Prognosis in sudden hearing loss: Is it the disease or the treatment that determines the prognosis?

Abstract

Objective: To compare the various treatment modalities for Sudden Hearing Loss (SHL) and to determine whether the prognosis depends upon the treatment or upon the disease itself.

Materials and Methods: A total of 160 patients with SHL that were examined retrospectively between January 1995 and December 2006 were reviewed. Out of these, 115 patients, who a) presented within the first 15 days, b) completed monthly audiometric controls in the follow-up period and received c1) classical medical treatment (plasma volume expanders, vasodilators, diuretics, anti-aggregates, sedative agents and vitamin-B complex), c2) plus carbogen inhalation and/or c3) corticosteroid (systemic) therapy, c4) and/or intratympanic steroid therapy, were included into the study. Audiograms were received on the 5th 10th and 30th day of the treatment and hearing is compared based on "Pure Tone Averages" (PTA) at 500, 1000, 2000 and 4000 Hz.

Results: Patients who received treatment within the first 5 days showed 35.2% improvement at PTA while others showed only 20.5% improvement (p=0.022). Patients with vertigo showed 18.2% mean percentile improvement in PTAs, whereas this recovery was 32.9% in the audiograms of the patients without vertigo (p=0.018). The percentile of improvement in PTAs was 49.7% for ascending type audiogram group which was significantly better than other groups (p=0.001). According to severity of hearing loss, recovery of mild hearing losses was higher, compared to other groups (p=0.018). A statistically significant difference was not detected between treatment modalities.

Conclusions: All treatment methods used for the SHL provided certain degree of improvement in the audiometric measurements. But, the only statistically significant factor was the beginning of the therapy with in the first five days. Associated vertigo may have a negative effect on the outcome. Main prognostic factors were time of presentation, and presence of additional factors such as vertigo, severity of hearing loss and audiogram configurations, rather than the therapeutical agents used.