BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.
Blood Glucose ; Dexamethasone ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Perilymph ; Prednisolone ; Steroids

Idiopathic sudden sensorineural hearing loss (ISSNHL) in children is rare, accounting for less than 10% of all sudden deafness. The etiology of ISSNHL is uncertain, but viral infeqction and the distribution of blood circulation in the inner ear are suspected as the causes of the disease. Therefore, stellate ganglion block (SGB) and antiviral agent have been used for its treatment. Recently we experienced an effective series of 12 SGBs in pediatric patient with ISSNHL, with no severe complication.
Blood Circulation ; Child ; Ear, Inner ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Stellate Ganglion*

BACKGROUND AND OBJECTIVES : Diabetes mellitus (DM) is a risk factor for sudden sensorineural hearing loss (SSNHL), possibly due to microvascular damage as well as increased blood viscosity and embolic and thrombotic episodes. To perform a prospective, randomized clinical trial to evaluate the therapeutic effect of lipo-prostaglandin E(1) (lipo-PGE(1)) on SSNHL in Korean patients with type 2 diabetes. MATERIALS AND METHOD : The study group consisted of 270 patients (130 males, 140 females) consecutively diagnosed with SSNHL. Patients were classified as diabetic or nondiabetic by the new American Diabetes Association criteria. With the approval of the institute ethics committee, patients were randomly assigned to treatment with a continuous infusion of 10 L lipo-PGE(1) (lipo-PGE(1) group) or saline (placebo group). In addition, all patients studied were treated with 48 mg methylprednisolone for 5 days. RESULTS : The overall recovery rates after treatment were 51.5% in diabetic and 64.2% in nondiabetic patients. In diabetic patients, there was a significantly higher rate of hearing improvement in the lipo-PGE(1) group (64.7%) than in the placebo group (37.5%), whereas, in nondiabetic patients, there was no significant difference in the rate of hearing improvement between the lipo-PGE(1) group (70.3%) and the placebo group (58.3%). CONCLUSION : Lipo-PGE(1) may have beneficial effects in the treatment of SSNHL in Korean patients with type 2 diabetes.
Blood Viscosity ; Diabetes Mellitus ; Ethics Committees ; Hearing ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Male ; Methylprednisolone ; Prospective Studies ; Risk Factors

BACKGROUND AND OBJECTIVES: The idiopathic sudden sensorineural hearing loss is a disease that develops within several hours to several days. Its etiology is not verified yet, but disturbance of blood circulation in the inner ear, intracochlear membrane break, inner ear hydrops and viral infection are considered as possible causes of disease. The herpes virus family is one of the possible viral pathogens that can cause a sudden hearing loss. The purpose of this study was to evaluate the effect of antiviral agent (Vacrovir, 200 mg/T, acyclovir) on sudden sensorineural hearing loss. MATERIALS AND METHOD: Fifty-eight ears were studied from 56 patients who were admitted to Konkuk University Medical Center Minjoong Hospital from December 1993 to August 1999. Fifty eight ears were divided into experimental (30 ears) and control (28 ears) groups. Acyclovir (3000 mg/ day) was added to the therapeutic regimen in the experimental group. The effect of antiviral agent therapy was analyzed according to the factors relating to the prognosis. RESULT: 1) Total recovery rate of the experimental group(76.7%) was significantly (p<0.05) better than that of the control group (46.4%). 2) In the patients whose age was less than fifty, the recovery rate of experimental group (84.2%) was significantly better than that of the control group (50,0%). 3) The patients who had been treated within 2 weeks after symptoms had developed had a better recovery rate in the experimental group (80.8%) as compared with the control group (48.0%) significantly(p<0.05). 4) If the initial hearing loss was in the mild to severe range, the recovery rate of experimental group (77.8%) was better than that of the control group (41.7%) with the significance of p<0. 05. 5) In the patients who had tinnitus as a accompanying symptom, the recovery rate of experimental group (76.0%) was better than that of the control group (43.5%) significantly (p<0.05). 6) In the patients who had no dizziness, the recovery rate of experimental group (80.0%) was better than that of the control group (47.4%) significantly (p<0.05). 7) In the cases associated with URI (upper respiratory infection), the recovery rate of experimental group (100.0%) was better than that of the control group (66.7%), but this was not statistically significant (p>0.05). CONCLUSION: These results suggest that the antiviral agent therapy seems to be effective on the recovery of sudden sensorineural hearing loss. The factors which affect good prognosis in the antiviral agent therapy were age (less than fifty years), early initial treatment that began within 2 weeks, mild to severe hearing loss, accompanying symptom of tinnitus and no dizziness.
Academic Medical Centers ; Acyclovir ; Blood Circulation ; Dizziness ; Ear ; Ear, Inner ; Edema ; Hearing Loss ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Membranes ; Prognosis ; Tinnitus

OBJECTIVE: To study the relationship between fibrinogen level and pathogenesis of sudden sensorineural hearing loss(SSHI.). METHOD: Fifty patients (55 ears) with SSHL within 7 days of the onset were studied: a control group was consist of 50 normal-hearing people who were individually matched on a pairwise basis according to the same gender and age. Both the patients and the normal people were tested for the parameters of hemorheology, blood biochemistry, whole blood cell count and clotting function. RESULT: Fibrinogen level and plasma viscosity in patients with SSHL were significantly higher than that in control subjects. Prothrombin time and activated partial thromboplastic time were significantly less in the patients group than that in the control group (P < 0.05). There were statistical difference. The parameters of blood biochemistry, whole blood cell count and platelet adhesion test of two groups had no significant difference (P > 0.05). CONCLUSION Elevated plasma fibrinogen may be a major pathogenesis of SSHL. An increase in plasma fibrinogen level may lead to elevated plasma viscosity. All these may promote a prothrombin or hypercoagulable state and impair blood perfusion of cochlea.
Adolescent ; Adult ; Aged ; Case-Control Studies ; Female ; Fibrinogen ; metabolism ; Hearing Loss, Sensorineural ; blood ; etiology ; Hearing Loss, Sudden ; blood ; etiology ; Hemorheology ; Humans ; Male ; Middle Aged ; Young Adult

Sudden sensorineural hearing loss due to the initial manifestation of hematologic disease is very rare. Chronic myelogenous leukemia has been implicated as a causative factor of sudden sensorineural hearing loss. Leukemic infiltration, hemorrhage, infection, and hyperviscosity have been suggested as possible mechanisms in patients with chronic myelogenous leukemia. A 49-year-old male presented unilateral sudden sensorineural hearing loss. The patient was found to have chronic myelogenous leukemia during the work-up for the hearing loss. The WBC count upon admission was 485,100/mm(3). Hemoglobin, hematocrit, and platelet count were within the normal limits. The patient underwent three cycles of leukapheresis and chemotherapy with interferon alpha and hydroxyurea for the treatment of leukemia. The hearing threshold level was 75 dB on admission. It improved to 35 dB when the WBC count fell to 294,000/mm(3), and finally settled at 32 dB two weeks after the termination of chemotherapy when the WBC count was 125,900/mm(3). We present a case of a chronic myelogenous leukemia patient who initially presented with sudden sensorineural hearing loss. We presume that cochlear vessel occlusion as a result of elevated blood viscosity was responsible for this patient's hearing loss. Early onset of sudden deafness in a chronic myelogenous leukemia patient may be due to the hyperviscosity syndrome and be possible to reverse hearing loss through early leukapheresis.
Blood Viscosity ; Drug Therapy ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hematocrit ; Hematologic Diseases ; Hemorrhage ; Humans ; Hydroxyurea ; Interferon-alpha ; Leukapheresis ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemic Infiltration ; Male ; Middle Aged ; Platelet Count

BACKGROUND: Both stellate ganglion block (SGB) and polarized light irradiation (Superlizer) have a tendency to increase blood flow. Increases in blood flow can be estimated indirectly by changes in tympanic membrane temperature. In this study, we sought to evaluate how simultaneous SGB and Superlizer treatment affects tympanic temperature and tympanic blood flow in individuals suffering from sudden deafness. METHODS: Among patients who visited the pain clinic complaining of sudden deafness, we divided them into two groups: one receiving only SGB; the other receiving both SGB and Superlizer treatment. By comparing the tympanic membrane temperature measurements of both groups on 10, 30, and 60 minutes after treatment through a prospective study, we intended to evaluate the effect of treatment with SGB and Superlizer. RESULTS: Temperature changes measured after the injection were statistically significant in both groups. Temperature changes of the tympanic membrane were greater in the group who received both SGB and Superlizer compared to the group receiving only SGB. CONCLUSIONS: The results suggest that SGB followed by Superlizer has effects on the amount of increase in tympanic membrane temperature. This seems to be attributed to the increase in blood circulation of the inner ear compared with the group receiving only SGB. We came to the conclusion that in sudden deafness patients, the use of SGB combined with polarized light irradiation appears to be more effective in the treatment of sudden deafness.
Blood Circulation ; Ear, Inner ; Hearing Loss, Sudden ; Humans ; Light ; Pain Clinics ; Porphyrins ; Prospective Studies ; Stellate Ganglion ; Stress, Psychological ; Tympanic Membrane

Previously, we reported the expression levels of specific microRNA machinery components, DGCR8 and AGO2, and their clinical association in patients with idiopathic sudden hearing loss (SSNHL). In the present study, we investigated the other important components of microRNA machinery and their association with clinical parameters in SSNHL patients. Fifty-seven patients diagnosed with SSNHL and fifty healthy volunteers were included in this study. We evaluated mRNA expression levels of Dicer and Drosha in whole blood of patients with SSNHL and the control group, using RT & real-time PCR analysis. The Dicer mRNA expression level was down-regulated in patients with SSNHL. However, the Drosha mRNA expression level was not significantly altered in patients with SSNHL. Neither the Dicer nor Drosha mRNA expression level was not associated with any clinical parameters, including age, sex, duration of initial treatment from onset (days), initial Pure tone average, Siegel's criteria, WBC, and Erythrocyte sedimentation rate. However, mRNA expression levels of Dicer and Drosha were positively correlated to each other in patients with SSNHL. In this study, we demonstrated for the first time that the Dicer mRNA expression level was down-regulated in patients with SSNHL, suggesting its important role in pathobiology of SSNHL development.
Acute Disease ; Adult ; Biomarkers ; DEAD-box RNA Helicases/*blood ; Down-Regulation ; Female ; Gene Expression Regulation ; Hearing Loss, Sensorineural/*blood ; Hearing Loss, Sudden/*blood ; Humans ; Male ; MicroRNAs/*metabolism ; Middle Aged ; Ribonuclease III/*blood/*metabolism ; Statistics as Topic

OBJECTIVES: The microRNAs have been implicated in the development and function of the inner ear, especially in contribution to hearing. However, the impact of idiopathic sudden sensorineural hearing loss (SSNHL) on expression of miRNA biogenesis-related components has not been established. To investigate the regulations of microRNA (miRNA) biogenesis-related components, argonaute 2 (AGO2) and DiGeorge syndrome critical region gene 8 (DGCR8) mRNA expression in SSNHL and to evaluate the value of clinical parameters on their expression. METHODS: Thirty-seven patients diagnosed with SSNHL and fifty-one healthy volunteers were included in this study. We measured mRNA expression levels of AGO2 and DGCR8 in whole blood cells but erythrocytes of patients with SSNHL and controls, using reverse transcription and real-time polymerase chain reaction analysis. RESULTS: The mRNA expression level of AGO2 is upregulated in SSNHL. The expression level of AGO2 was significantly correlated with that of DGCR8 in both patients with SSNHL and controls. Expression level of AGO2 in SSNHL was correlated with white blood cell counts. CONCLUSION: This study demonstrated for the first time that the AGO2 mRNA expression level was upregulated in SSNHL, suggesting its important role in pathobiology of SSNHL development.
Blood Cells ; DiGeorge Syndrome ; Ear, Inner ; Erythrocytes ; Healthy Volunteers ; Hearing ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Leukocyte Count ; MicroRNAs ; Real-Time Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Social Control, Formal

To evaluate the immunological role in the etiopathogenesis of sudden deafness, sera from 44 patients with sudden sensorineural hearing loss were analyzed by 1) immunologic screening tests such as erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), immunoglobulin(IgG, IgM) levels, complement(C3, C4) levels, autoantibody(rheumatoid factor, anti-DNA antibody, antinuclear antibody) levels, cryoglobulin and FTA-ABS 2) Western blotting immunoassay against cow's inner ear proteins 3) viral marker assay(serum IgG and IgM titer against cytomegalovirus, herpes simplex virus, varicella-zoster virus, measles virus, mumps virus and rubella virus). Thirteen(29.5%) of 44 patients displayed positive responses on immunologic screening tests. Significantly higher incidences of immunological abnormalities were found in the parameters such as levels of IgG, ESR, IgM and anti-nuclear antibody. Of 41 patients whose sera were analyzed by Western blot against fresh bovine inner ear antigen preparation, nobody showed the antibody against 68kD protein, and 1(2.4%), 4(9.8%), and 4(9.8%) had antibody which reacted with 60kD, 50kD and 33-35kD protein. On viral marker assay, 8(44.4%) of 18 patients showed positive IgG titers against herpes simplex virus, cytomegalovirus, varicella-zoster virus, measles virus, mumps virus and rubella virus. But any of 10 patients did not show significant IgM titers against those viruses. Statistical analysis revealed a significant correlation between the results of immunologic screening tests and the age of the patients(p<0.05 by chi-square), but no correlations with other clinical parameters such as sex, bilaterality, initial hearing level, and recovery(p>0.05 by chi-square respectively). There was no correlation between the results of viral marker assay(IgG) and recovery(p>0.05 by chi-square). The results suggest that viral infection may play a role in development and progress of sudden deafness, while the immunologic disorder may not affect the etiopathogenesis of sudden deafness.
Antibodies, Antinuclear ; Biomarkers ; Blood Sedimentation ; Blotting, Western ; Cytomegalovirus ; Ear, Inner ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Herpesvirus 3, Human ; Humans ; Immune System* ; Immunoassay ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Mass Screening ; Measles virus ; Mumps virus ; Rubella ; Rubella virus ; Simplexvirus