Tympanoskopie mit Abschottung der Rundfenstermembran beim idiopathischen Hörsturz

[Does sealing the oval window in addition to the round window bring an advantage in reserve therapy of acute idiopathic deafness?]

BACKGROUND

Following sudden unilateral deafness or severe sensorineural hearing loss, patients with unsuccessful intravenous steroid therapy can be treated with explorative tympanotomy with sealing of the round (RW) and/or oval window (OW), due to suspected rupture of the RW with perilymph fistula (PLF) or a fissula ante fenestram (FAF). This study investigated whether additional sealing of the oval window (RW+OW) achieved an improved hearing benefit as compared to sealing of the round window only (RW) .

METHODS

This retrospective study investigated 54 patients with acute profound hearing loss who underwent tympanoscopy. Audiometric examinations were performed preoperatively and at two postoperative intervals (1 month and 3-6 months after surgery). In 28 patients, the OW was sealed in addition to the RW.

RESULTS

No intraoperatively visible PLF or FAF were reported. Hearing thresholds were significantly reduced in the early postoperative follow-up period and further improvement was observed 3-6 months later. No significant differences between the RW and RW+OW subgroups were seen at either follow-up timepoint. In 65% (Kanzaki criteria) and 74% (Siegel criteria) of patients, partial or complete postoperative hearing improvement was observed. Upon comparing the groups of patients with and without hearing improvement, no statistical significance was found in terms of gender, age, secondary diagnoses, or latency period between symptom onset and surgery.

CONCLUSION

Additional sealing of the OW did not lead to significantly better postoperative hearing thresholds. In general, postoperative hearing improvement corresponds to published spontaneous remission rates.

Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula - retrospective analysis and review of the literature

OBJECTIVE

The diagnostic value of exploratory tympanotomy in sudden sensorineural hearing loss remains controversial. This study and review were performed to identify the incidence of perilymphatic fistula in patients with sudden sensorineural hearing loss. The effectiveness of tympanotomy for sealing of the cochlear windows in cases with perilymphatic fistula was evaluated.

METHODS

A search in common databases was performed. Overall, 5034 studies were retrieved. Further, a retrospective analysis on 90 patients was performed.

RESULTS

Eight publications dealing with tympanotomy in patients with sudden sensorineural hearing loss were identified. In 90 patients diagnosed with sudden sensorineural hearing loss and undergoing exploratory tympanotomy, 10 patients (11 per cent) were identified with a perilymphatic fistula, and this corresponds to the results obtained from our review (13.6 per cent).

CONCLUSION

There was no significant improvement after exploratory tympanotomy and sealing of the membranes for patients with a definite perilymphatic fistula.

Diagnostics and therapy of sudden hearing loss

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.

Tympanotomy with sealing of the round window as surgical salvage option in sudden idiopathic sensorineural hearing loss

CONCLUSION

Tympanotomy with sealing of the round window is a promising surgical alternative as a salvage strategy in younger patients with acute idiopathic sensorineural hearing loss (SNHL) and may be considered as an alternative drug delivery method to the round window.

OBJECTIVES

To analyze the potential benefit of the sealing of the round window with special emphasis on the age of treated patients and the influence of time elapsed between symptom onset and surgery.

METHODS

This was a retrospective cohort study of 25 patients (13 males,12 females) with an average age of 55 years (range 31-75 years) with sudden SNHL, who underwent an enaural tympanotomy with sealing of the round niche using triamcinolone-soaked fascia. Pre- and postoperative bone conduction thresholds were compared for each frequency and for the pure-tone average (PTA) measured at 500 Hz, 1 kHz, 2 kHz, and 3 kHZ. The time (days) between primary symptom onset and surgery as well as age was scrutinized. Hearing improvement was described as 'no improvement' (0-9 dB), 'moderate recovery' (10-29 dB), or 'marked recovery' (≥30 dB). The difference in age of patients who improved was compared to those who did not.

RESULTS

A statistically significant improvement in PTA values (mean change 20.4 dB) was noted (p = 0.0002). In all, 13/25 (52%) patients exhibited improved bone conduction postoperatively regardless of age and time of treatment. A marked recovery (≥30 dB) could be seen in eight patients (median time to surgery, 9 days; average age, 48.5 years); recovery between 10 and 30 dB in five patients (median time to surgery, 10 days; average age, 46.6 years). Twelve significantly older patients showed no improvement (average time to surgery, 19 days; average age, 61.8 years; p = 0.004). No patient over the age of 65 years showed improvement in bone conduction.