Results of Exploratory Tympanotomy following Sudden Unilateral Deafness and its Effects on Hearing Restoration

Abstract

In cases of acute unilateral deafness, no consensus exists as to whether tympanotomy and sealing of the round window should be performed routinely. To further address this issue, we conducted a retrospective study of pre-, intra-, and postoperative findings in 97 patients who had undergone exploratory tympanotomy (EXT) after the onset of sudden and severe unilateral deafness. Our goal was to ascertain, if we could, whether the benefits of EXT outweigh the risks. We also took into account the effects of perilymph fistula (PLF) on the etiology of sudden hearing loss and postoperative outcomes. We found that routine EXT was indeed beneficial for these patients. It was associated with a very low surgical complication rate, and its effects on hearing as assessed by objective measures were beneficial. The greatest benefits were seen in patients who underwent EXT within 7 days after the onset of their hearing loss. With respect to PLF, we found that the presence or absence of the “typical history” of PLF (i.e., a sudden unilateral hearing loss within 48 hours after a precipitating trauma or physical exertion) had no bearing on whether a PLF was actually present in our group; nor was vertigo a reliable predictor of PLF. We recommend that EXT be performed on all patients with new-onset acute unilateral deafness, barring any contraindications, of course. The absence of a typical history of PLF should not dissuade the surgeon from proceeding with EXT.

Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss

“…Yet, the therapeutic benefit of some of these treatment options remains unclear since results from randomised controlled trials are still missing. Besides classical drug therapy with steroids most task forces recommend exclusion of a PLF by an exploratory tympanotomy especially in pancochlear SSHL with additional symptoms like disequilibrium or nystagmus [27, 28]. This procedure is an uncomplicated and fast surgical intervention, but, detection of a PLF is technically difficult and dependent on the investigator.…”

Increased Neutrophil-Lymphocyte Ratio in Patients With Idiopathic Sudden Sensorineural Hearing Loss

“…17,18 The cochlear membrane rupture theory supposes that a perilymph fistula, due to physical effort or barotrauma, may be the cause of ISSHL. 19,20 Ischemic processes of the inner ear have also begun to be considered as the pathogenic mechanism in ISSHL. 21 Considering that the cochlear vascular supply is a terminal type, an abrupt interruption of vascular flow could impair cochlear membrane functions.…”

Labyrinthine window rupture as a cause of acute sensorineural hearing loss

“…They are actual observation of fluid leak [6, 7], direct inspection of the round window membrane rupture [8–11] and no simultaneous pressure transmission from the oval to the round window [11, 12]. The actual fluid leak in the labyrinthine window recesses was found in 71% [6] and 40% [7].…”

“…Exploratory tympanotomy for SHL with inspection and sealing of the labyrinthine windows is therapeutic option if conservative treatment for SHL fails to improve the hearing level [6–12]. However, early surgical intervention appears to be rewarded with good hearing recovery [8, 9, 11]. One reason for preferring conservative treatment at the early stage is absence of diagnostic tests for LWR.…”