Professional Documents
Culture Documents
Prakash Adhikari
2nd Year M.S.Resident (ENT-HNS)
Ganesh Man Singh Memorial Academy of ENT and
Head and Neck Studies,
TU Teaching Hospital, IOM,Kathmandu,Nepal
ROADMAP………
Introduction
Definition
Causes
ISSNHL
Investigations
Prognostic factors
Treatment modalities
Conclusion
Take home message
Introduction-SSNHL
Devastating to patients
Several
Most accepted:
30dB SNHL
More or equal to 3 contiguous frequencies
Less than 3 days (Wilson et al)
More or equal to 20dB (Haberkamp and Tanyeri)
More or equal to 20dB in no more than 1 week
(Kronenberg et al)
Causes of sudden or fluctuating
SNHL
COCHLEAR
Traumatic
Inflammatory
Vascular
Haematological conditions
Autoimmune disease
Endolymphatic hydrops
Metabolic disorders
Skeletal system
Ototoxicity
Miscellaneous
Retrocochlear and central nervous
system
Meningitis
Multiple sclerosis
Friedrich’s ataxia
Amyotrophic lateral sclerosis
Xeroderma pigmentosum
Tumors
Central deafness
Idiopathic
Cochlear causes- Traumatic
Electricity
Rupture of tympanic membrane
From telephone during thunderstorm
Cordless-complex signal
3 cases reported-HL-during use of
cordless during lightening (Singleton et al 1984)
Traumatic HL
Breaks in the membranous labyrinth
Intracochlear – Meniere’s
Oval and/or round window – perilymph fistula
Bilateral HL
Neurotropic and lymphotrophic virus-never
been cultured from 7th cranial nerve or
spiral ganglion cells. (Morris and prasad,1990)
Temporal bone reports by AIDS. (Michaels et al
1994)
Protozoa
Toxoplasmosis
Lymphadenopathy-commonest
Hearing rarely affected
Katholm et al,1991
SSNHL-Both ear.
Improved hearing with sulphadiazine
and pyrimethamine
Buerger’s disease
Iatrogenic
Radiotherapy
Significant correlation between total
radiation dose to inner ear and
observed hearing impairment. (Garu et al,
1991,n-22)
Polycythaemia vera
Thalassaemia
B/L high freq SNHL in a patient on desferrioxamine
(Back,1980, n=52)
(Oliveri et al, 1986,n=89)-22::: abnormal Hearing
Low serum Ferritin was also a risk factor
Waldenstrom’s macroglobulinaemia
Characterized by retinal changes,
abnormal bleeding tendencies,
generalized weakness and dyspnoea
Leukaemia
Common in ALL
CLL- few reported
Treatment with cyclophosphamide and
prednisolone improved hearing
Cryglobulinaemia
SLE, multiple myeloma or macroglobulinaemia
Autoimmune disease
SLE
Cyclophosphamide and steroids
fail to improve hearing
ANF, Ds DNA ACLA
Systemic vasculitis
ANCA, proteinase 3 and myeloperosidase
PAN
b/L deafness, treated with prednisolone improved
Obliterative vasculitis of the labyrinthine artery or its
branches resulting in diffuse or focal areas of
ischaemic necrosis
Cogan’s syndrome
4% deafness in syphilitic keratitis
(Cogan 1945)
Non syphilitic keartitis- progressive HL
Aortitis – 10%
Hypothyroidism
Symmetrical B/L HL
? Association
-13% improved hearing
Vant Hoff and Stuart 1979.n-48
when they became euthyroid
No improvement- Parving et al 1983,n-15
TUTH STUDY
45.7% HAD SYSTEMIC DISEASE
DM alone-7
HTN alone-3
Hyperlipidemia alone-2
DM+HTN-6
DM+Hyperlidemia-2
DM+HTN+Hyperlipidemia-1
Ototoxicity
Interferon
Contraceptive pills
Xeroderma pigmentosa
B/L HL absence of tone decay, absent
stapedial reflexes
Tumors
Vestibular schwannoma
10% sudden (Higgs 1973,n-44)
In between 10-15%
MRI with Gadolinium- compression of
vasculature within the bony IAM
Treatment
Treatment
Therapy for ISSNHL is controversial
Difficult to study
High spontaneous recovery rate
Low incidence
Makes validation of empiric treatment
modalities difficult
TREATMENT
Increasing cochlear blood flow
No proven value
Betahistine-histamine like effect on
H1 receptors in the cochlea
vasculature leading to increase in
cochlear blood flow
Glycerol-iv in rabbit
Pentoxiflline / oxpentyfylline
Hydroxyethyl starch/Hetastarch-Hespan
Cerebral vasodilator
10% co2 –dangerous
After carbogen inhalation- perilymphatic oxygenation of
8.6mmHg rose to 14.8mmHg
95% o2 and 5% Co2 for 30 mins 8 times per day at intervals of
one hour. (Fisch et al 1984)
3/4th pts improved
Giger 1979,n-55:
Carbogen or iv infusion with papaverine and Dextran
No difference on 5th day but better result at 1 year
It mat improve spontaneous rate recovery in sudden deafness
Placebo 81%
Carbogen 55%
Trends:
Low frequency loss improved more
High frequency loss improved less
Patients without vertigo have better outcome
The Newest Treatment:
Intra-Tympanic Dexamethasone