Idiopathic Sudden Sensorineural Hearing Loss in Patients with Obstructive Sleep Apnea

Abstract

Purpose: Obstructive sleep apnea (OSA) is characterized by recurring hypoxic-apneic events during sleep, and labyrinthine vascular compromise is a pathophysiologic hallmark of idiopathic sudden sensorineural hearing loss (ISSNHL). Some reports have discussed the relationship between OSA and hearing impairment; however, few have examined hearing prognosis in OSA and patients without OSA with ISSNHL. We aimed to investigate clinical manifestations of ISSNHL in patients with OSA, including severity of hearing loss and response to treatment. Patients and Methods: A case-control study was conducted by extracting data from the sleep center and cochlea center databases of the Chang Gung Memorial Hospital. A retrospective chart review was performed to include confirmed adult OSA patients diagnosed with unilateral ISSNHL. Age and sex-matched patients without OSA with ISSNHL were enrolled as controls. Pure-tone average (PTA) thresholds were measured at specific frequencies. Changes in PTA before and after standard treatment with oral prednisolone (1mg/kg/day for 5 days, then tapered) and between participants with OSA and without OSA were compared. Standard treatment was given to all ISSNHL patients. Results: Twenty-eight out of 8500 (0.33%) OSA patients experienced subsequent ISSNHL in 9 years. Patients with OSA (n=28) had poorer high-frequency perception in the unaffected ear than the patients without OSA (n=120), although the difference was not significant. Hearing in the affected ear among patients with OSA was comparable to that patients without OSA at individual frequencies and average, suggesting no difference in hearing loss in the affected ear between the two groups. In terms of high-frequencies (4000 and 8000 Hz) perception, patients with OSA had significantly poorer responses to steroid treatment than patients without OSA. Conclusion: ISSNHL may be one of the auditory complications associated with OSA. Patients with OSA had poorer prednisolone related hearing improvement in high frequencies than patients without OSA. Despite study limitations, OSA-related hypoxia and snoring noise is hazardous to hearing and standard treatments with CPAP is suggested in OSA patients for both holistic and auditory health.

Association of sleep duration and noise exposure with hearing loss among Chinese and American adults: two cross-sectional studies

“…Most previous studies have suggested that sleep disturbance is a potential risk factor for sudden HL. 40 41 Sleep disturbance can cause negative emotions, such as anxiety and depression, which may affect the hearing of patients. 42 Animal and human studies have demonstrated that repeated sleep deprivation potentially aggravates noise-induced damage to the outer and inner hair cells of the cochlear basal gyrus synaptic band, thus reducing the ability of the cochlea to transcode sound.…”

Effects of oral N-acetylcysteine combined with oral prednisolone on idiopathic sudden sensorineural hearing loss

“…This was consistent with the results of Bai et al, [ 13 ] whose NAC group (which received concurrent intratympanic steroid injection therapy and oral NAC) showed a significant hearing gain at 8 kHz in comparison to the control group treated with intratympanic steroid injection therapy alone. Chen et al [ 15 ] reported that the hearing threshold of the affected ear improved after steroid therapy at all frequencies, except 8 kHz, in patients with obstructive sleep apnea, which also confirmed the damaging effect of hypoxia on high-frequency hearing. The association between the use of the antioxidant NAC and hearing gain at higher frequencies suggests region-specific susceptibility to oxidative stress in the cochlea.…”

“…The therapeutic effects of steroids, taken orally or administered by intratympanic injection, are widely known, so recovery of hearing in both the NAC and non-NAC groups was expected. Chen et al [ 15 ] also reported that steroids have potent antiinflammatory effects, so effective improvement in the hearing threshold of the affected ear after steroid treatment was not surprising.…”

“…The mean hearing level was defined as the average hearing threshold at four frequencies (500 Hz, 1 kHz, 2 kHz, and 4 kHz). [ 13 , 15 ] The mean hearing level gain, SRT gain, and SDS gain indicated improvement between the pretreatment and posttreatment mean hearing level, SRT, and SDS, respectively. For both groups, all patients underwent hearing tests before and 1 month after the onset of treatment.…”

Increasing obstructive sleep apnea risk is associated with hearing impairment in middle-aged Chinese men—A cross-sectional study

“…Prior study reported poorer responses to steroid treatment for the improvement of hearing in patients with OSA and idiopathic sudden sensorineural hearing loss (ISSNHL) than patients without OSA. It was indicated that OSArelated hypoxia and snoring noise is hazardous to hearing and standard treatments with CPAP is suggested in OSA patients for both holistic and auditory health [22]. The rat experiment also proved the combination of noise and hypoxia will lead to 70-100% loss of outer hair cells in the high-frequency coding region, and even some loss of inner hair cells.…”