudden sensorineural hearing loss in children although idiopathic sudden sensorineural hearing loss isshl is a frequent disease in adults, less is known about. Idiopathic is an adjective meaning of unknown cause, as regards a disease. This condition may be extremely distressing for the patients affected as it has a significant impact on their ability to. Bilateral idiopathic sensorineural hearing loss following. The aim of this retrospective study was to evaluate the recurrence rate of ssnhl and to analyze the correlation with clinical and audiometric characteristics. It may be missed in children, specially when it is unilateral. Management of idiopathic sudden sensorineural hearing. About onethird of people in the united states between the ages of 65 and 75 have some degree of hearing loss. Successful treatment of sudden sensorineural hearing loss. Idiopathic sudden sensorineural hearing loss issnhl is defined as ssnhl with no identifiable cause despite adequate investigation. The term idiopathic sudden sensorineural hearing loss is often used to describe the remainder of patients.
Sensorineural hearing loss snhl is a type of hearing loss in which the root cause lies in the inner ear or sensory organ cochlea and associated structures or the vestibulocochlear nerve cranial nerve viii. Relationship between idiopathic sudden sensorineural hearing. Ethics of placebo control in trials for idiopathic sudden. Acute idiopathic sensorineural hearing loss is a rare occurrence. To describe the temporal bone histopathology in 17 ears aged 4594 yr with idiopathic sudden sensorineural hearing loss in our temporal bone collection and to discuss the implications of the. Acute hearing loss can have a major impact on a patients life. Asymmetrical hearing loss theme reprinted from australian family physician vol.
The current standard treatment for sudden hearing loss is a tapered course of oral highdose corticosteroids. This condition started from mild, which can become severe if left untreated and can be ended up profoundly to sudden sensorineural hearing loss sshl. Because premorbid audiometry is generally unavailable, hearing loss is defined as related to the opposite ear s thresholds. Facial and trigeminal nerve function may also be altered. A commonly used criterion to qualify for this diagnosis is a sensorineural hearing loss of greater than 30 db over 3 contiguous puretone frequencies. Sep 15, 2003 idiopathic unilateral sudden sensorineural hearing loss, defined as hearing loss of 30 db within a threeday period, is an urgent situation. Idiopathic sudden sensorineural hearing loss is classically defined as a hearing loss of at least 30 db occurring within three days over at least three contiguous frequencies. Predictors of hearing recovery in patients with severe. Purpose longterm outcomes of sudden sensorineural hearing loss ssnhl are poorly studied. Seventy percent of all genetic hearing losses are recessive hearing loss, fifteen percent are dominant and the remaining fifteen percent are other form of. The rest of the physical examination was unremarkable.
Typically, the idiopathic sudden sensorineural hearing loss isshl is unilateral, with a flat. These lesions are unlike those resulting from known vascular causes. Typically hearing loss is gradual, but sudden onset of hearing loss has been found in 1216% of affected patients. We conducted a retrospective study in order to identify parameters that influence hearing recovery. Pathology and pathophysiology of idiopathic sudden. The us national institute for deafness and communication disorders nicdc defines sshl as the idiopathic loss of hearing of at least 30 db over at least 3 contiguous test frequencies occurring within 3 days. The use of hyperbaric oxygen therapy in acute hearing loss. Differential diagnosis and treatment of hearing loss. Idiopathic sudden sensorineural hearing loss 1997 7 in this thesis a literature survey of etiology and therapy of isshl provides the basis for the theory that a subclinical viral labyrinthitis plays an important part in the pathophysiology ofisshl. This study comprised 1 patients who were diagnosed with unilateral sudden sensorineural.
Approximately 1% of cases of sudden sensorineural hearing loss are due to. Relationship between idiopathic sudden sensorineural. Dec 02, 2010 acute idiopathic sensorineural hearing loss is a rare occurrence. Longterm results of intratympanic prednisolone injection in patients with idiopathic sudden sensorineural hearing loss. Sudden sensorineural hearing loss sshl is considered an ear, nose, and throat ent emergency. The impact of an idiopathic sudden sensorineural hearing loss issnhl on.
The average annual stroke incidence rate after idiopathic sudden sensorineural hearing loss was comparable with that in. Idiopathic sudden sensorineural hearing loss indicates a more commonimportant condition. Sensorineural hearing loss, usually severe unknown etiology for reference hearing loss i. It is characterized by sudden hearing impairment up to deafness within a short period of time and is possibly associated with vestibular dysfunction, tinnitus and pressure sensation in the affected ear. This hearing loss can be accompanied by tinnitus andor vertigo. Oral and intratympanic steroid therapy for idiopathic. Sudden sensorineural hearing loss best guide to cure. An experimental and clinical study on pathogenesis and treatment of inner ear lesions after acute noise exposure.
The underlying pathomechanisms have not been finally clarified yet and outcome is not predictable. Ototopical antibiotics and precautions to keep the ear dry are recommended. Pdf sudden hearing loss shl is a common disease in the daily practice of. By focusing on opportunities for quality improvement, this guideline should improve diag. A sudden sensorineural hearing loss snhl typically occurs either instantaneously or over a period of hours. The correlation between idiopathic sudden sensorineural hearing loss and subsequent stroke is unclear. Objectives a determine the demographic and medical risk factors for patients who presented with unilateral idiopathic sudden sensorineural hearing loss issnhl. Our aim was to report the patterns and prognostic role of abnormal findings on labyrinthine imaging in patients with sudden sensorineural hearing loss. Idiopathic sudden sensorineural hearing loss is a medical emergency that requires. Twigg v, lawrence r, thevasagayamr, fergie n, daniel m.