Sudden deafness


Introduction

 

Sudden deafness is sensorineural hearing impairment, appearing suddenly without obvious cause, in most cases, usually one-sided, with varying levels of hearing loss, including total deafness. Although usually dominates hearing loss at high frequencies, it is observed sudden deafness of dominance in the band of low or medium frequencies.

 

Medical definition of sudden deafness is sensorineural hearing loss of at least 30 dB for at least three adjacent frequencies, which increases no longer than three days. Sometimes patients complain of tinnitus occurring simultaneously, and dizziness. Sudden deafness is usually carried out within 1-3 days and is caused by hypoxia of sensory ear cells or is a consequence of acoustic trauma or viral infection.

 

The primary risk factors for this disease include general factors associated with systemic diseases such as diabetes, cardiovascular diseases and diseases of central nervous system.

 

Symptoms

 

The main symptoms of sudden deafness is sudden, usually unilateral hearing loss. Often the symptoms occur in the morning, with the impression of hearing deterioration. Hearing loss is felt as a blocked ear, feeling of retention of wool, fullness in the ear, often accompanied by tinnitus, with a squeak or whistle. Less frequently coexist dizziness and imbalance.

 

Diagnostics

 

Each patient with symptoms of sudden hearing loss, should have a physical and otolaryngological examination. In order to conclude that we are dealing with sudden hearing loss patient, after physical examiantion, should has conducted audiological testing –pure tone audiometry, acoustic impedance audiometry. The imaging examination that we perform is computed tomography of the head, in justified cases - head MRI with contrast.

 

Treatment

 

In most cases, intensive treatment with different drugs use, targeting the improvement of microcirculation, drugs affecting the coagulation system by inhibiting platelet aggregation is needed. In some cases it may be indicated anti-oedematous and anti-inflammatory therapy, antiviral therapy, or hyperbaric oxygen treatment. Cases of profound hearing loss may require administer a drug directly into the tympanic cavity.

 

Diagnosis and treatment of sudden deafness cases in the hospital covers the period from 5 to 7 days.

 

Essential protective effects on the structure of the inner ear have drugs called steroids. Steroids may be administer generally or locally to the tympanic cavity.

 

Another group of drugs that are especially useful in the course of vascular disorders are vasodilators and drugs preventing vasoconstriction. In patients with a tendency to thrombosis because of heart rhythm disorders or thrombophlebitis of the lower limbs, it is indicated administration of antithrombotic drugs.

 

In the treatment of sudden deafness we can still use the neuroprotective drugs, B vitamins, magnesium, anti- inflammatory medications.

 

The Department of Otolaryngology, Medical University of Warsaw carries out a program of pharmacological treatment of sudden deafness that is international. Into the tympanic cavity is administered a drug that is absorbed into the cochlea liquid, and directly affects its structure.

 

The use of drugs into the tympanic cavity is important in patients which may not take general steroids, for example, with hypertension, peptic ulcer disease or diabetes.

 

Prognosis

 

The prognosis as to the hearing recovery varies widely and depends on coexisting factors. Worse prognosis have people who have deafness including the entire frequency band and deafness accompanied by disorders of the organ of balance. Adverse factors are also:

 

  • older age of the patient
  • tendency to thrombosis or embolism
  • metabolic diseases (eg. diabetes)
  • hypertension
  • Late notification to a physician, the therapy with a long delay

 

It is believed that the optimum is when patient reports within 24 hours after occurrence of an episode of sudden deafness and treatment is undertaken immediately

 

Krzysztof Morawski, MD