Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc
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the “e” in ent |<br />
Oral vs. Transtympanic Injection of Steroids<br />
as Treatment Options for Idiopathic Sudden<br />
Sensorineural Hearing loss<br />
By Mary Edgar, BKin, David Clinkard, MS, and Vincent lin, MD, FRCSC<br />
edgarmary01@hotmail.com<br />
Sudden sensorineural hearing loss<br />
(SSNHL) is a relatively common<br />
complaint in audiology and otolaryngology<br />
practices. SSNHL is the acute<br />
onset of hearing loss of at least 30 dB in<br />
at least three different frequencies over a<br />
72-hour period. 1 While usually<br />
unilateral in origin, bilateral occurance<br />
is possible, though rare (1–2%).<br />
The overall incidence of diagnosed<br />
ISSNHL ranges from 5 to 20 per<br />
100,000 persons per year, with some<br />
estimates as high as 160 per 100,000. 2<br />
Given the high spontaneous recovery<br />
rates (32–65%), the actual incidence of<br />
ISSNHL may be higher. 3 ISSNHL<br />
typically occurs between the ages of 50<br />
and 60, with no gender predominance. 4,5<br />
Etiology is often unknown, with the<br />
majority (85%) of patients having no<br />
identifiable cause. 5,6 However, viral,<br />
vascular and immunologic contributions<br />
have been suggested as possible<br />
etiologies. 2,3<br />
diagnosis and treatMent<br />
Aural fullness and muffled hearing are<br />
About the Authors<br />
Mary Edgar (left) has a bachelor’s degree in<br />
kinesiology and has just been accepted into the<br />
MSc physiotherapy program at UBC. She has<br />
worked as an audiometric technician at the Vernon<br />
Health Unit for the past five years. David Clinkard<br />
(middle), and Vincent Lin (left) are with the<br />
Otolaryngology Department at Sunnybrook Health<br />
Sciences Centre, Toronto, Ontario.<br />
aBstraCt<br />
There is a myriad of treatment options for sudden sensorineural hearing loss. However<br />
clinical evidence supporting the efficacy of these treatments are generally limited to case<br />
series and a few clinical trials. Due to the paucity of good clinical evidence, the treatment<br />
of sudden sensorineural hearing loss continues to challenging for otolaryngologists.<br />
Although controversial, corticosteroids are considered the standard of care. A typical<br />
treatment regiment is a tapering course of high dose oral corticosteroids. Recently,<br />
transtympanic corticosteroids have been administered as salvage therapy, primary therapy<br />
or in addition to oral corticosteroid treatments. The role of oral versus transtympanic<br />
corticosteroid therapy remains poorly understood.<br />
the most common presenting symptoms<br />
of SSNHL and may be mistaken for less<br />
serious conditions such as cerumen<br />
impaction or nasal congestion leading to<br />
eustachian tube dysfunction 7 . These can<br />
be ruled out with a complete history,<br />
physical exam, and audiologic<br />
evaluation. 2 A rapid diagnosis of SSNHL<br />
is vital because a delay in diagnosis may<br />
reduce the efficacy of treatments thought<br />
to restore hearing. 3,4<br />
Given the multifactorial and ultimately<br />
unknown nature of ISSNHL multiple<br />
REVUE CANADIENNE D’AUDITION | CANADIAN HEARING REPORT 15
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