Study of clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital

 

 

Abstract              Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency defined as sensorineural hearing loss ≥ 30 dB that affects at least 3 consecutive frequencies and occurs within a 72-hour window. Present study was aimed to study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Material and Methods: Present study was single-center, retrospective study, conducted in case records of patients with sudden onset sensorineural hearing loss. Results: We studied total 74 case records. All patients were compared according to recovery status. Recovery was noticed in 31 patients (41.89 %) while no or less than 50 % recovery was noticed in 43 patients (58.11 %). Majority of patients were from 41-60 years age group (43.24 %) and in patients with recovery, mean age was 41.87 ± 9.34 years as compared to patients without recovery as 50.51 ± 10.78 years and difference was statistically significant (p<0.05). Gender was comparable among total patients as well as patients with or without recovery and difference was statistically not significant (p>0.05). Hypertension (33.78 %), diabetes (17.57 %), dyslipidemia (20.27 %) and thyroid disorder (8.11 %) were common comorbidities noted among patients. Vertigo was significant in patients without recovery (68.75 %) as compared to patients with recovery (31.25 %) and difference was statistically significant (p<0.05). Degree Of hearing loss was mild (8.11 %), moderate (10.81 %), moderately severe (20.27 %), severe (25.68 %) and profound (35.14 %). Incidence of patients without recovery was increased with increase in severity of hearing loss and difference was statistically significant (p<0.05). Time to initiate treatment was ≤ 14 days (62.16 %) in majority of patients followed by 15-30 days (25.68 %) and >30 days (12.16 %). Recovery was noted in early initiation of treatment and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

Keywords: sudden onset sensorineural hearing loss, vertigo, profound hearing loss, prednisolone

 

INTRODUCTION

Sudden sensorineural hearing loss (SSNHL) is an otologic emergency defined as sensorineural hearing loss ≥ 30 dB that affects at least 3 consecutive frequencies and occurs within a 72-hour window.¹ The incidence of SSNHL is estimated at 5 to 27 per 100,000 people annually.² Chronic sensorineural hearing loss (SNHL) accounts for roughly 90% of this sensory deficit and is likely caused by noise, chemical, viral, and aging insults with potentially debilitating effects.^3,4 In people with SNHL, audibility (loudness of sound) and intelligibility (clarity of words) deteriorate due to the aforementioned auditory insults. Recently, microcirculation disturbance has been hypothesized as the main etiology. Any disease interrupting the cochlear perfusion may eventually result in a reduction of the oxygen supply to cochlea and trigger ISSNHL. Cardiovascular and metabolic diseases such as hypertension, diabetes mellitus (DM) and hyperlipidemia, reduces the elasticity of blood vessels and induce the formation of atherosclerosis, thus causing microangiopathy.^5,6 Audiological evaluation provides a criterion for the diagnosis of ISSNHL; in the case of retro-cochlear lesions, further investigations like imaging studies are necessary to rule out other causes like vestibular Schwannoma, cerebro-vascular accidents and the like. Present study was aimed to study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital.

              

MATERIAL AND METHODS

Present study was single-center, retrospective study, conducted in Department of otorhinolaryngology, at District Civil Hospital, Sindhudurg, India. Study approval was taken from institutional ethical committee. Case records of patients with sudden onset sensorineural hearing loss examined between January 2016 to December 2020 were considered for present study. The diagnosis of all the patients had been made by experienced Otolaryngologists. Patient’s demographic data, onset, and duration of hearing loss, associated symptoms, presence of cardiovascular risk factors and other co-morbid factors, findings of clinical examination, initial diagnosis were noted. Findings of various blood investigations such as complete haemogram, serum electrolytes, thyroid function tests, findings of initial audiogram, treatment received were documented. As per standard medical treatment, Tapering dose of oral prednisolone for fourteen days was administered (60 mg/day for 5 days, followed by 50 mg/day for 3 days, followed by 40 mg for 2 day, followed by 30 mg for 1 day, followed by 20 mg for 1 day, followed by 10 mg for 1 day, and followed by 5 mg for 1 day), with oral pentoxifylline 400 mg twice per day. In all cases, the hearing assessment was done by pure tone audiometry on the day of presentation and weekly after treatment initiation until one month. The hearing improvement was evaluated based on the change in hearing threshold from the pre-treatment to the 1-month follow-up audiogram. Recovery was considered when post-treatment PTA that was ≥ 50% of the reference hearing level. Data was collected and compiled using Microsoft Excel, analysed using SPSS 23.0 version. Frequency, percentage, means and standard deviations (SD) was calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. Difference of proportions between qualitative variables were tested using chi- square test or Fisher exact test as applicable. P value less than 0.5 was considered as statistically significant.

 

RESULTS

We studied total 74 case records. All patients were compared according to recovery status. Recovery was noticed in 31 patients (41.89 %) while no or less than 50 % recovery was noticed in 43 patients (58.11 %). Majority of patients were from 41-60 years age group (43.24 %) followed by from 21-40 years age group (29.73 %). In patients with recovery, mean age was 41.87 ± 9.34 years as compared to patients without recovery as 50.51 ± 10.78 years and difference was statistically significant (p<0.05). Gender was comparable among total patients as well as patients with or without recovery and difference was statistically not significant (p>0.05). Hypertension (33.78 %), diabetes (17.57 %), dyslipidemia (20.27 %) and thyroid disorder (8.11 %) were common comorbidities noted among patients. We compared comorbidities among patients with or without recovery and difference was statistically not significant (p>0.05).

 

 

 

 

 

 

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