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SUDDEN HEARING LOSS

Timothy C. Hain, MD. Hearing Page Page last modified: January 16, 2011

• What is Sudden Hearing Loss?

• What Causes Sudden Hearing Loss?
• How is Sudden Hearing Loss Diagnosed?
• How is Sudden Hearing Loss Treated?
• Research Studies in Sudden Hearing Loss
• References

What is Sudden Hearing Loss?

Sudden hearing loss (SHL) is defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over 72 hours or less.
It occurs most frequently in the 30 to 60 year age group and affects males and females equally. Although called sudden, it seems unlikely that hearing
loss is abrupt but rather it probably evolves over a few hours.

SHL can affect different people very differently. SHL is usually unilateral (that is, it affects only one ear); and is often accompanied by tinnitus. vertigo,
or both. The amount of hearing loss may vary from mild to severe, and may involve different parts of the hearing frequency range. SHL may be
temporary or permanent. About one third of people with SHL awaken in the morning with a hearing loss.

Sudden hearing loss is associated with vertigo in between 20 to 60% of patients (Rambold et al, 2005).

There is presently no convincing evidence that any oral or intravenous treatment for idiopathic SHL is better than placebo. The question remains open
regarding injections of steroids through the ear drum.

What Causes Sudden Hearing Loss?

If one knows what causes SHL, it isn't idiopathic (by definition).

Neurological Trauma or Infections and

Autoimmune Vascular
Neoplastic Toxin viral
Autoimmune Cardiopulmonary Acoustic Large Cryptococcal
inner ear bypass Neuroma vestibular Meningitis
disease (AIED) aqueduct
 syndrome
Contralateral
deafness after
Cogan's Red blood cell Inner ear
acoustic Cytomegalovirus
syndrome deformability concussion
neuroma
surgery
Inner ear
Focal pontine
Lupus Sickle cell decompression Herpes-simplex I
ischemia
sickness
Small vessel Otologic
Meniere's Leukemia HIV
disease surgery
Vascular disease
Polyarteritis Meningeal
associated with Ototoxicity Lassa Fever
nodosa carcinomatosis
mitochondriopathy
Relapsing Vertebrobasilar Perilymph Meningococcal
Migraine
polychondritis insufficiency Fistula meningitis
Ulcerative Multiple Temporal bone
Blood dyscrasias Mumps
Colitis sclerosis fracture
CSF leak, such
Wegeners's as caused by
Myeloma Rubeola
granulomatosis lumbar
puncture
Rubella
syphilis
Toxoplasmosis

Table adapted from Wynne, 2003

Although some hold that this disease is generally idiopathic (of unknown cause), the differential diagnosis includes viral disease, Lyme disease and its
relatives (Lorenzi et al, 2003), vascular disease (1%), autoimmune phenomena, perilymph fistulae and Meniere's disease, and acoustic neuroma (about 4
to 6% of SHL -- see table above and Daniels et al, 2000 for a longer list of diagnoses).

Viral disease has been claimed to be the basis for about 60% of all cases of SHL. Viruses detected at a study at the Massachusetts Eye/Ear infirmary
included influenza type B, CMV (Seguira et al, 2003), mumps, rubeola, and varicella-zoster (Harris, 1998). Others include measles, herpes-1, and
infectious mononucleosis. Many of these are in the herpes family. Numerous other causes are possible (see next section). A temporal bone study of 17
bones from the Mass Eye/Ear infirmary suggests that pathology does not support the concept of membrane breaks (e.g. Meniere's), perilymphatic
fistulae or vascular occlusion (Merchant et al, 2005). In our view, this study includes too few temporal bone samples to be relied upon. More temporal
bone donations are needed. Unfortunately the infrastructure to gather temporal bones in the USA does not presently work.

Some authors maintain that vascular disease is the most likely cause (Rambold et al, 2005). This is largely a conclusion based on exclusion of other
causes. In general, when viruses or vascular etiologies are held out as the "cause" of a particular illness, it often means that the details are unclear.
Recently there has been some weak recent evidence that blood flow plays a role as some measures of hearing improve in animals after a "stellate ganglion
block" that improves blood flow (Firat et al, 2008). High levels of cholesteral and low levels of Coenzyme Q are associated with SHL (Cadoni et al,
2007). Use of some agents that affect blood flow, such as sildenafil (Viagra) but not vardenafil (Levitra) or Tidalafil (Cialis), have been associated with
hearing loss (McGwin, 2010). Migraine is associated with SHL.

Cerebrospinal fluid (CSF) leak is a particularly interesting causal variant of SHL. CSF leaks may be caused by diagnostic or therapeutic procedures in
medicine such as. lumbar puncture, spinal anesthesia or epidural anesthesia (Johkura et al. 2000). Symptoms may occur weeks after the procedure
(Lybecker and Anderson, 1995). CSF leak may occur spontaneously and may follow trauma. While CSF leak is generally accompanied by an orthostatic
(upright only) headache, this association is not universal and in fact, hearing loss may be more common than headache (Oncel et al, 1992).
Orthostatic tinnitus is also possible.(Arai, Takada et al. 2003). The hearing loss of CSF leak likely results from lowering of CSF pressure, which lowers
perilymphatic (inner ear) pressure, and results in a picture similar to Meniere's disease. (Walsted et al., 1991). Fortunately, the hearing loss is generally
temporary. The treatment is with blood patch.
How is Sudden Hearing Loss Diagnosed?
Bottom line: we favor audiometry, MRI of the posterior fossa with gadolinium, CBC and sed-rate in all persons with SHL, and additional testing decided
based on historical features.

In essence, SHL is diagnosed by documenting a recent decline in hearing. This generally requires an audiogram.

Other studies are performed mainly to look for specific causes. Evaluation usually begins with a careful history looking for potential infectious causes
such as otitis media and exposure to known ototoxic medications. Autoimmune hearing loss is suggested by good recovery, response to steroids, and
relapse.

Tests worth considering

• Audiometric testing including pure tone and speech

audiometry, otoacoustic emissions (OAE), and tympanometry. If OAE's
are present, prognosis is better (Schweinfurth et al, 1997).
• MRI testing of the brain and IAC, Brain MRI testing detects tumors as
well as CSF leak, and stroke.Tumors, such as an acoustic neuroma, can
even cause SHL that resolves completely (Nageris and Popovtzer, 2003)
• More general tests that may be useful include CBC, sed-rate, and FTA
(for syphilis),
Tests worthwhile in special cases

• hemoglobin electropheresis (for sickle cell),

• electrolytes,
• comprehensive metabolic screen.
• HIV test,
• Lyme test.
• CT scan of the temporal bone.
Tests unlikely to be helpful

• VEMP tests are generally normal in SHL (Wu and Young, 2002)
• Anticochlear antibodies are not useful in SHL (Samuelson et al, 2003).
Antiendothelial antibodies may be useful (Cadoni et al, 2003) but at this
writing there is no commercially available test.
• middle and late evoked potentials, ENG and rotatory chair testing.

Natural History of Sudden Hearing Loss

Mattox and Simmons (1977) reported a rate of 65% spontaneous recovery to "functional hearing levels." Byl also reported a recovery rate of about 69%
(Byl, 1984). Those that recover 50% of hearing in the first 2 weeks following SHL have a better prognosis than those who do not recover at this rate (Ito
et al, 2002). Serum antiendothelial cell antibodies are associated with a poorer prognosis (Cadeni et al, 2003). Recurrence of SHL is rare but possible
(Furohashi et al, 2002).

Cvorocic et al recently reviewed the prognosis of SHL (2008). Using step-wise discriminant analysis, they reported that a "recovery value" was predicted
by the following formula.
R=0.968-.216*Severity-.231*Vertigo+.211*speed of treatment+.113*other ear-.064*audiogram shape

It is better to have a minor hearing loss, no vertigo, and rapid treatment (within 1 week). Less important features are hearing in the other ear and
the pattern of the hearing test.

How is Sudden Hearing Loss Treated?

Bottom line: At this writing (6/2008) intratympanic steroids are promising.

Because hearing tends to recover spontaneously at such a high rate, treatment is not always felt necessary, especially when impairment is minor.
Nevertheless the prospect of being permanently deaf in one ear is daunting and has prompted many trials of therapy.

The present consensus in the literature is that while there are many interesting treatments, none have been proven to work. As a few examples, Finger and
A. O. Gostian (2006), in "Idiopathic sudden hearing loss: contradictory clinical evidence, placebo effects and high spontaneous recovery rate--where do
we stand in assessing treatment outcomes? concluded that the lack of a standard protocol among trials made comparison difficult and a conclusion
unreachable. Similarly, Kanzaki, J., Y. Inoue, et al. (2003) found no statistically significant effect of any oral or intravenous drug among many agents.

Steroids: When a treatment of SHL is used, it often consists of burst of steroids such as prednisone. Eisenman and Arts recently reviewed the topic of
steroid treatment (2000). Evidence to date for a good effect is generally mixed. Two recent meta-analysis of steroid treatment (Conlin and Parnes, 2007;
Labus et al, 2010) suggested there was no benefit.

Nevertheless, most (generally uncontrolled) studies suggest a better hearing prognosis for treated vs. untreated patients (Haberkamp and Tanyeri, 1999;
Alexiou et al, 2001; Chen et al, 2003; Slattery et al, 2005; Jeyakumar and Francis, 2006), but a few, a worse prognosis (Minoda et al, 2000). In the study
of Alexiou et al, a better prognosis was associated with very high doses of intravenous prednisolone. Hearing outcome is not altered differentially by IV
steroids administered in the first day vs. within the first week ( Huy and Sauvaget, 2005). A recent metaanalysis concluded that there was no significant
effect (Labus et al, 2010).

Our impression from the literature is that systemic steroids, while conventional treatment, are ineffective for SHL.

Transtympanic (aka intratympanic) Steroids.

Gianoli reported a good response to transtympanic steroids, in persons who were unable to tolerate oral steroids (Gianoli, 2001). Many others, in
uncontrolled studies, have made made a similar reports (Banerjee and Parnes, 2005; Gouveris, and Selivanova, 2005; Slattery and Fisher, 2005; Plaza
and. Herraiz 2007; Haynes et al, 2007; Van Wijck and Staecker 2007). There is an obvious trend for an increasing number of positive reports, albeit
nearly all uncontrolled, over time. One wonders why there are no good controlled studies ? Perhaps this is because good controlled studies show no
effect, and studies that show no effect are hard to publish. Lets look more closely.

Studies that are suggestive of good results but have obvious flaws:

There has been a "controlled" study, and also a recent placebo controlled study. Xenellis, J., N. Papadimitriou, et al. (2006) reported a "rescue" approach
where intratympanic steroids were used after 10 days of intravenous steroids. They used patients as their own controls. They reported a statistically better
effect in the IT patients, with no change in the controls. We are hopeful but a little dubious. The problem with this study is that it is not a protocol likely
to be helpful clinically, as it is not presently common to give 10 days of intravenous steroids in the treatment of SHL. Another concern with this study is
that it is implausible in that conventional thought is that treatments provided after 10 days of illness are intrinsically unlikely to work.

A slightly better recent double-blinded study of only 60 patients split into 3 groups (Battaglia et al, 2008) indicated that patients treated with a
combination of intratympanic dexamethasone and high dose steroids are more likely to recover hearing than those treated with high dose steroids alone.
Placebo IT injections were used in one arm. The steroid regimen involved prescribing 66 tablets of prednsone (10 mg) given in a dose of 6 tablets for 7
days, then 5 capsules for 2 days, then 1 less capsule per day until finished. IT steroids or placebo were administered once/week for a total of 3 weeks.
This study suggested a powerful treatment effect where the combination group did far better than groups with either IT dexamethasone alone or high
dose steroids + placebo injections. This protocol also would be expected to have numerous steroid side effects due to the prolonged use of high-
dose prednisone.

This trial was stopped prematurely due to slow subject accumulation. Because of this it may be underpowered and the conclusions may reflect random
statistical events combined with the known tendency of journals to publish "positive" results.A concern that we have with this trial is that the placebo arm
involved 4 injections of saline through the ear drum. It seems to us that the injections themselves might have an adverse effect on hearing (compared to
oral steroids given without a placebo injection). In other words, this study needs to be repeated, preferably with different subject groups - -combination
vs. IT dex vs. oral alone, as realistically these groups are the one that a clinician might choose.

Here are a few obvious problems with the intratympanic dexamethasone treatment approach:

• We would expect a conductive hearing loss from injection of a fluid

through the ear drum. This may confound hearing assessments.
 • Steroid injections through the ear drum are far more costly (in the USA)
than the alternatives of no-treatment or oral steroid treatment.
• Steroid injections through the ear drum are prone to produce long lasting
perforations of the ear drum. This is a simple and straightforward effect
of steroids on wound healing. We do not see any way around this
problem.
Nevertheless, at this writing, in the author's opinion, the transtympanic/intratympanic treatment approach to steroid delivery is diffidently recommended
for a significant SHL. While a clear indication for transtympanic steroids has not yet been established in SHL, if they can be administered quickly (i.e.
within 4-10 days) and a decision to use steroids has been arrived at, they do make more sense than oral steroids alone. The recent study by Battaglia
suggests that the optimum protocol is to use both IT and oral steroids. The data is clearly not strong enough right now to make steroid injections the
"standard of care". We would put this instead as an equivical cost/benefit ratio with low cost (in terms of complications), but unfortunately also low
benefit (in terms of efficacy).

Other immunosuppresants
In a person whose hearing improves to a useful level during administration of steroids, and then relapses after steroids are stopped, ongoing
immunosuppressant therapy should be considered (such as etanercept). Detection of this pattern requires monitoring of hearing past initial treatment. This
doesn't happen very often, and there is an obvious fallacy in that if hearing tends to improve anyway, improvements cannot necessarily be attributed to
steroids.

Antivirals seem reasonable, given the frequency that herpes family viruses have been associated with SHL. Nevertheless, studies do not show that they
work (Conlin and Parnes, 2007).

In a recent animal study, combination treatment with an antiviral (acylovir) and steroids reduced damage in animals whose ears were inoculated with
herpes simplex virus type 1 (HSV-1) (Stokroos, 1999), compared to treatment with either acyclovir or prednisolone alone. Similar results were found in a
human study by Zadeh et al (2003). On the other hand, several groups using good methodology and substantial numbers of patients have reported no
benefit of Valacyclovir or Acyclovir plus steroids over steroids alone (Tucci et al, 2002; Uri et al, 2003; Westerlaken et al. 2003) and as mentioned
above, a meta-analysis showed no effect (Conlin and Parnes, 2007).

Medications like acyclovir or valacyclovir may be unhelpful when the cause is a virus that is not in the herpes family, and one rarely knows at the time of
the hearing loss which if any virus is responsible. It is also possible that this sort of treatment is just too late in the course of the disorder, as the average
time to treat in the Tucci et al study was 4 days.

Unusual treatments that are probably ineffective.

SHL is a very disturbing experience and there have been many unusual protocols and drugs advocated.

There are several protocols involving increasing blood flow or oxygenation:

Fattori et al (2001) suggested that hyperbaric oxygen therapy was the treatment of choice. This involved 10, 90-minute sessions of breathing pure
oxygen at 2.2 atmospheric pressure in a chamber. Horn et al (2005) also reported some good responses to hyperbaric treatment in an uncontrolled study
of 9 patients. Similar results were reported in a larger but still uncontrolled study by Racic, G., S. Maslovara, et al. (2003). Again, Narozny, W., Z. Sicko,
et al. (2004) advocate combining steroids with hyperbaric oxygen. This is based on an unblinded and retrospective data. While these studies are
encouraging, is is difficult to see why this treatment should work and we would like to see this result confirmed with larger rigorous studies.

Somewhat similarly, Mora, R., M. Barbieri, et al. (2003) reported a positive effect of "Intravenous infusion of recombinant tissue plasminogen activator
for the treatment of patients with sudden and/or chronic hearing loss." TPA is a powerful anticoagulant. We are very unenthused about this treatment
suggestion deriving from this uncontrolled treatment trial.

Carbogen and MgS04 treatment have also been advocated for SHL (Gordin et al, 2002). Haberkamp and Tanyeri (1999) noted that while numerous
treatments have been studied aiming to improve blood flow, such as carbogen inhalation or stellate ganglion block, all remain controversial or simply
lack convincing evidence of efficacy. Very few placebo controlled studies have performed of treatment of SHL and for this reason, there is presently a
limited ability to determine what is the optimal treatment of SHL. At this writing we do not feel that there is enough evidence for either treatment to
advocate for its use.

We have had a few patients improve remarkably with migraine treatment (mainly verapamil).No conclusion can be drawn.

Surgical exploration
Surgery is NOT the standard of care for sudden hearing loss. Rather, there are a few unusual institutions that perform surgery in spite of the general
opinion that surgery is not indicated. At the University of Freiburg, exploration of the middle ear and patching is recommended for patients with SHL.
According to their recent article on their experience in 97 patients, it can be beneficial if performed within 7 days (Maier et al, 2008). These authors
reported that 34% of persons with SHL had a fistula. Their method of judging whether or not a fistula was present was direct observation of the round
window while displacing the stapes footplate. There are several problems with this report. First, it is difficult to follow the logic described by the authors
that led them to designated fistula or no-fistula. If the logic is faulty, then their conclusions are also faulty. Second, the natural history of SHL is such that
improvement cannot be necessarily attributed to surgical exploration and patching. Without a control group, nothing can be concluded with certainty.

Vitamins and minerals:

Ahn, J. H., T. Y. Kim, et al. (2006) wrote that Lipo-prostaglandin E1 in combination with steroid therapy is effective for treatment of sudden
sensorineural hearing loss in Korean patients with Type 2 diabetes. Even if there is an additional effect of adding prostaglandin, this is a very narrow
population and it seems doubtful that this experience generalizes to others.

Hatano, M., N. Uramoto, et al, in a paper entitled Vitamin E and vitamin C in the treatment of idiopathic sudden sensorineural hearing loss. (2007)
reported a positive effect. Similarly, Joachims, H. Z., J. Segal, et al. (2003) reported a positive effect of vitamin E, when combined with steroids. We
think that these positive result are likely to be erroneous and related to the greater ease of publishing positive results over the lack of results. While it is
doubtful that vitamin E does any harm, we think it is best to remain cautions given the general lack of efficacy of vitimin E in other contexts. We think it
is fine to take vitamin E, but would not criticize care in which it was omitted. A much larger controlled study of these agents would be helpful.

Nageris, B. I., D. Ulanovski, et al. (2004). recommended magnesium treatment for sudden hearing loss based on a small but controlled study in which
steroids were combined with either magnesium or a placebo. In our opinion, a much larger trial would be needed to establish efficacy. We also do not
see a clear mechanism for this effect.

Research Studies in Sudden Hearing Loss

Wang et al recently reported that etanercept given acutely in experimental labyrinthitis resulted in much better hearing results. While this animal study
may not apply to humans, it suggests that acute treatment with etanercept or a related anti-TNF drug (Remicade, Humira), may improve hearing results
for sterile inflammation. See theautoimmune-hearing loss page for more information about these drugs.

References
• Alexiou C and others. Sudden sensorineural hearing loss. Does
application of glucocorticoids make sense? Arch OHNS 2001;127:253-
258
• Arai, M., T. Takada, et al. (2003). "Orthostatic tinnitus: an otological
presentation of spontaneous intracranial hypotension." Auris Nasus
Larynx 30(1): 85-7.
• Battaglia A, Burchette R, Cueva R. Combinatin therapy (intratympanic
dexamethosone + high-dose predisone taper) for the treatment of
idiopathic sudden sensorineural hearing loss. Otol Neurotol 29:463-460,
2008
• Banerjee, A. and L. S. Parnes (2005). "Intratympanic corticosteroids for
sudden idiopathic sensorineural hearing loss." Otol Neurotol26(5): 878-
81.
• Byl FMJ. Sudden hearing loss: eight years experience and suggested
prognostic table. Laryngoscope 1984:94:647-651
• Cadoni G, Agostino S, Manna R, De Santis A, Fetoni AR, Vulpiani P,
Ottaviani F. Clinical associations of serum antiendothelial cell antibodies
in patients with sudden sensorineural hearing loss. Laryngoscope 2003
May;113(5):797-801
• Cadoni, G., S. Scipione, et al. (2007). "Coenzyme Q 10 and
cardiovascular risk factors in idiopathic sudden sensorineural hearing
loss patients." Otol Neurotol 28(7): 878-83.
• Chen CY, Halpin C and Rauch SD (2003). "Oral steroid treatment of
sudden sensorineural hearing loss: a ten year retrospective analysis."
Otol Neurotol 24(5): 728-33.
• Conlin AE, Parnes LS. Treatment of sudden sensorineural hearing loss.
Arch OHNS 2007:133;582-586
• Cvorovic L and others. Prognostic model for predicting hearing recoery
in idiopathic sudden sensorineural hearing lossl. Otol Neurol 29:464-
469, 2008
• Daniels and others. Causes of unilateral sensorineural hearing loss
screened by high-resolution fast spin echo magnetic resonance imaging:
review of 1070 consecutive cases. Am. J. Otol 21:173-180, 2000
• Eisenman DJ, Arts HH. Effectiveness of treatment for sudden
sensorineural hearing loss. Arch Otol HNS 126, 1161-1166, 2000
• Fattori and others.. Sudden hypoacusis treated with hyperbaric oxygen
therapy: a controlled study. ENT journal, 80, 9, 655-
• Finger and A. O. Gostian (2006), in "Idiopathic sudden hearing loss:
contradictory clinical evidence, placebo effects and high spontaneous
recovery rate--where do we stand in assessing treatment outcomes?"
Acta Otolaryngol126(11): 1124-7.
• Firat Y and others. Experimental otoacoustic emission and auditory
brainstem response changes by stellate ganglion blockage in rat. Am J
Otolaryngol. 2008 Sep-Oct;29(5):339-45. Epub 2008 Jul 22.
• Furuhashi A, Matsuda K, Asahi K, Nakashima T Sudden deafness: long-
term follow-up and recurrence. Clin Otolaryngol 2002 Dec;27(6):458-63
• Gianoli GJ, Li JC. Transtympanic steroids for treatment of sudden
hearing loss. Otolaryngol Head Neck Surg 2001 Sep;125(3):142-6
• Garcia-Berrocal JR, Ramirez-Camacho R, Millan I, Gorriz C, Trinidad
A, Arellano B and Lobo D (2003). "Sudden presentation of immune-
mediated inner ear disease: characterization and acceptance of a
cochleovestibular dysfunction." J Laryngol Otol 117(10): 775-9
• Gouveris, H., O. Selivanova, et al. (2005). "Intratympanic
dexamethasone with hyaluronic acid in the treatment of idiopathic
sudden sensorineural hearing loss after failure of intravenous steroid and
vasoactive therapy." Eur Arch Otorhinolaryngol262(2): 131-4.
• Gordin A and others. Magnesium: a new therapy for idiopathic sudden
hearing loss. Otol Neurotol 23:447-451, 2002.
• Haberkamp TJ, Tanyeri HM. Management of sudden sensorineural
hearing loss. AM J. Otol 20:587-595, 1999
• Hatano, M., N. Uramoto, et al. (2007). "Vitamin E and vitamin C in the
treatment of idiopathic sudden sensorineural hearing loss." Acta
Otolaryngol: 1-6.
• Haynes DS, O'Malley M, Cohen S, Watford K, Labadie RF.
Intratympanic dexamethasone for sudden sensorineural hearing loss after
failure of systemic therapy. Laryngoscope. 2007 Jan;117(1):3-15.
• Horn, C. E., H. N. Himel and S. H. Selesnick (2005). "Hyperbaric
oxygen therapy for sudden sensorineural hearing loss: a prospective trial
of patients failing steroid and antiviral treatment." Otol Neurotol26(5):
882-9.
• Huy, P. T. and E. Sauvaget (2005). "Idiopathic sudden sensorineural
hearing loss is not an otologic emergency." Otol Neurotol26(5): 896-
902.
• Ito S, Fuse T, Yokota M, Watanabe T, Inamura K, Gon S, Aoyagi M.
Prognosis is predicted by early hearing improvement in patients with
idiopathic sudden sensorineural hearing loss. Clin Otolaryngol 2002
Dec;27(6):501-4
• Jeyakumar, A., D. Francis, et al. (2006). "Treatment of idiopathic sudden
sensorineural hearing loss." Acta Otolaryngol126(7): 708-13.
• Joachims, H. Z., J. Segal, et al. (2003). "Antioxidants in treatment of
idiopathic sudden hearing loss." Otol Neurotol24(4): 572-5.
• Johkura, K., Y. Matsushita, et al. (2000). "Transient hearing loss after
accidental dural puncture in epidural block." Eur J Neurol 7(1): 125-6.
• Kanzaki, J., Y. Inoue, et al. (2003). "Effect of single-drug treatment on
idiopathic sudden sensorineural hearing loss." Auris Nasus Larynx30(2):
123-7.
• Labus L,Breil J, Stutzer H, ;Michel O. Meta-Analysis for the Effect of
Medical TherapyVs.Placebo on Recovery of Idiopathic Sudden Hearing
Loss. Laryngoscope 120:1863–1871,2010
• Lorenzi MC, Bittar RS, Pedalini ME, Zerati F, Yoshinari NH, Bento RF.
Sudden deafness and lyme disease. Laryngoscope 2003 Feb;113(2):312-
5
• Lybecker, H. and T. Andersen (1995). "Repetitive hearing loss following
dural puncture treated with autologous epidural blood patch." Acta
Anaesthesiol Scand 39(7): 987-9.
• Maier W and others. Results of exploratory tympanotomy following
sudden unilateral deafness and its effects on hearing restoration. ENT
journal, 2008, 438-451
• Mattox DE, Simmons FB. Natural history of sudden sensorineural
hearing loss. Ann ORL 1977:86:463-480
• McGwin G. Phosphodiesterase Type 5 Inhibitor Use and Hearing
Impairment. Arch Otolaryngol Head Neck Surg. 2010;136(5):488-492
• Merchant SN, Adams JC, Nadol JB. Pathology and pathophysiology of
idiopathic sudden sensorineural hearing loss. Otology & Neurotology
26:151-160, 2005
• Minoda R, Masuyama K, Habu K, Yumoto E. Initial steroid hormone
dose in the treatment of idiopathic sudden deafness. Am J. Otol, 2000,
21,819-825
• Mora, R., M. Barbieri, et al. (2003). "Intravenous infusion of
recombinant tissue plasminogen activator for the treatment of patients
with sudden and/or chronic hearing loss." Ann Otol Rhinol
Laryngol112(8): 665-70.
• Nageris BI, Popovtzer A. Acoustic neuroma in patients with completely
resolved sudden hearing loss. Ann Otol Rhinol Laryngol 2003
May;112(5):395-7
• Nageris, B. I., D. Ulanovski, et al. (2004). "Magnesium treatment for
sudden hearing loss." Ann Otol Rhinol Laryngol113(8): 672-5.
• Narozny, W., Z. Sicko, et al. (2004). "Usefulness of high doses of
glucocorticoids and hyperbaric oxygen therapy in sudden sensorineural
hearing loss treatment." Otol Neurotol25(6): 916-23.
• Oncel, S., L. Hasegeli, et al. (1992). "The effect of epidural anaesthesia
and size of spinal needle on post-operative hearing loss." J Laryngol
Otol 106(9): 783-7.
• Phillips JS and Prinsley PR (2003). "Sudden unilateral deafness after
bilateral knee replacement." J Laryngol Otol 117(4): 310-1.
• Plaza, G. and C. Herraiz (2007). "Intratympanic steroids for treatment of
sudden hearing loss after failure of intravenous therapy." Otolaryngol
Head Neck Surg137(1): 74-8.
• Racic, G., S. Maslovara, et al. (2003). "Hyperbaric oxygen in the
treatment of sudden hearing loss." ORL J Otorhinolaryngol Relat
Spec65(6): 317-20.
• Rambold H and others. differential vestibular dysfunction in sudden
unilateral hearing loss. Neurology 2005:64:148-51
• Samuelsson AK, Hyden D, Roberg M, Skogh T.Evaluation of Anti-
hsp70 Antibody Screening in Sudden Deafness. Ear Hear 2003
Jun;24(3):233-5
• Schweinfurth JM and others. Clinical applications of otoacoustic
emissions in sudden hearing loss. Laryngoscope 1997: 107:1457-1463
• Slattery, W. H., L. M. Fisher, et al. (2005). "Intratympanic steroid
injection for treatment of idiopathic sudden hearing loss." Otolaryngol
Head Neck Surg133(2): 251-9.
• Stokroos RJ, Albers FWJ, Schirm J. Therapy of idiopathic sudden
sensorineural hearing loss; antiviral treatment of experimental herpes
simplex virus infection of the inner ear. Ann ORL 108:1999:423-428
• Saiko Sugiura 1 2, Tetsushi Yoshikawa 2 *, Yukihiro Nishiyama 2,
Yoshihiro Morishita 2, Eisuke Sato 1, Taku Hattori 1, Tsutomu
Nakashima. Detection of human cytomegalovirus DNA in perilymph of
patients with sensorineural hearing loss using real-time PCR Journal of
Medical Virology Volume 69, Issue 1, 2003. Pages: 72-75
• SLATTERY WH, Fisher LM, Iqbal Z, Liu N, et al. Oral steroid
regimens for idiopathic sudden sensorineural hearing loss. Otolaryngol
Head Neck Surg 2005;132:5-10.
• Tucci DL and others. Treatment of sudden sensorineural hearing loss
with systemic steroids and valacyclovir. Otol Neurotol 23:301-308, 2002
• Xiaobo Wang; Tim Truong; Peter B. Billings; Jeffrey P. Harris;
Elizabeth M. Keithley. Blockage of Immune-Mediated Inner Ear
Damage by Etanercept Otology & Neurotology 2003; 24(1):52-57.
Comment: This is an animal study.
• Uri N, Doweck I, Cohen-Kerem R, Greenberg E. Acyclovir in the
treatment of idiopathic sudden sensorineural hearing loss. .: Otolaryngol
Head Neck Surg 2003 Apr;128(4):544-9
• Van Wijck, F., H. Staecker, et al. (2007). "Topical steroid therapy using
the Silverstein Microwicktrade mark in sudden sensorineural hearing
loss after failure of conventional treatment." Acta Otolaryngol: 1-6.
• Walsted, A., G. Salomon, et al. (1991). "Low-frequency hearing loss
after spinal anesthesia. Perilymphatic hypotonia?" Scand Audiol 20(4):
211-5.
• Westerlaken BO, Stokroos RJ, Dhooge IJ, Wit HP and Albers FW
(2003). "Treatment of idiopathic sudden sensorineural hearing loss with
antiviral therapy: a prospective, randomized, double-blind clinical trial."
Ann Otol Rhinol Laryngol 112(11): 993-1000.
• Wu CC, Young YH. vestibular evoked myogenic potentials are intact
after sudden deafness. Ear and Hearing (2002), 235-238
• Wynne MK. Sudden sensorineural hearing loss. The Hearing Journal,
July 2003, vol 56, page 10-15
• Xenellis, J., N. Papadimitriou, et al. (2006). "Intratympanic steroid
treatment in idiopathic sudden sensorineural hearing loss: a control
study." Otolaryngol Head Neck Surg134(6): 940-5.
• Zadeh MH, Storper IS, Spitzer JB Diagnosis and treatment of sudden-
onset sensorineural hearing loss: A study of 51 patients.Otolaryngol
Head Neck Surg 2003 Jan;128(1):92-8
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