Sensorineural Hearing Loss

Sudden Sensorineural Hearing Loss

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Definition:
– hearing loss more 30 db
– 3 consecutive frequencies
– within 3 days
Causes:
1- Vascular : Inner ear stroke- cochlear artery branch (thrombosis) of labyrinthine artery branch of AICA)
2- Inflammation,infection :
  • labyrinthitis
  • autoimmune disease (eg: Cogan’s syndrome)
3- Neoplasia: CP angle tumour – usually progressive. sudden onset may be due to bleeding tumour).
  • Acoustic neuroma grows 1mm/year grow ,unilateral (bilateral in Type 2 Neurofibromatosis)
  • Meningioma
4- Ototoxic drug: bilateral ear affected
  • Vestibulotoxic: gentamicin(aminoglycoside), dietatic, aspirin, quinolone(antimalaria)
  • Cochleotoxic: streptomycin, kanamycin,neomycin
5- Trauma
Ix
Blood:
  • FBC – anemia, polycythemia, high twc
  • ESR
  • RP
  • Fasting serum lipid
  • FBS, HbA1c
  • Autoimmune screening c3/4
  • TFT -hypothyroid
  • VDRL -syphilis
Others:
  • PTA
  • MRI- do later
Clinical presentation
Elderly f>m
99% unilateral, 1- 2% bilateral
Management
Inpatient vs outpatient
  • DM patient – monitor sugar as steroid started, vertigo, logistic —> treat in patient
  • Others treat as outpatient
1) Start steroid-tab prednisolone( to start within 7 days of onset–>1mg/kg/day) and taper down in 2 weeks
2) LMW (heparin) dextran- reduce viscosity of blood – 2 pints a day for 3 days
3) methylcobalamine
4) acyclovir if hx suggestive of viral infection ( eg URTI)
5) carbogen ( 5% co2- vasodilator effect,95% o2) 30mins for 5days
6) hyperbaric o2 (100% o2)
Or
SHOTGUN regime
Latest management:
Intratympanic dexamethasone
  • inject dexamethasone through TM under LA  (use EMLA) n lie down for 30 minutes- every week once for 3 weeks
  • dose: 4 mg ( 1ml) each injection
– higher succession  rate
– less systemic steroid effect
Prognosis
  • Age: Young <10 years old and >60 years old: bad
  • Esr > 25: bad
  • Vertigo: bad
  • Comorbid: bad
  • Severity: Severe to profound HL: bad, mild / moderate: good
  • Bilateral: bad
  • Tinnitus: good (protective)
Rehabilitation
Unilateral —> do nothing/ CROS/ BAHA/ CI
Bilateral—> HA/ CI

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