Risk of Stroke and Myocardial Infarction After Sudden Sensorineural Hearing Loss: A Meta‐Analysis

Abstract

Objectives/Hypothesis: The pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown, but labyrinthine artery infarction has been proposed. The objective of this study was to perform a systematic review and conduct a meta-analysis assessing the risk of developing stroke and myocardial infarction after presentation with ISSNHL.Methods: A systematic literature review was conducted using Pubmed, Embase, Web of Science, and Cochrane Libraries. All studies investigating an association between ISSNHL and stroke and/or myocardial infarction (MI) were included. Adhering to the MOOSE guideline, two independent reviewers extracted data, assessed risk of bias, and evaluated the relevance and quality of evidence.Results: Three observational studies evaluating the risk of stroke in ISSNHL were included (n = 6,521 patients). All individual study results indicated an increased relative risk of stroke after ISSNHL (unadjusted relative risk range 1.21-1.63). Pooled adjusted hazard ratios revealed a 1.42-fold increased risk of stroke after ISSNHL (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.15-1.75, I 2 = 55%). Subgroup analysis of one study demonstrated that the increased risk is only present in adults aged above 50 years (HR 1.23; 95% CI 1.07-1.42). Five observational studies evaluating the risk of MI in patients with ISSNHL were included (n = 61,499 patients). Pooled analyses demonstrated that ISSNHL was not associated with MI (HR 1.08, 95% CI 0.87-1.34).Conclusion: ISSNHL may be an independent risk factor for the subsequent development of stroke especially in a subgroup of elderly patients. More studies are needed to confirm this association and to assess whether such patients would benefit from cardiovascular risk assessment and management to prevent future strokes.

Influence of Metabolic Syndrome on the Recovery from Idiopathic Sudden Sensorineural Hearing Loss

“…In the present study, the cases were identified as idiopathic taking into account our exhaustive protocol, which excludes classic viral/infectious, vascular, autoimmune, and oncological causes. Accordingly, other studies 2 5 6 7 13 15 were published, which attempted to correlate ISSHL with other potential risk factors such as cardiovascular, metabolic, or autoimmune conditions. One of the factors that will definitely help to explain the pathophysiological mechanism, and even refine the diagnosis of sudden hearing loss, is the improvement in imaging exams, namely high-field magnetic resonance imaging of the inner ear.…”

“… 1 2 5 On the other hand, ISSHL was regarded as a possible sign preceding the development of ischemic stroke. 5 6 7 Despite this evidence, it is still controversial if the occurrence of ISSHL and its recovery should be considered cardiovascular risk biomarkers. The knowledge of this association would be important for the treatment of ISSHL and to address these cardiovascular preconditions in ISSHL patients.…”

Serum Albumin Levels as a Potential Marker for the Predictive and Prognostic Factor in Sudden Sensorineural Hearing Loss: A Prospective Cohort Study

“…Recently, increasing studies have confirmed that ALB plays an important role in the occurrence and development of cardiovascular and cerebrovascular diseases (13)(14)(15). Several studies indicated that SSNHL has similar pathogenesis with cardiovascular and cerebrovascular diseases (16)(17)(18). The determination of ALB values could be of prognostic value in acute inflammation and hemodynamic disorders related to SSNHL.…”

Cardiovascular Risk and Sudden Sensorineural Hearing Loss: A Systematic Review and Meta‐Analysis

“…[7][8][9][10][11] However, past reviews reported evidence until 2014 and did not report information from some CVRFs (high levels of triglycerides [TG], high-density lipoprotein cholesterol [HDL-c], and metabolic syndrome [MetS]) 7 issues that are addressed in the present work. It was also suggested that patients with ISSNHL had a higher risk of developing future stroke, 12,13 although ISSNHL was not associated with future acute myocardial infarction. 13,14 Quaranta et al reported signs of endothelial dysfunction in ISSNHL and Fisch described the blood pressure dysregulation of the stria vascularis (a process related to age and CVRFs) as a consequence of cochlear atherosclerosis, in which the tunica adventitia loses fibroblasts and becomes thicker, which in turn leads to plasmatic viscosity and platelet aggregation.…”

“…It was also suggested that patients with ISSNHL had a higher risk of developing future stroke, 12,13 although ISSNHL was not associated with future acute myocardial infarction. 13,14 Quaranta et al reported signs of endothelial dysfunction in ISSNHL and Fisch described the blood pressure dysregulation of the stria vascularis (a process related to age and CVRFs) as a consequence of cochlear atherosclerosis, in which the tunica adventitia loses fibroblasts and becomes thicker, which in turn leads to plasmatic viscosity and platelet aggregation. [15][16][17] As a consequence, vascular pathology is supposed an important etiological factor of ISSNHL.…”