Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

Park, Kye Hoon; Lee, Chi-Kyou; Lee, Jong Dae; Park, Moo Kyun; Lee, Byung Don

doi:10.7874/kja.2012.16.2.71

Cited by 20 publications

(15 citation statements)

References 13 publications

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“…It is suggested that patients with low-frequency hearing losses -upward sloping audiograms -or mid-frequency hearing losses -flat type audiograms -may have a better prognosis (21)(22)(23). It was also suggested that low-frequency hearing losses tend to have better recoveries as they have a better tolerance of impairment (24). Another possible mechanism explaining why patients with low-frequency loss were more likely to recover is differences in the vulnerability of hair cells.…”

Section: Discussionmentioning

confidence: 99%

“…Hair cells in the basal turn are known to be more susceptible to ototoxic drugs and noise than those in the apex (23,24). Therefore, despite having more glucocorticoid receptors, basal turn damage -known as high-frequency losses -have a worse prognosis (24). Thus, the prognostic effect of initial configuration of PTA on outcomes was also evaluated in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Another possible mechanism explaining why patients with low-frequency loss were more likely to recover is differences in the vulnerability of hair cells. Hair cells in the basal turn are known to be more susceptible to ototoxic drugs and noise than those in the apex (23,24). Therefore, despite having more glucocorticoid receptors, basal turn damage -known as high-frequency losses -have a worse prognosis (24).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors in Sudden Sensorineural Hearing Loss

Atay¹,

Kayahan²,

Çınar³

et al. 2016

Balkan Med J

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Background: Sudden sensorineural hearing loss (SSNHL) is still a complex and challenging process which requires clinical evidence regarding its etiology, treatment and prognostic factors. Therefore, determination of prognostic factors might aid in the selection of proper treatment modality. Aims: The aim of this study is to analyze whether there is correlation between SSNHL outcomes and (1) systemic steroid therapy, (2) time gap between onset of symptoms and initiation of therapy and (3) audiological pattern of hearing loss. Study Design: Retrospective chart review. Methods: Patients diagnosed at our clinic with SSNHL between May 2005 and December 2011were reviewed. A detailed history of demographic features, side of hearing loss, previous SSNHL and/or ear surgery, recent upper respiratory tract infection, season of admission, duration of symptoms before admission and the presence of co-morbid diseases was obtained. Radiological and audiological evaluations were recorded and treatment protocol was assessed to determine whether systemic steroids were administered or not. Treatment started ≤5 days was regarded as "early" and >5 days as "delayed". Initial audiological configurations were grouped as "upward sloping", "downward sloping", "flat" and "profound" hearing loss. Significant recovery was defined as thresholds improved to the same level with the unaffected ear or improved ≥30 dB on average. Slight recovery was hearing improvement between 10-30dB on average. Hearing recovery less than 10 dB was accepted as unchanged. Results: Among the 181 patients who met the inclusion criteria, systemic steroid was administered to 122 patients (67.4%), whereas 59 (32.6%) patients did not have steroids. It was found that steroid administration did not have any statistically significant effect in either recovered or unchanged hearing groups. Early treatment was achieved in 105 patients (58%) and 76 patients (42%) had delayed treatment. Recovery rates were no different in these two groups; however, when unchanged hearing rates were compared, it was statistically significantly lower in the early treatment group (p<0.05). When hearing outcomes were compared according to initial audiological pattern, significant recovery and unchanged hearing rates did not differ between groups; however, slight recovery rate was highest in the "flat" type audiological configuration (p<0.05). Conclusion: According to this patient series, oral steroid therapy does not have any influence on the outcomes of SSNHL. However, mid-frequency hearing loss of flat type and initiation of treatment earlier than 5 days from the onset of symptoms, seem to have positive prognostic effects. Further randomized controlled subject groups might contribute to determine prognostic factors of SSNHL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors in Sudden Sensorineural Hearing Loss

Atay¹,

Kayahan²,

Çınar³

et al. 2016

Balkan Med J

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“…Treatment protocols for ISSNHL aim to decrease the inflammatory state of the inner ear and to increase the blood supply and oxygenation [1,12] . Steroids, vasodilators, plasma expanders, and antiviral and diuretic agents are preferred for these purposes in different combinations [10] .…”

Section: Introductionmentioning

confidence: 99%

“…Steroids, vasodilators, plasma expanders, and antiviral and diuretic agents are preferred for these purposes in different combinations [10] . Low-molecular-weight heparin (LMWH) and hyperbaric oxygen (HBO) therapies have also been reported to have some treatment advantages [12,13] .…”

Section: Introductionmentioning

confidence: 99%

Recovery of Idiopathic Sudden Sensorineural Hearing Loss

Edızer¹,

Çelebi²,

Hamit³

et al. 2015

Int Adv Otol

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OBJECTIVE:The objective was to identify and evaluate factors that may influence the recovery rate in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIALS and METHODS:A retrospective analysis was performed for patients with sudden sensorineural hearing loss between 2009 and 2013. Those with an identified etiology were excluded. The patients were divided into four treatment groups: (i) systemic corticosteroids (SC) only, (ii) SC+low-molecular-weight heparin (LMWH), (iii) SC+hyperbaric oxygen (HBO), and (iv) SC+LMWH+HBO. Recovery was evaluated according to Siegel's criteria. Age, initial hearing level, onset, treatment and audiogram types, comorbidities, and associated tinnitus and vestibular symptoms were investigated for their impact on prognosis. RESULTS:Two hundred five patients with ISSNHL were included. Recovery was seen in 59% of the patients. The complete recovery rate was significantly lower in patients older than 60 years and in patients presenting with profound hearing loss. Different audiogram curves had no significant effect on recovery. Sudden hearing loss was accompanied by tinnitus in 107 (52.1%) patients and vestibular symptoms in 55 (26.8%); however, neither was noted to affect prognosis. Different treatment combinations did not significantly affect prognosis. However, hypertension and a delay in treatment by more than 10 days from the onset of hearing loss were associated with a worse prognosis. CONCLUSION:Profound hearing loss, older than 60 years, a delay in treatment by more than 10 days, and hypertension were negative prognostic factors in this study, whereas, the type of audiogram curve and addition of HBO to SC did not affect prognosis.

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Heparin therapy as adjuvant treatment for profound idiopathic sudden sensorineural hearing loss

Kim

Jeong

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: This study aimed to provide evidence of whether unfractionated heparin used as adjuvant therapy in conjunction with systemic corticosteroid therapy improves hearing recovery in patients with profound idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare the effect of this treatment with those of additional intratympanic corticosteroid therapy.Study Design: Retrospective chart review. Methods: Eighty-seven patients with profound ISSNHL (≥90 dB) and who had been admitted at a tertiary referral center between 2010 and 2018 were retrospectively reviewed, 67 patients for additional intratympanic corticosteroid injection (ITSI) (ITSI group) and 21 for adjuvant heparin therapy (heparin group). Hearing recovery was evaluated by grade assessment according to the American Academy of Otolaryngology-Head and Neck Surgery criteria.Results: Of the patients in the heparin group, 42.8% recovered serviceable hearing, which was significantly higher than the recovery rates (19.7%) of those in the ITSI group. Particularly, in patients with pretreatment hearing level of 90 to 100 dB, adjuvant heparin therapy enhanced therapeutic effects with a significant hearing recovery rate of 80%. However, in patients with initial hearing level >100 dB, the rates of significant hearing recovery in the two groups were roughly equal and remained unsatisfactory (8.1% in the ITSI group and 9.1% in the heparin group).Conclusions: The results of this study suggest that the treatment of profound ISSNHL with adjuvant heparin therapy, in combination with systemic steroid therapy, results in higher hearing recovery rates when compared to combined local and systemic corticosteroid therapy, without serious complications.

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Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

Cited by 20 publications

References 13 publications

Prognostic Factors in Sudden Sensorineural Hearing Loss

Prognostic Factors in Sudden Sensorineural Hearing Loss

Recovery of Idiopathic Sudden Sensorineural Hearing Loss

Heparin therapy as adjuvant treatment for profound idiopathic sudden sensorineural hearing loss

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