Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients

Abstract

Vertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis. Subjects and methods Thisstudy assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16 mg/d) or oral methylprednisolone (64 mg/d) for 4 days and tapered oral methylprednisolone for 8 days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively. Results Ninety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0 dB vs 72.7 dB, P=.002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4 dB vs 73.0 dB, P=.004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0 dB vs 20.9 dB, P=.028).PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0 dB vs 18.4 dB, P=.013).

Contribution of Audiogram Classification in Evaluating Vestibular Dysfunction in Sudden Sensorineural Hearing Loss With Vertigo

“…Inner ear diseases such as sudden hearing loss can cause vertigo ( 28 ). Previous studies have shown that cochlear impairment could be more serious in SSNHL patients with vertigo than in those without, and our results are consistent with those studies ( 14 , 29 , 30 ), and more serious hearing loss was seen in SSNHL patients with vertigo. Anatomically, the base cochlear turns are closer to the terminal vestibular organs than the frontal cochlear turns ( 7 , 13 ), and the anterior vestibular artery provides blood supply to the LSCC, ASCC, utricle, and saccule.…”

“…In the present study, we also attempted to assess the impact of various variables on the prognosis of hearing outcomes. In agreement with previous studies, vestibular abnormalities are associated with more severe hearing loss and indicate a poorer prognosis ( 14 , 31 , 34 – 36 ).…”

“…In addition, a correlation ( p < 0.01) was found between the initial PTA and the number of involved VEOs, not only in SSNHL patients with vertigo but also in those without vertigo. Consistent with our results in patients without vertigo, Lim et al found that utricular dysfunction is associated with the severity of initial hearing ( 14 ). In our study, although there were statistical differences in the initial PTA of the two groups, there was no difference in the number of involved VEOs.…”

“…Furthermore, to clear the necessity of classifying SSNHL by audiogram configuration, we separately analyzed the vestibular function of patients with profound SSNHL. As discussed before ( 14 , 29 , 31 ), cochlear impairment, initial PTA, and hearing recovery were much worse in patients with vertigo. In those with profound SSNHL with or without vertigo, higher abnormal rates of oVEMP (88–90%) and cVEMP (88–90%) were found but with no significant differences between the two subgroups, respectively.…”

“…Iwasaki et al suggested that the saccule was involved more frequently than the horizontal semicircular canal (HSC) in patients with idiopathic sudden hearing loss with vertigo ( 13 ). Lim et al demonstrated that the functions of vestibular organs, particularly the utricle and HSC, are associated with disease severity and hearing outcome in patients with SSNHL ( 14 ). Byun et al studied the function of each semicircular canal and saccule using vHIT, cVEMP, and caloric tests, and found that abnormal vHIT gain in the posterior semicircular canal (PSC) appears to be a specific prognostic factor for incomplete hearing recovery in SSNHL ( 15 ).…”