Sudden
Sudden Sensorineural Hearing Loss
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