PROGNOSTIC IMPACT OF

STANDARD LABORATORY
VALUES ON OUTCOME IN
PATIENTS WITH SUDDEN
SENSORINEURAL
HEARING LOSS
CREATED BY MUHAMMAD ARIES FITRIAN
030.09.159
BACKGROUND
Defines as unexplained unilateral sensorineural heraling loss of 30 dB HL or
greater over 3 frequencies with onset over period less than 72 hours and with no
marked verstibular symptom
Incidences between 160 to 400 in 100.000 person per year.
Multifactorial causes such as cardiovascular disease, cigarette smoking,
hypertension (the most common risk factors), age, severe hearing loss,
audiogram shape, vertigo (negative factors).
While cardiovasular disease were disccused as a common risk factors, it is
surprising that so far prgnostic impact of the entire range routine laboratory
values hasnt been evaluated systematically.

METHODS
Retospective analysis was perform in germany, all adult with unilateral idiopathic sensorineural hearing loss
between 2006 to 2009. The number of the pastient that followed in this reasearch were 173.
Prequisite was DD evaluation excluding a spesific etiology ( head trauma, vestibular schwanoma). and all
patient was received brain electrical response audiometry. If BERA pathologic the patient will be examined
by MRI of the head and cerebellopontine angle.
Inclusion criteria was at least 2 pure tone audiograms were available (the first at presentation of the
symptoms before the therapy and second after the therapy)
Exclusion criteria was hearing loss <30 dB bone conduction in 3 frequencies, time between symptom and
therapy >4 weeks, acute bilateral hearing loss, combination with acute vestibular hypofunction and history
chronic ear disease
METHODS
This reasearch present the audigram test with 6 frequencies ( 250,500,1000,2000,4000 dan 6000 Hz)

The severity of hearing loss dB
Mild 15-39
Moderate 40-59
Severe 60-79
Profound 80-100
Deaf >100 db
Pattern audiogram Criteria Image
Low frequency Ascending
pattern, 500 Hz
or less




Mid frequency U-shaped,
greater 500 hz
and 2000 hz.





High frequency Descending,
greater 2000 hz,
8000 or less





Flat



Total deafness Hearing loss
>100 dB in 500
Hz,1000 Hz, 2000
Hz, 4000 Hz




LABORATORY VALUES



RESULT
Patient and disease characteristic
Median age was 64 and 4 of 5 patient complained also of the tinnitus in affected ear.
14% were smokers
Half of the patient showed cardiovascular risk
3 patient were reported deaf on contralateral ear

Overall recovery
81 patients had a final hearing gain >10 dB
29 patients had a relative hearing gain of >50%
72 patients has a relative hearing gain in relation to contralateral ears of >50 %
RESULT
Prognostic impact od clinical and laboratory parameters
A blood test showed half patients had a elevated glucose values.
1/3 had elevated cholesterol and 1/4 had a elevated trygliceride
showed a hyperfibrinogenemia.
Low frequency hearing loss had a better outcome than other audiogram pattern
Start of inpatient treatment <4 days after onset was better than >4 days after onset
First SSNHL had a better outcome than reccurent SSNHL
Initial hearing loss >60 dB had a better outcome than initial hearing loss < 60 dB
Quick values lower than references
Hyperbrinogenemia
DISCUSSION
Those result was showed in previous study. Treatment using corcicosteroids with in 1-2 week after onset will
give a better outcome.
Low frequencies hearing loss had better outcome than high frequencies
Hypercholesterolemia were found in 38% patient and hyperglycemia were found in 58% patient at the time
of diagnosis.
Erytrocite sedimentation values rate was correlated to better outcome.
CRP values had no influence on outcome and CRP values only play role in underlying implamatory disease is
not related to at least most cases of SSNHL not play role in prognostic.

RESULT
The quick prothrombin time test still is the basis for monitoring anticoagulant therapy in many countries.
But there are effect on this theraphy that affect on quick laboratory value.
Thsi study believe that combination of anticoagulant therapy and SSNHL therapy significantly improved the
microcircularity in inner ear.
Hyperfibrinogenemia is independent risk factor to SSNHL in half patient in this study and we believe that
therapy regime for anticoagulant can be used for improvement of rheological blood performance.
CONCLUSION
The presented cohort study on 173 patient with SSNHL revealed that beside clinical and audiological
factors also the laboratory markers decreased a quick test value and hyperfibrinogenemia were positive
prognostic marker for better outcome using treatment regime mainly intending to improve cochlear
microcirculation.
Hyperfibrinogenemia is a positive prognostic marker on outcome when using rheological regime to
treat SSNHL.
Fibrinogen can be used as a biomarker for better patient selection for treatment regime of SSNHL.