Does acute sensorineural deafness befall to urgent conditions?

Abstract

Background/Aim. Idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in otology. The aim of this study was to determine whether a delay in treatment has any influence on hearing recovery in ISSHL. Method. This study was designed as a retrospective evaluation of an electronic patient data base of the University Hospital Z?rich from January 1995 to August 2006. Five hundred and forty one patients with a sudden hearing loss were identified. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 eight times per day in the duration of 30 minutes) and prednisone orally (100 mg in one morning dose) for 7 days. Factor that was analyzed included the interval between the onset of symptoms and the beginning of the treatment. The initial hearing loss was described using the pure tone average (PTA in dB) hearing level at 4 frequencies (0.5, 1, 2 and 4 kHz). Hearing gain was expressed either as absolute hearing gain (dB values from initial PTA minus dB values from final PTA) or as relative hearing gain (absolute hearing gain divided by initial PTA minus baseline PTA) ? 100. Significant recovery of hearing was defined as the final PTA ? 30 dB (or same as PTA of the opposite ear). Results. An absolute hearing gain between the initial audiogram and the final audiogram was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had a significant recovery of hearing, and 228 (43%) had not. If the patients received treatment in the first 24 hours after onset of symptoms, then the rate of significant recovery was 56%, and no significant difference existed between this group and the patients who received the therapy after 24 hours, but within seven days (?2 = 0.007, DF = 1, p > 0.01). Conclusion. These results suggest that it is not critical to begin the treatment of ISSHL immediately as an emergency, but within seven days.Uvod/Cilj. Akutna idiopatska senzorineuralna nagluvost (AISNN) jedna je od najkontroverznijih tema u otologiji. Cilj istrazivanja bio je da se utvrdi da li vreme zapocinjanja terapije ima ikakav efekat na bolji oporavak sluha kod AISNN. Metode. Studija je dizajnirana kao retrospektivno istrazivanje elektronske baze podataka bolesnika Klinike za uho, nos i grlo, Univerzitetske bolnice u Cirihu, u jedanaestogodisnjem periodu od 1995. do 2006. Identifikovan je 541 bolesnik sa dijagnozom AISNN. U analiziranom periodu, bolesnici su leceni sedam dana inhalacijom karbogena (95% O2 i 5% CO2) i oralnim prednizolonom. Inicijalni gubitak sluha definisan je kao prosecni prag sluha u dB (PPS inicijalni) u 4 frekvence (0,5; 1; 2 i 4 kHz) zahvacenog uha. Na isti nacin odredjena je vrednost finalnog praga sluha nakon terapije (PPS finalni). Poboljsanje sluha definisano je na tri nacina: apsolutno poboljsanje sluha (dB) = PPS inicijalni - PPS finalni; relativno poboljsanje sluha (%) = apsolutno poboljsanje / (PPS inicijalni - PPS drugog uva) ? 100; znacajnim oporavkom smatrao se finalni PPS ? 30 dB ili ukoliko je bio jednak sa PPS drugog uha. Rezultati. Prosecni apsolutni oporavak sluha bio je 15,1 dB, a prosecni relativni oporavak 47%. Tristotine jedan bolesnik (57%) imao je znacajan oporavak, dok 228 (43%) nije. Medju bolesnicima koji su primili terapiju u prva 24 h od pocetka nagluvosti, znacajan oporavak sluha imalo je 56% i nije postojala znacajna razlika izmedju ove grupe bolesnika i grupe koja je primila terapiju posle 24 h, ali unutar sedam dana (?2 = 0,007, DF = 1, p > 0,01). Zakljucak. Na osnovu rezultata retrospektivne studije moze se zakljuciti da akutni gubitak sluha nije urgentno stanje i da terapiju nije potrebno zapoceti u prva 24 h, nego u prvih sedam dana.