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3 days, 30 dB, 3 frequencies

For purposes of this discussion, sudden sensorineural hearing loss develops over 12 hours or less.

Incidence 5-10%/100,000/yr

40-60 YO

Various S/S : sudden deafness during rest or activity, vertigo(30%), tinnitus(50%),usually unilateral but <4% bilateral later attack c opposite side or fluctuation

S/S

The most common presentation is a patient noticing a unilateral hearing loss on awakening.

Others notice a sudden, stable hearing loss or a rapidly progressive loss.

Occasionally, patients will note a fluctuating hearing loss, but most patients have an identifiable diagnosis.

A sensation of aural fullness in the affected ear is common and frequently is the only complaint.

Tinnitus is present in the ear to a variable degree, and the hearing loss sometimes is preceded by the onset of tinnitus. Vertigo or disequilibrium is present to a variable degree in approximately 40% of patients

Audiometry 4 types

• Downsloping
• Upsloping
• Flat loss
• Profound loss

Unknown

• Viral (labyrinthitis, neuronitis, ganglionitis)
• Vascular theory
• Cerebellopontine angle tumor
• Goodhill : Round window fistula
• Wetmere and Abrason : bullous myringitis
• Others : change of physical env., alcohol, DM, arteriosclerosis, pill, surgery

Classification

Localized lesion of temporal bone

Acoustic neuroma

Cerebellopontine angle tumor

Oval and round window fistula

Aneurysm of anteroinferior cerebellar artery (AICA)

Systemic disease involving the temporal bone

Viral infection that are cochleopathic

Accelerated coagulogram

Hypervicosity

• Polycytemia vera
• Macroglobulinemia

Arteriosclerosis secondary to

• Aging
• Hypertension
• Diabetic
• Hyperlipidemia

Collagen vascular disease

Multiple sclerosis, syphilis, and many others

Systematic evaluation

Otologic examination

• Otoscopic
• Tuning fork test
• Audiometry test
• Vestibular function test

Audiogram

• CBC, UA, ESR, Coagulogram
• VDRL, TPHA, FTA-Abs, Anti HIV,LP
• Fasting blood sugar,s-electrolyte
• BUN, Cr, Uric acid
• Lipid profile
• TFT
• EKG, CXR, Film mastoid, CT, MRI
• Viral study

Management

“Depend on etiology”

Medical Management

• Bed rest,avoid noise voice,head tilt30
• Low salt diet
• Diuretic
• Corticosteroid
• Vasodilater,Carbogen(95%O2+5%CO2)
• Anticoagulation etc.
• Plasma explander (10%Dextran)
• Acyclovia
• Avoid ototoxic drugs
• Combined therapy

Surgical management

• Perilymph fistula
• Tympanotomy -> occlude by gelfoam

Prognosis

The more severe the loss, the lower the prognosis for recovery, and profound losses have an exceptionally poor prognosis.

Upsloping and mid-frequency losses recover more frequently than downsloping and flat losses.

Reduced speech discrimination

Children and adults aged more than 40 years

Summarized By Thirayost Nimmanon

โดย ธีรยสถ์ นิมมานนท์

ปรับปรุงครั้งล่าสุด 15/06/2010

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