Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu tutaj
© Borgis - New Medicine 2/2021, s. 35-39 | DOI: 10.25121/NewMed.2021.25.2.35
Elżbieta Niemczyk-Cieślak, Karolina Raczkowska, *Lidia Zawadzka-Głos
Sudden sensorineural hearing loss
Nagły niedosłuch czuciowo-nerwowy
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Associate Professor Lidia Zawadzka-Głos, MD, PhD
Streszczenie
Nagły niedosłuch czuciowo-nerwowy (SSNHL), powszechnie zwany nagłą głuchotą, definiuje się jako podwyższenie progu słyszenia krzywej kostnej i krzywej powietrznej o co najmniej 30 decybeli dla trzech kolejnych częstotliwości w przeciągu 72 godzin. Utrata słuchu jest często związana z pojawieniem się szumów usznych lub, rzadziej, zawrotów głowy o charakterze vertigo. Etiologia większości przypadków SSNHL jest nieznana. Nawet 32-65% pacjentów doświadcza spontanicznej poprawy. Leczenie obejmuje sterydoterapię (systemową i miejscową), a także terapię tlenem hiperbarycznym (HBOT). Leki antywirusowe, trombolityczne, wazodylatacyjne czy wazoaktywne nie powinny być przepisywane rutynowo. Jedynie w przypadku stwierdzenia ogniskowych zaburzeń neurologicznych powinna zostać wykonana tomografia komputerowa głowy. Poza tym należy zawsze wykluczyć patologię pozaślimakową na podstawie skanów rezonansu magnetycznego głowy czy słuchowych potencjałów wywołanych. Kontrolne badania audiometryczne powinny być wykonane tuż po i 6 miesięcy po zakończeniu leczenia. W populacji pediatrycznej postawienie rozpoznania SSNHL jest trudne, często opóźnione, ale rokowanie co do poprawy słuchu lepsze niż w populacji osób dorosłych.
Summary
Sudden sensorineural hearing loss (SSNHL), commonly known as sudden deafness, is an increase of bone and air conduction thresholds of greater than or equal to 30 decibeles affecting at least three consecutive frequencies within a 72-hour window. The loss of hearing is commonly accompanied by tinnitus and, rarely, vertigo. The vast majority of SSNHL is of unknown cause. Even 32 to 65% of cases of SSNHL may recover spontaneously. Treatment includes systemic and topical steroids and hyperbaric oxygen therapy (HBOT). Antivirals, thrombolytics, vasodilators, or vasoactive substances should not be routinely prescribed. Patients who have local neurologic findings require computed tomography scan of a head. A retrocochlear pathology should be excluded by obtaining magnetic resonance imaging or auditory brainstem response. The follow-up audiometric evaluation should be obtained at the conclusion of treatment and within 6 months of completion of treatment. The presentation of SSNHL in pediatric population is commonly delayed. Treatment options are similar to those of adults but the hearing recovery rate is higher.



Introduction
Sudden hearing loss (SHL) is defined as a rapid-onset subjective sensation of hearing impairment in one or both ears. The hearing loss may be either conductive, sensorineural or mixed. Sudden sensorineural hearing loss (SSNHL) affects in Poland 5 to 20 per 100 000 adults annually and is sometimes referred colloquially as “nerve hearing loss” (1, 2). The true incidence in pediatric population is unknown. It is estimated to occur in approximately 3-10% of all cases (3). The audiometric criterion for the entity is an increase of bone and air conduction thresholds of greater than or equal to 30 decibels affecting at least three consecutive frequencies within a 72-hour window. Patients may complain of ear fullness prior to the SSNHL onset. Tinnitus and vertigo may be co-occurring symptoms. Tinnitus, when persistent, may become a primary concern. Vertigo, on the other hand, is associated with poorer prognosis for hearing recovery in adults (1, 2). The vast majority of cases of SSNHL affects only one ear. Bilateral cases have been reported to occur in < 2% of adults and are associated with poorer prognosis (4-6).
Ethiology
SSNHL indicates the abnormal functioning of the cochlea, auditory nerve or even central nervous system. It may be caused by pathologies in cerebello-pontine angle (a.o. vestibular schwannoma), stroke, malignancy, noise, ototoxic medications, trauma. Nevertheless 90% of cases is considered to be idiopathic (2, 7-10). Causes of SSNHL in most of patients is never identified. Possible etiologies include infection, central nervous system pathology, inner ear pathology, autoimmune disease, vascular compromise. Viral infections include: herpes simplex virus, varicella zoster virus, human immunodeficiency virus. Bacterial pathogens which may influence development of SSNHL are: mycoplasma, Lyme disease, tuberculosis, syphilis (1, 2). An association of autoimmune disease with SSNHL has been noted by several studies (11-13). Cerebral microangiopathy co-occuring with diabetes, hypertension and hyperlipidemia in older patients could be associated with worse prognosis. Nevertheless, there is insufficient evidence that any routine laboratory test will impact the diagnosis, treatment or prognosis (2). Signs and symptoms which may suggest non-idiopathic SSNHL are presented in table 1.
Tab. 1. Signs and symptoms which may suggest non-idiopathic SSNHL
Sudden onset of bilateral hearing loss (Cogan’s syndrome, viral infections, ototoxic medications, trauma, lead poisoning, genetic disorders, mitochondrial disorders, MELAS, sarcoidosis, hyperviscosity syndrome)
Antecedent fluctuating hearing loss on one or both sides (Meniere’s disease, Cogan’s syndrome, hyperviscosity syndrome)
Concurrent severe bilateral vestibular loss with oscillopsia
Gaze evoked or downbeat nystagmus
Concurrent eye pain, redness, lacrimation and photophobia
Focal neurologic symptoms or signs: headache, confusion, diplopia, dysarthria, focal weakness, focal numbness, ataxia, facial weakness (stroke, brainstem and auditory cortex infarct, anterior inferior cerebellar artery occlusion, severe atherosclerotic narrowing of the vertebrobasilar vessels, multiple sclerosis, meningitis, neoplasms)
Recent head trauma
Recent acoustic trauma
Recent barotrauma
Management and prognosis
Even 32 to 65% of cases of SSNHL in adults may recover spontaneously (2, 14, 15). Treatment include systemic and topical steroids and hyperbaric oxygen therapy (HBOT). Other options mentioned in the literature are as follows: antiviral agents, rheologic agents, diuretics, other medications, herbal treatments. The presence of fistula requires middle ear surgery. The alternative is observation alone (2).
Newest clinical practice guidelines for sudden hearing loss include 13 key action statements (KAS) introduced in 2019 by American Academy of Otolaryngology-Head and Neck Surgery Foundation (2):
1. Clinicians should distinguish sensorineural hearing loss from conductive hearing loss when the patients first presents with SHL.
2. Clinicians should assess patients with presumptive SSNHL through history and physical examination for bilateral SHL, recurrent episodes of SHL, and/or focal neurologic findings.
3. Clinicians should not order routine computed tomography (CT) of the head in the initial evaluation of patients with presumptive SSNHL.
4. In patient with SHL, clinicians should obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm diagnosis of SSNHL.
5. Clinicians should not obtain routine laboratory tests in patients with SSNHL.
6. Clinicians should evaluate patients with SSNHL for retrocochlear pathology by obtaining magnetic resonance imaging (MRI) or auditory brainstem response (ABR).
7. Clinicians should evaluate patients with SSNHL about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

19

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

49

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Śliwińska-Kowalska M, Narożny W, Sekula A et al.: Nagły niedosłuch czuciowo-nerwowy – stanowisko Polskiego Towarzystwa Audiologicznego i Foniatrycznego dotyczące zaleceń diagnostycznych i terapeutycznych. Otorynolaryngologia 2015; 14(2): 65-73.
2. Chandrasekhar SS, Tsai Do BS, Schwartz SR et al.: Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg 2019; 161(1_suppl.): S1-S45.
3. Wood JW, Shaffer AD, Kitsko D, Chi DH: Sudden Sensorineural Hearing Loss in Children-Management and Outcomes: A Meta-analysis. Laryngoscope 2021; 131(2): 425-434.
4. Byl FM Jr: Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984; 94(5 Pt 1): 647-661.
5. Fetterman BL, Saunders JE, Luxford WM: Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 1996; 17(4): 529-536.
6. Huy PT, Sauvaget E: Idiopathic sudden sensorineural hearing loss is not an otologic emergency. Otol Neurotol 2005; 26(5): 896-902.
7. Federspil P: Drug-induced sudden hearing loss and vestibular disturbances. Adv Otorhinolaryngol 1981; 27: 144-158.
8. Govindaraju R, Omar R, Rajagopalan R et al.: Hearing loss after noise exposure. Auris Nasus Larynx 2011; 38(4): 519-522.
9. Saunders JE, Luxford WM, Devgan KK, Fetterman BL: Sudden hearing loss in acoustic neuroma patients. Otolaryngol Head Neck Surg 1995; 113(1): 23-31.
10. Norris CH: Drugs affecting the inner ear. A review of their clinical efficacy, mechanisms of action, toxicity, and place in therapy. Drugs 1988; 36(6): 754-772.
11. Bovo R, Aimoni C, Martini A: Immune-mediated inner ear disease. Acta Otolaryngol 2006; 126(10): 1012-1021.
12. Dayal VS, Ellman M, Sweiss N: Autoimmune inner ear disease: clinical and laboratory findings and treatment outcome. J Otolaryngol Head Neck Surg 2008; 37(4): 591-596.
13. Toubi E, Ben-David J, Kessel A et al.: Immune-mediated disorders associated with idiopathic sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 2004; 113(6): 445-449.
14. Mattox DE, Simmons FB: Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 1977; 86(4 Pt 1): 463-480.
15. Stachler RJ, Chandrasekhar SS, Archer SM et al.: Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012; 146(3 Suppl.): S1-35.
16. van den Brand MJ, van Miltenburg A, de Boer MJ et al.: Correlation between clinical course and quantitative analysis of the ischemia related artery in patients with unstable angina pectoris, refractory to medical treatment. Results of two randomized trials. The European Cooperative Study Group. Int J Card Imaging 1994; 10(3): 177-185.
17. Shuman AG, Li X, Halpin CF et al.: Tuning fork testing in sudden sensorineural hearing loss. JAMA Intern Med 2013; 173(8): 706-707.
18. Chandrasekhar SS, Brackmann DE, Devgan KK: Utility of auditory brainstem response audiometry in diagnosis of acoustic neuromas. Am J Otol 1995; 16(1): 63-67.
19. Pasquini L, Napolitano A, Visconti E et al.: Correction to: Gadolinium-Based Contrast Agent-Related Toxicities. CNS Drugs 2018; 32(6): 601.
20. Cadoni G, Cianfoni A, Agostino S et al.: Magnetic resonance imaging findings in sudden sensorineural hearing loss. J Otolaryngol 2006; 35(5): 310-316.
21. St Martin MB, Hirsch BE: Imaging of hearing loss. Otolaryngol Clin North Am 2008; 41(1): 157-178, vi-vii.
22. Nosrati-Zarenoe R, Hansson M, Hultcrantz E: Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome. Acta Otolaryngol 2010; 130(3): 384-391.
23. Fitzgerald DC, Mark AS: Sudden hearing loss: frequency of abnormal findings on contrast-enhanced MR studies. AJNR Am J Neuroradiol 1998; 19(8): 1433-1436.
24. Jeong KH, Choi JW, Shin JE, Kim CH: Abnormal Magnetic Resonance Imaging Findings in Patients With Sudden Sensorineural Hearing Loss: Vestibular Schwannoma as the Most Common Cause of MRI Abnormality. Medicine (Baltimore) 2016; 95(17): e3557.
25. Schick B, Brors D, Koch O et al.: Magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo. Otol Neurotol 2001; 22(6): 808-812.
26. Aarnisalo AA, Suoranta H, Ylikoski J: Magnetic resonance imaging findings in the auditory pathway of patients with sudden deafness. Otol Neurotol 2004; 25(3): 245-249.
27. Ramos HV, Barros FA, Yamashita H et al.: Magnetic resonance imaging in sudden deafness. Braz J Otorhinolaryngol 2005; 71(4): 422-426.
28. Suzuki M, Hashimoto S, Kano S, Okitsu T: Prevalence of acoustic neuroma associated with each configuration of pure tone audiogram in patients with asymmetric sensorineural hearing loss. Ann Otol Rhinol Laryngol 2010; 119(9): 615-618.
29. El-Kashlan HK, Eisenmann D, Kileny PR: Auditory brain stem response in small acoustic neuromas. Ear Hear 2000; 21(3): 257-262.
30. Schmidt RJ, Sataloff RT, Newman J et al.: The sensitivity of auditory brainstem response testing for the diagnosis of acoustic neuromas. Arch Otolaryngol Head Neck Surg 2001; 127(1): 19-22.
31. Montaguti M, Bergonzoni C, Zanetti MA, Rinaldi Ceroni A: Comparative evaluation of ABR abnormalities in patients with and without neurinoma of VIII cranial nerve. Acta Otorhinolaryngol Ital 2007; 27(2): 68-72.
32. Musiek FE, Kibbe-Michal K, Geurkink NA et al.: ABR results in patients with posterior fossa tumors and normal pure-tone hearing. Otolaryngol Head Neck Surg 1986; 94(5): 568-573.
33. Han X, Yin X, Du X, Sun C: Combined Intratympanic and Systemic Use of Steroids as a First-Line Treatment for Sudden Sensorineural Hearing Loss: A Meta-Analysis of Randomized, Controlled Trials. Otol Neurotol 2017; 38(4): 487-495.
34. Dedhia K, Chi DH: Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children. Int J Pediatr Otorhinolaryngol 2016; 88: 208-212.
otrzymano: 2021-04-27
zaakceptowano do druku: 2021-05-18

Adres do korespondencji:
*Lidia Zawadzka-Głos
Klinika Otolaryngologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Żwirki i Wigury 63A, 02-091 Warszawa
tel. +48 (22) 317-97-21
laryngologia.dsk@uckwum.pl

New Medicine 2/2021
Strona internetowa czasopisma New Medicine