Plontke SK
GMS current topics in otorhinolaryngology, head and neck surgery. Date of publication 2018 Feb 19;volume 16():Doc05.
1. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2018 Feb 19;16:Doc05. doi:
10.3205/cto000144. eCollection 2017.
Diagnostics and therapy of sudden hearing loss.
Plontke SK(1).
Author information:
(1)Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine
Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
This article reviews recent aspects of diagnostics, differential diagnostics,
and evidence in systemic and local therapy of idiopathic sudden sensorineural
hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden
hearing loss, a meaningful and targeted diagnostic strategy is of utmost
importance. An important differential diagnosis of sudden hearing loss are
intralabyrinthine schwannomas (ILS). The incidence of ILS is probably
significantly underestimated. This may be due to the lack of awareness or lack
of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI
technique for the evaluation of sudden hearing loss ("head MRI" instead of
"temporal bone MRI" with too high slice thicknesses). Therefore, the request to
the radiologist should specifically include the question for (or exclusion of)
an ILS. With special MRI techniques, it is possibly today to visualize an
endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to
the quality and not quantity of studies - unsatisfying. The value of
systemically (low dose) or intratympanically applied corticosteroids in the
primary treatment of ISSHL is still unclear. In order to investigate the
efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a
national, multicenter, three-armed, randomized, triple-blind controlled clinical
trial is currently performed in Germany (http://hodokort-studie.hno.org/). After
insufficient recovery of the threshold with systemic therapy of ISSHL,
intratympanic corticosteroid therapy appears to be associated with a
significantly higher chance of an improved hearing threshold than no therapy or
placebo. Both, hearing gain and final hearing threshold, however, appear to be
independent from the onset of secondary therapy. Based on currently available
data from clinical studies, no recommendation can be made with respect to the
type of corticosteroid and specifics of the intratympanic application protocol.
DOI: 10.3205/cto000144
PMCID: PMC5818684
PMID: 29503670
Conflict of interest statement: The author is or has been a consultant to
companies with questions regarding inner ear physiology and pathophysiology,
inner ear diseases, and therapy of inner ear disorders including trial design,
drugs and drug applications strategies (Otonomy Inc., San Diego USA; Hoffmann-La
Roche, Basel, Switzerland; Boehringer Ingelheim Pharma GmbH & Co. KG; Ingelheim
am Rhein, Germany). The author is head of the scientific advisory board of
AudioCure Pharma GmbH, Berlin, Germany. The authors institution receives
research grant support from MedEl, Austria and MedEl, Germany. The author
received honorary for lectures in this topic from the ENT-Physician’s
organisation in Germany and Infectopharm, Heppenheim, Germany. The author
received travel support, e.g. for lectures from Cochlear Deutschland GmbH & Co.
KG. The author received a major research grant from the Federal Ministry of
Education and Science in Germany (BMBF: KS2013-190). The author also received
honorary for lectures or session moderations not related to this topic by Merck
Serono, Darmstadt, Germany.
