Journal Reading sudden deafness

8/12/2019 Journal Reading sudden deafness

1/20

JOURNAL READING

Idiopathic Sudden Sensorineural

Hearing Loss

Pembimbing:

dr. Khairan, Sp.THT-KL

Presentan:Desti (UPN)

Aldian (YARSI)


2/20

CASE


3/20

A healthy 58-year-old woman answers thetelephone and realizes that her hearing is

diminished on the left side. She notices aural

fullnessand loud tinnitusin the affected ear.Later that day she has several hours of mildvertigothat clears by the following morning. Overthe next few days, repeated self-administered ear

cleaning with the use of an over-the-counter kitdoes not relieve the symptoms. How should she

be evaluated and treated?


4/20

THE CLINICAL PROBLEM

Idiopathic sudden sensorineural hearing loss

(i.e., unexplained unilateral sensorineuralhearing loss with onset over a period of less

than 72 hours) has an estimated incidence

between 5 and 20 per 100,000 persons peryear


5/20

7500 cases in the United States, Europe, and

Japan indicate that sudden sensorineural

hearing loss typically occurs between 43 years

and 53 years of age, with equal sex

distribution. Vestibular symptoms are present

in 28 to 57% of patients


6/20

The likelihood of recovery of hearinghas been

reported to vary with the severity of hearingloss at presentation: patients with mild losses

usually achieve full recovery, those with

moderate losses often show somespontaneous recovery but seldom have a fullrecovery unless treated, and those with

severe-to-profound hearing losses rarely show

spontaneous improvement or make a fullrecovery


7/20

The prognosis for recovery of hearingalso

seems to be worse in older patients and those

with associated vestibular symptoms

Approximately 1% of cases of sudden

sensorineural hearing loss are due to retro-

cochlear disorders that may be related tovestibular schwannoma, demyelinating

disease, or stroke


8/20

Another 10 to 15% are due to another

identifiable cause, such as Menieresdisease,trauma, autoimmune disease, syphilis, Lyme

disease, or perilymphatic fistula

The remainder are idiopathicand almostexclusively unilateral


9/20

Rare cases of bilateral sudden deafness most

often reflect a psychiatric (functional) causeor a neurologic process

A common problem in sudden sensorineural

hearing loss is delay in diagnosis


10/20

Ear fullness, a common presenting symptom, is

often attributed by patients and clinicians toimpaction of cerumenor congestion from

upper respiratory illnessor allergies

Insofar as evidence suggests that permanent

hearing lossis more likely when treatment isdelayed


11/20

DIAGNOSIS


12/20

Sudden sensorineural hearing loss is oftenaccompanied by intense aural fullness or

pressure, as well as tinnitus

Because aural fullness is nonspecific and often

has nonotologic causes, the first step in

diagnosis is to determine whether symptomsare caused by hearing loss


13/20

Screening for hearing loss can be performed by telephone

The patient should be explicitly asked whether the hearingis reduced

The patient can move the phone from ear to ear or crinklea few hairs next to the ear on each side to check for

hearing asymmetry

To assess whether an apparent hearing asymmetry is likelyto indicate sensorineural hearing loss, the patient should

be instructed to hum and to report whether the sound is

louder in one ear than in the other

In conductive hearing loss, sound lateralizes to the blockedear, whereas in sensorineural loss, sound lateralizes to the

good ear


14/20


15/20

The Weber and Rinne

tests should be

performed using a

512Hz tuning fork


16/20

AUDIOMETRY


17/20

A complete audiogram, including threshold

measurements of bone- and air-conducted

pure tones and speech audiometry, is needed

for definitive diagnosis in patients in whom

hearing loss or asymmetry is suspected


18/20

In sensorineural hearing loss, the sensitivity to

sounds delivered as bone-conducted stimuli

and the sentivity to sounds delivered as air-conducted stimuli are equal in the affected

ear, but both are reduced

In conductive hearing loss, the bone conduction

is normal, but the air-conducted thresholdsare worse (elevated) in the affected ear.


19/20


20/20

TREATMENT

Journal Reading sudden deafness

Documents

Transcript of Journal Reading sudden deafness