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JOURNAL READING
Idiopathic Sudden Sensorineural
Hearing Loss
Pembimbing:
dr. Khairan, Sp.THT-KL
Presentan:Desti (UPN)
Aldian (YARSI)
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CASE
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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?
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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
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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
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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
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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
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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
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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
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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
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DIAGNOSIS
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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
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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
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The Weber and Rinne
tests should be
performed using a
512Hz tuning fork
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AUDIOMETRY
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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
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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.
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TREATMENT