Rano - JR - SSHL

JOURNAL READING
SCORE RISK SCALE AS A PROGNOSTIC FACTOR

AFTER SUDDEN SENSORINEURAL HEARING LOSS
Rano Digdayan Makerto
Supervisor:
Sally Mahdiani, dr., M.Kes.,SpTHT-KL(K)
DEPARTEMENT OF OTORHYNOLARYNGOLOGY-HEAD & NECK SURGERY
FACULTY OF MEDICINE PADJAJARAN UNIVERSITY-HASAN SADIKIN HOSPITAL
BANDUNG
2020
INTRODUCTION
• Sudden sensorineural hearing loss is an otologic urgency affects 5-30 subjects per 100000/year.
• Hearing loss 30 dB affecting three consecutive frequencies.
• Etiology remains unknown in 70-90% cases.
• Treatment is still controversial as therapy decisions are usually made without knowing the
etiology.
• 32-65% cases may recover spontaneously
• Cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia have been
implicated in the etiopathogenensis
Ana Sousa Menezes, Daniela Ribeiro, António Lima, Daniel Miranda, Joana Guimarães, Luís Dias. SCORE risk scale as a prognostic factor after sudden sensorineural
hearing loss. European Archives of Oto-Rhino-Laryngology. 13 June 2019.
• Patients with high-risk group based on Framingham Risk Score showed poor outcomes of
hearing improvement compared to the low risk group.
• Classifies risk into different categories ranging from less than 1-15% or more and includes the
variables gender, age, smoking, systolic blood pressure, and total cholesterol.
• Aimed to determine the potential prognostic value of SCORE risk scale In the recovery after
SSHL
SUDDEN SENSORINEURAL HEARING LOSS
DEFINITION
• 30 Decibel or greater sensorineural loss over three contiguous frequencies occurring within 3
days.
• Abrupt and rapidly progressive losses.
• Awakening with hearing loss, hearing loss noted over a few days, selective low- or high-
frequency loss, and distortions in speech perception.
Oliver ER, Hashisaki GT. Sudden Sensorineural Hearing Loss. In: Bailey's Head and Neck Surgery Otolaryngology. 2. 5 ed: Wolters Kluwer, Lippincot William and Wilkins; 2014. p.
2589-94.
CAUSES
Vascular
Viral Infection
Compromise
Intracochlear Autoimmune
Membrane Inner Ear
Rupture Disease
2589-94.
EVALUATION
Coagulation
CBC FTA-Abs
Studies
Thyroid
Function MRI CT Scan
Tests
2589-94.
TREATMENT
Triiodobenzoic
Anti-Inflamatroy Vasodilators Diuretics
Acid Derivative
Hyperbaric
Surgery Antiviral
Oxygen Therapy
2589-94.
MATERIALS AND METHODS
PARTICIPANT
• Prospective analysis of patients with SSHL from January 2015 up to December 2017.
• This study received approval from the Ethics Committee.
• All patients experienced unilateral SSHL that developed within 72 h with ≥ 30 dB hearing loss at
three consecutive frequencies.
• Patients were treated with same protocol of intravenous dexamethasone (5-10 mg, twice daily for
5 days) and intratympanic injection was administered weekly.
• Patients with any previous history of hearing loss or ear surgery on the affected side or HL
developed more than 15 days before admission were exclude
AUDIOMETRIC DATA
• All patients were evaluated using the standard method for pure tone average (PTA) threshold
(0.5,1,2, and 4 kHz).
• For thresholds that could not be tested due to the limit of the audiometric equipment, it was set at
120 dB.
EVALUATION OF HEARING RECOVERY
• Audiometric recovery was classified into complete, partial, and no recovery

• Complete PTA within 10 dB HL of initial HL or within 10 dB HL of the unaffected ear
• Partial PTA (dB HL) within 50% of initial HL or > 10 dB HL improvement of the HL
• No recovery < 10 dB HL improvement in HL relative to the initial HL.
STANDARD ASSESSMENTS
• Routine audiometric testing and routine serological tests, include total cholesterol, HDL, Blodd
pressure, BMI, history diabetes or hypertension, smoking, coronary heard disease, and
cerebrovascular disease.
• Patients underwent MRI of the internal auditory canal and cerebellopontine angle with
gadolinium enhancement image
• The score risk scale categories : low risk <1%, moderate risk ≥1% to <5%, high risk ≥5% to
<10%, and very high risk ≥10%
RESULTS
DEMOGRAPHIC
COMPARISON OF PTA
COMPARISON SCORE
AUDIOMETRIC RECOVERY
DISCUSSION
• Complete recovery rate with SSHL was 35,9%.
• 26% experienced partial recovery.
• 38,9% had no recovery
• High incidence of CVRF  more than a half of our patients admitted for SSHL had at least one
CVRF
• SCORE system stratification of patients did not show any predictive or prognostic role in this
study population
• MRI chronic cerebral microvascular ischemic changes
• Smaller proportion of patients with vascular lesions in the MRI presented a complete
audiometric recovery  differences were not significant
• SSHL co-occurring with diabetes, hypertension, and hyperlipidemia in older patients has been
shown to be associated with cerebral microangiopathy and prognosis, but the association is
unclear
• Risk factors for CVRF  lack of clear relationship between SSHL and CVRF.
• All studies previously mentioned evaluating CVRF and SSHL are particulary limited by
sampling size and the observational nature.
• The lack of a clear relationship between SSHL and CVRF might suggest a predominantly
multifactorial disease profile.
CONCLUSION
• This preliminary study could not confirm the validity for SCORE scale for cardiovascular risk
assessment in predicting audiometric recovery in patients with SSHL with multiple
comorbidities.
• Further research with larger samples are needed to elucidate the etiology of SSHL and the exact
role of cardiovascular risk factors in the pathophysiology of SSHL
THANK YOU

Rano - JR - SSHL

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Rano - JR - SSHL

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JOURNAL READING

SCORE RISK SCALE AS A PROGNOSTIC FACTOR

Rano Digdayan Makerto

• Audiometric recovery was classified into complete, partial, and no recovery

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