Aim: To compare bilateral (BSSHL) with unilateral (USSHL) sudden sensorineural hearing loss. Methods and Subjects: Two hundred and thirty-two patients with USSHL, 11 with simultaneous BSSHL and 7 with sequential BSSHL, who were older than 15 years had onset of hearing loss <30 days, no head injuries or history of acoustic trauma. All patients received the same treatment (prednisolone). Results: Hearing loss was more severe in simultaneous BSSHL in comparison to sequential BSSHL (p = 0.01) or USSHL (p = 0.03). Autoimmune diseases were far more common in simultaneous BSSHL (36% of patients) than USSHL. Positive antinuclear antibody was found in half of BSSHL patients and in only 8% of unilateral cases (p = 0.01). The frequency of hearing improvement was much lower in simultaneous BSSHL than in USSHL (p = 0.001). Complete or partial improvement was noted in 74% of unilateral cases versus 27% in simultaneous bilateral cases. Patients with sequential BSSHL improved in a similar way to unilateral cases. Conclusions: Simultaneous BSSHL, sequential BSSHL and USSHL may have a completely different profile and should not be managed as one disease. Hearing loss, underlying autoimmune diseases, antinuclear antibodies, and improvement/recovery of hearing loss vary in a degree that implies different pathophysiology and prognosis.

Blind-sac closure of the external ear canal without obliteration is a rather safe surgical procedure in cases with chronic otitis media or atelectasis. Meticulous surgical technique and proper patient selection are of paramount importance. However, a 2-stage procedure may not always be necessary and might best be confined to those patients who have active inflammatory disease at the primary procedure.

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Background: Neonatal intensive care unit graduates are considered to be of higher risk for hearing impairment, either auditory neuropathy or hearing loss. In this study we examine the presence of risk factors and try to identify their effect on the hearing of high-risk neonates. Material and methods:In this prospective cohort study we used automated auditory brainstem responses (a-ABRs) and otoacoustic emissions (OAEs) to screen 453 neonatal intensive care unit neonates who had at least one risk factor for hearing impairment.Results: In the initial examination, 382 (84.3%) infants passed and 71 (15.7%) failed a-ABRs. Out of those who failed, 39 newborns (55%) passed the transiently evoked otoacoustic emission (TEOAE) test, while 32 (45%) failed that test too. Re-examination was performed before their first month of age, eventually resulting in 8 newborns being diagnosed with possible hearing loss and 8 with possible auditory neuropathy. The overall dropout rate was 4.9%. Low birth-weight (p=0.016), as well as craniofacial abnormalities (p=0.03) and TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections proved to have a statistically significant correlation (p=0.05) with hearing impairment. Conclusion:Because a significant number of children may have auditory neuropathy, ABRs and OAEs (both transiently evoked and distortion product OAEs) remain the cornerstones of any universal hearing screening program in neonatal intensive care units. An efficient tracking system is needed to reduce the number of neonates lost to follow-up. Low birth-weight, craniofacial deformities, and congenital infections appear to be the most significant factors predisposing an infant to hearing impairment.

The differences between study groups indicate that when tinnitus becomes chronic, DPOAEs suppression presents changes that might reveal corresponding steps in tinnitus pathophysiology. Treatment implications are discussed.