Sudden sensorineural hearing loss in adults — Our experience with a multidrug high-dose steroid regimen at a tertiary care hospital

Abstract

Abstract Introduction: Sudden sensorineural hearing loss is a confusing and controversial issue in our practice since no standard definition, evaluation method and treatment protocol exists. It is more a symptom than a disease entity. It is an otological emergency with narrow golden period of treatment. Objective: To establish the early diagnosis, treatment and study the outcome of treatment. Design and method: It is a prospective study, including patients >18 year age who had presented with sudden sensorineural hearing loss in ENT opd. Patients underwent general systemic and ENT examination, pure tone audiometry, impedance audiometry and necessary imaging. After diagnosis patients were treated with i.v. methylprednisolone 2 gm loading dose on day 1 followed by 1 gm BD for 2 days. and then tab. Prednisolone (1 mg/kg/day) for 5 days, gradually tapered over next 10 days along with tab. pentoxyfylline 400 mg TDS for 14 days with inj. methylcobalamine i.m. OD for 3 days. Pure tone audiogram was repeated on 4th day, 3 week, and 6 weeks after diagnosis. Results: The study group included 37 patients who were diagnosed and treated. 56.76% of patients had sudden SNHL of < 72 hrs. duration, while 43.24% had sudden SNHL of >72 hrs. duration. The majority i.e. 35.14% had severe hearing loss (71-90 db) followed by 29.73% with moderate hearing loss (41-55 db). Tinnitus was noted as commonest associated symptom in 78.38% followed by tinnitus & vertigo in 21.62%. As per etiology, idiopathic cause (64.86%) was followed by acoustic trauma (24.32%) and head trauma (10.81%) in study group. In terms of recovery, 35.14% patients had complete recovery while 40.54% and 24.32% patients had partial and no recovery respectively. Conclusion: The diagnosis of sudden SNHL is easily obtained by audiometry. Exact etiology often remains unknown so early diagnosis by avoiding unnecessary investigations and prompt treatment in <72 hrs. still carry good prognosis.