Etiological Analysis Of Sudden Sensorineural Hearing Loss And Its Efficacy Of Different Topical Administration Of Glucocorticoid

Part Ⅰ:The clinical characteristics,laboratory results and comorbidity analysis of patients with sudden sensorineural hearing loss Objectives:The aim of this study is to investigate the clinical characteristics,laboratory parameters and comorbidities of patients with sudden sensorineural hearing loss(SSNHL).Methods:A total of 869 patients with a diagnosis of SSNHL were consecutively hospitalized to a provincial tertiary referral hospital in southeast China between August 2013 and December 2017.739 patients with complete medical record data were included in this study.Routine general physical examination,audiological and laboratory tests were performed in all subjects.Magnetic Resonance Imaging scans of ear and brain were performed in all patients.We reviewed the clinical characteristics,audiometry results,hematological outcomes and the occurrence of comorbidities.Moreover,we evaluated the correlations among these parameters.Results:1.Comparing this data with the demographic condition in the referral area,we estimated that the annual incidence of SSNHL patients was roughly 19 per 100 000.2.Of the 739 participants,392 patients were male(53.0%),and 347 subjects were female(47.0%);the mean age was 47 years(range: 4-82years),and the peak age incidence was in patients aged 41–50 years.3.The hearing results were as follows: regarding the degree of hearing loss,72(9.5%)were identified as mild,79(10.4%)as moderate,114(15%)as moderate to severe,146(19.2%)as severe,120(15.8%)as profound,and 228(30%)as complete SSNHL.In terms of audiometric type,the hearing loss in 79 ears(10.4%)were characterized as ascending,67 ears(8.8%)as descending,259 ears(31.2%)as flat,343 ears(45.2%)as profound,and 11 ears(1.4%)as concave or convex type.4.Of all cases,150 patients(20.3%)were observed with comorbidities of hypertension,41(5.5%)with diabetes mellitus,276 patients(37.3%)with increased cholesterol(TC),136 cases(18.4%)with increased triglycerides(TG),308 patients(40.6%)with decreased high-density lipoprotein(HDL),316 patients(42.8%)with elevated low-density lipoprotein(LDL),and 24 patients(3.2%)with hyperfibrinogenemia.5.Several patients presented with concurrent symptoms such as tinnitus(97%),short-lasting spontaneous vertigo(duration 1–48 h)(11.8%),and benign paroxysmal positional vertigo(2.6%).The patients with vertigo,hypertension,DM and high TG suffered more often from severe hearing loss compared with the counterparts.Conclusions:1.The clinical characteristics of SSNHL patients are different according to age distribution and hearing loss levels and audiometric types.2.The pathogenesis of SSNHL is still unclear,and cochlear microcirculation disturbance is considered to be the main cause.The cardiovascular and metabolic diseases(hypertension,diabetes mellitus and hyperlipidemia)appeared to be closely associated with the severity of SSNHL.3.SSNHL patients with vertigo often suffer more severe hearing loss.Part Ⅱ:Etiological analysis of patients with sudden sensorineural hearing loss: a prospective case-control studyObjectives: To investigate the personal history,comorbidity and laboratory test results of patients with sudden hearing loss(SSNHL),and to study the possible etiology and risk factors of SSNHL.Methods: Prospective case-control study.This study included 255 patients with SSNHL and 255 non-SSNHL patients in the control group,all subjects were hospitalized in our hospital from June 2021 to December 2021.Each patient in the case group and the control group was matched by age,gender and residence.All patients in both the case group and control group underwent medical history interview,routine physical examination,general otorhinolaryngology examination,neurological examination,and laboratory test.The patients in the case group underwent routine audiological tests and magnetic resonance image scans of ear and brain.The patients in the control group underwent rough audiological tests and tuning fork tests.Risk factors including the smoking and drinking habits,the prevalence of hypertension,diabetes were evaluated in patients of the two groups.Peripheral blood white blood cell count,Neutrophil-to-lymphocyte ratio(NLR),Platelet-to-lymphocyte ratio(PLR),blood lipid level and fibrinogen level of the two groups were also compared.Results: 1.There were 124 males(48.6%)and 131 females(51.4%)in both groups.In the case group,245 patients suffered from unilateral SSNHL and 10 patients were affected by bilateral SSNHL.The course of disease ranged from 1 day to 30 days,with an average of 8.07 days.The degree of hearing loss in 265 ears of 255 patients is as follows: the most common one is complete hearing loss(22.6%),followed by mild hearing loss(19.2%);profound hearing loss was relatively rare(13.2%).Regarding audiogram shape,flat type hearing loss occurred in 131 ears(49.4%),pronounced hearing loss affected 75 ears(28.3%),followed by ascending(11.7%)and descending type(10.6%).2.In the case group,53 patients(20.8%)had hypertension,20 patients had comorbidity of diabetes(7.8%).In the control group,45 patients suffered from hypertension(17.6%)and 13 patients had diabetes(5.1%).There was no significant difference in the prevalence of comorbidities between the two groups(P>0.05).3.In the case group,28 patients(11%)had a personal history of smoking and 21 patients(8.2%)had drinking habits.In the control group,20 patients(7.8%)had a history of smoking and 13 patients(5.1%)had drinking habits.There was no significant difference in the proportion of subjects with smoking and drinking personal history between the two groups(P>0.05).4.The laboratory test results showed that there was no significant difference in peripheral blood lymphocyte count,platelet count,PLR,cholesterol,triglyceride,high-density lipoprotein and low-density lipoprotein level in patients between the two groups(P>0.05).However,the peripheral blood white blood cell count,neutrophil count,NLR and fibrinogen level of patients in the case group were significantly higher than those in the control group(P<0.05).5.The values of Odds Ratio(OR)for risk factors indicated that the presence of hypertension,diabetes and hyperlipidemia,as well as past smoking and drinking were not risk factors for SSNHL.Conclusions: 1.Smoking,drinking,hypertension and diabetes may not be related to the onset of SSNHL.2.The increased level of serum fibrinogen among SSNHL patients suggests that hypercoagulable state and inner ear vascular micro thrombosis might be risk factors of SSNHL.3.The elevated peripheral blood white blood cell count,neutrophil count,and NLR in SSNHL patients indicate that inflammation play an important role of SSNHL onset.Part Ⅲ:Efficacy of intratympanic and postauricular subperiosteal glucocorticoid injection in the treatment of sudden hearing loss: a prospective randomized controlled studyObjectives: To investigate the efficacy and safety of intratympanic or postauricular subperiosteal glucocorticoid injection combined with systemic glucocorticoid in the treatment of sudden hearing loss(SSNHL).Methods: Prospective randomized controlled study.This study included SSNHL patients who hospitalized in our department between January 2020 and June 2021.The criteria for a diagnosis of SSNHL were based on the 2015 Chinese guidelines of diagnosis and treatment of SSNHL.Enrolled patients included unilateral SSNHL patients who underwent the standard course of treatment for 10 days or whose hearing completely restored although they did not receive the standard course of treatment.Patients who met the inclusion criteria were randomly divided into 3 groups.The cases number of group A,B,C were 311,375 and 369,respectively.Patients in group A underwent intratympanic steroid injection combined with systemic drug treatment,and patients in group B received postauricular steroid injection combined with systemic drug treatment.The patients in the control group(group C)were treated with systemic glucocorticoid alone.The patients’ hearing was evaluated before and 6 months after treatment.They were followed up twice during the posttreatment 6 months to assess their hearing and the occurrence of other complications,such as tympanic membrane perforation,acute and chronic otitis media,etc.Results: 1.There was no significant difference in gender distribution,the proportion of left and right affected ears and the average course of disease among the three groups(P > 0.05).However,there were significant differences in their average age,the distribution of type and degree of hearing loss among the patients of the three groups(P < 0.01).2.There was significant difference in the average hearing threshold of the hearing impairment frequency of the three groups before and after treatment(P < 0.05).As for the gap of pre-and posttreatment hearing threshold of hearing impairment frequency between these groups,the difference in the postauricular injection group was maximum(23.479 ± 21.740 dB),followed by the intra auricular injection group(19.205 ± 20.115 dB)and the control group(18.507 ± 16.681 dB).Regarding the grading of hearing efficacy,the cure rate of patients in the control group was highest(44.6%),as well as the cure + effective + efficiency rate.The second highest one was in the postauricular injection group(22.7%).The most ineffective one was in the intratympanic injection group,up to 47.3%.3.Among patients with ascending hearing loss,there was significant difference in the average hearing threshold of the hearing impairment frequency between these three groups before and after treatment(P < 0.05),but no significant difference existed in the gap of pre-and posttreatment average hearing threshold of hearing impairment frequency between these three groups(P > 0.05).4.Among patients with descending hearing loss,there was no significant difference in the average hearing threshold of the hearing impairment frequency between these three groups before and after treatment(P > 0.05),and there was no significant difference in the gap of pre-and posttreatment average hearing threshold gap of the hearing impairment frequency between the three groups(P > 0.05).5.Among patients with flat hearing loss,there was significant difference in the average hearing threshold of the hearing impairment frequency between the three groups before and after treatment(P < 0.05),but there was no significant difference in the gap of pre-and posttreatment average hearing threshold of the hearing impairment frequency between the three groups(P > 0.05).6.Among patients with profound hearing loss,there was significant difference in the average hearing threshold of the hearing impairment frequency among the three groups before treatment(P < 0.05).However,there was no significant difference in the average hearing threshold of the hearing impairment frequency after treatment(P >0.05).There was no significant difference in the gap of pre-and posttreatment average hearing threshold of the hearing impairment frequency between the three groups(P > 0.05).7.In group A,33 patients(10.6%)had a transient vertigo attack during tympanic injection,which lasted for about 1-3 minutes.20 patients(6.43%)complained of pain at the injected ear,which disappeared after 1-3 days.In group B,after injection,18 patients(4.8%)complained of pain at the injection site,and the symptom lasted for 1-2 days.In the group A,no obvious adverse effects,such as tympanic membrane perforation or secondary acute or chronic otitis media occurred during follow-up.There were no adverse effects occurred in the other two groups during follow-up.Conclusions:1.The efficacy of intratympanic injection of glucocorticoid combined with systemic glucocorticoid is similar to that of postauricular injection of glucocorticoid combined with systemic glucocorticoid for treating of SSNHL,and is equivalent to that of systemic glucocorticoid therapy alone.2.No obvious adverse effects occur in SSNHL patients treated with intratympanic injection or postauricular injection of glucocorticoid.