Sudden Hearing Loss with Vertigo Portends Greater Stroke Risk Than Sudden Hearing Loss or Vertigo Alone

Assessing risk of stroke after idiopathic sudden sensorineural hearing loss using data from general practice

The cause of sudden sensorineural hearing loss (SSNHL) remains unknown in a significant number of cases, but vascular involvement in its pathophysiology has been proposed. Our study aimed to assess the incidence of stroke following idiopathic SSNHL (iSSNHL) and to evaluate associated cardiovascular risk factors and comorbidities. We extracted electronic medical record data from iSSNHL patients aged ≥ 50 years retrospectively from 84 general practices. Patients were matched for age, sex and general practice in a 1:4 ratio to controls. Primary outcome was the 5-years stroke risk following iSSNHL diagnosis. 480 iSSNHL cases could be matched to 1911 controls. The hazard ratio for iSSNHL compared with controls was 1.25 (95%CI 0.50-3.27; P = 0.646) for CVA (cerebrovascular accident) alone and 0.92 (95% CI 0.50-1.71; P = 0.804) for CVA and TIA (transient ischemic attack) combined. The hazard ratio for the interaction term between iSSNHL and age ≥ 60 years was 4.84 (95% CI 1.02-23.05; P = 0.048) for CVA and TIA combined. Patients with iSSNHL used antihypertensives and beta-blocking agents more frequently than controls (P = 0.006 and P = 0.022, respectively). In conclusion, no overall significant difference in the risk of stroke was observed, but the hazard ratio for stroke increased in iSSNHL patients aged 60 and older, suggesting potential vascular involvement in older subjects presenting with sudden sensorineural hearing loss.

The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value

OBJECTIVES

To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes.

DESIGN

We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry.

RESULTS

We assessed 71 AVS patients, 17 of whom had a central and 54 a peripheral cause of dizziness. 12.7% had an objective hearing loss. 'HINTS' had an accuracy of 78.9% to diagnose stroke, whereas 'HINTS' plus audiometry 73.2%. 'HINTS' sensitivity was 82.4% and specificity 77.8% compared to 'HINTS' plus audiometry showing a sensitivity of 82.4% and specificity of 70.4%. The four patients with stroke and minor stroke had all central 'HINTS'. 55% of the patients did not perceive their new unilateral hearing loss.

CONCLUSIONS

We found that almost one-eighth of the AVS patients had a new onset of hearing loss and only half had self-reported it. 'HINTS' plus audiometry proved to be less accurate to diagnose a central cause than 'HINTS' alone. Audiometry offered little diagnostic accuracy to detect strokes in the ED but might be useful to objectify a new hearing loss that was underestimated in the acute phase. Complete hearing loss should be considered a red flag, as three in four patients suffered from a central cause.

Early detection of stroke at the sudden sensorineural hearing loss stage

Background and purpose

Sudden sensorineural hearing loss (SSNHL) can be a prodromal symptom of ischemic stroke, especially posterior circulation strokes in the anterior inferior cerebellar artery (AICA) area. Early diagnosis and optimal treatment for vascular SSNHL provide an opportunity to prevent more extensive area infarction. The objective of our research was to find clues that suggest stroke at the stage of isolated sudden hearing loss.

Methods

We retrospectively investigated the medical records of patients who received an initial diagnosis of sudden sensorineural hearing loss upon admission from January 2017 to December 2022 at Capital Medical University Affiliated Beijing Tiantan Hospital. Among these patients, 30 individuals who developed acute ischemic stroke during their hospital stay were enrolled as the case group. To create a control group, we matched individuals from the nonstroke idiopathic SSNHL patients to the case group in terms of age (±3 years old) at a ratio of 1:4. We collected the clinical characteristics, pure tone hearing threshold test results, and imaging information for all patients included in the study.

Results

Three models were constructed to simulate different clinical situations and to identify vascular sudden sensorineural hearing loss (SSNHL). The results revealed that patients with SSNHL who had three or more stroke risk factors, bilateral hearing loss, moderately severe to total hearing loss, and any intracranial large artery stenosis and occlusion (≥50%) were at a higher risk of developing ischemic stroke during hospitalization. Consistent with previous studies, the presence of vertigo at onset also played a significant role in the early detection of upcoming stroke.

Conclusion

Clinicians should be alert to SSNHL patients with bilateral hearing loss, moderately severe to total hearing loss and other aforementioned features. Early pure tone audiometric hearing assessment and vascular assessment are necessary for high-risk patients with SSNHL.

Investigation of hearing loss in elderly vertigo and dizziness patients in the past 10 years

Background

Vertigo and hearing loss are both prevalent in the elderly. This study retrospectively analyzed hearing test results from elderly patients experiencing vertigo and dizziness at ENT outpatient over a 10-year period, in order to study the patterns of hearing loss in this patient population.

Methods

Nine thousand three hundred eighty four patients over 50 years old underwent retrospective collection and screening of outpatient diagnosis, pure tone audiometry, acoustic immittance measurement (tympanogram) and auditory brainstem response (ABR) test. The patient's audiograms are divided into 7 subtypes according to a set of fixed criteria. Meanwhile, K-Means clustering analysis method was used to classify the audiogram.

Results

The Jerger classification of tympanogram in elderly patients with vertigo and dizziness showed the majority falling under type A. The leading audiogram shapes were flat (27.81% in right ear and 26.89% in left ear), high-frequency gently sloping (25.97% in right ear and 27.34% in left ear), and high-frequency steeply sloping (21.60% in right ear and 22.53% in left ear). Meniere's disease (MD; 30.87%), benign recurrent vertigo (BRV; 19.07%), and benign paroxysmal positional vertigo (BPPV; 15.66%) were the most common etiologies in elderly vestibular diseases. We observed statistically significant differences in hearing thresholds among these vestibular diseases (P < 0.001). K-Means clustering analysis suggested that the optimal number of clusters was three, with sample sizes for the three clusters being 2,747, 2,413, and 4,139, respectively. The ANOVA statistical results of each characteristic value showed P < 0.001.

Conclusion

The elderly patients often have mild to moderate hearing loss as a concomitant symptom with vertigo. Female patients have better hearing thresholds than males. The dominant audiometric shapes in this patient population were flat, high-frequency gently sloping, and high-frequency steeply sloping according to a set of fixed criteria. This study highlights the need for tailored strategies in managing hearing loss in elderly patients with vertigo and dizziness.

Positive horizontal-canal head impulse test is not a benign sign for acute vestibular syndrome with hearing loss

Background

Diagnosis of acute vestibular syndrome (AVS) with hearing loss is challenging because the leading vascular cause—AICA territory stroke—can appear benign on head impulse testing. We evaluated the diagnostic utility of various bedside oculomotor tests to discriminate imaging-positive and imaging-negative cases of AVS plus hearing loss.

Method

We reviewed 13 consecutive inpatients with AVS and acute unilateral hearing loss. We compared neurologic findings, bedside and video head impulse testing (bHIT, vHIT), and other vestibular signs (including nystagmus, skew deviation, and positional testing) between MRI+ and MRI– cases.

Results

Five of thirteen patients had a lateral pontine lesion (i.e., MRI+); eight did not (i.e., MRI–). Horizontal-canal head impulse test showed ipsilateral vestibular loss in all five MRI+ patients but only in three MRI– patients. The ipsilesional VOR gains of horizontal-canal vHIT were significantly lower in the MRI+ than the MRI– group (0.56 ± 0.11 vs. 0.87 ± 0.24, p = 0.03). All 5 MRI+ patients had horizontal spontaneous nystagmus beating away from the lesion (5/5). One patient (1/5) had direction-changing nystagmus with gaze. Two had skew deviation (2/5). Among the 8 MRI– patients, one (1/8) presented as unilateral vestibulopathy, four (4/8) had positional nystagmus and three (3/8) had isolated posterior canal hypofunction.

Conclusion

The horizontal-canal head impulse test poorly discriminates central and peripheral lesions when hearing loss accompanies AVS. Paradoxically, a lateral pontine lesion usually mimics unilateral peripheral vestibulopathy. By contrast, patients with peripheral lesions usually present with positional nystagmus or isolated posterior canal impairment, risking misdiagnosis as central vestibulopathy.

Efficacy of Mesotympanum Injection and Posterior Auricular Injection in Sudden Hearing Loss of Diabetes Patients

The efficacy of tympanum injection and posterior auricular injection in diabetes with sudden hearing loss (SHL) was analyzed. A mobile terminal-based portable pure tone audiometry system and its processing method were established. Based on mobile terminals, a portable pure tone audiometry system including an Android system, pure sound signal generation, pure tone hearing threshold, and client module was established. A masking model and self-adaptive algorithm were used to detect and reduce noise. Besides, the performance of the portable pure tone audiometry system was detected. A total of 46 diabetes patients with SHL diagnosed at the otolaryngology department in BeiChen Hospital between August 2019 and November 2021 were selected as the research objects and randomly divided into the retroauricular group (posterior auricular injection) and the tympanic group (tympanum injection). Each group included 23 cases. All patients received pure tone audiometry (PTA) before and after the treatment. The changes in fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA1c) of the patients were monitored before and after the treatment. Besides, tinnitus loudness visual analog scale (VAS), pain VAS, efficacy, and the incidence of adverse reactions of the patients in two groups were compared. The results indicated that the hear threshold error detected by the medical audiometer and a portable pure tone audiometry system was within 2dB. Before the optimization, there was an error of about 10dB between the hear thresholds detected by the self-adaptive algorithm and a medical audiometer. After the treatment, the hear threshold and average PTA of the patients in the retroauricular and the tympanic groups under different frequencies were both reduced compared with those before the treatment (P < 0.05). The tinnitus VAS score in the retroauricular group was decreased more notably than that in tympanic group (P < 0.01), and the pain VAS score was much lower than that in the tympanic group (P < 0.001). The comparison of FPG, 2hPG, HbA1c, the proportions of cured, significantly effective, effective, ineffective patients, and the total effective rate in the patients in the retroauricular and the tympanic groups before and after the treatment all showed no statistical differences (P > 0.05). The incidence of adverse reactions in tympanic group after the treatment was dramatically higher than that in retroauricular group (P < 0.001). The above results demonstrated that posterior auricular injection showed potential application values in the treatment of SHL with diabetes and established a portable pure tone audiometry system as well as its noise processing method.

Cerebral Small Vessel Disease in Elderly Patients With Vestibular Neuritis

Background

Acute audiovestibular loss is a neurotologic emergency of which the etiology is frequently unknown. In vestibular neuritis a viral genesis is expected, although there is insufficient evidence to support viruses as the only possible etiological factor. In sudden deafness, a vascular etiology has been proposed in elderly patients, since cardiovascular risk factors are more frequently present and a higher risk of developing a stroke was seen compared to the general population. So far, very little research has been carried out on vascular involvement in elderly patients with vestibular neuritis. Cardiovascular risk factors have a positive correlation with cerebral small vessel disease, visible as white matter hyperintensities, brain infarctions, microbleeds and lacunes on MRI. The presence of these characteristics indicate a higher risk of developing a stroke.

Aim

We investigated whether elderly patients with vestibular neuritis have a higher prevalence of vascular lesions on MRI compared to a control cohort.

Materials and Methods

Patients of 50-years and older, diagnosed with vestibular neuritis in a multidisciplinary tertiary referral hospital, were retrospectively reviewed and compared to a control cohort. The primary outcome was the difference in cerebral small vessel disease on MRI imaging, which was assessed by the number of white matter hyperintensities using the ordinal Fazekas scale. Secondary outcomes were the presence of brain infarctions on MRI and the difference in cardiovascular risk factors.

Results

Patients with vestibular neuritis (N = 101) had a 1.60 higher odds of receiving a higher Fazekas score than the control cohort (N = 203) (p = 0.048), there was no difference in presence of brain infarctions (p = 1.0). Hyperlipidemia and atrial fibrillation were more common in patients experiencing vestibular neuritis.

Conclusion

We found a positive correlation of white matter hyperintensities and VN which supports the hypothesis of vascular involvement in the pathophysiology of vestibular neuritis in elderly patients. Further prospective research is necessary to confirm this correlation.

[Analysis of coagulation state in sudden deafness patients with total deafness and vertigo]

Objective:To analyze the coagulation status and prognosis of sudden deafness patients with total deafness accompanied by vertigo, and to provide basis for improving the treatment of this disease. Methods:From January 2017 to December 2020, 33 patients with total deafness and vertigo sudden deafness who were hospitalized in the Department of Otolaryngology Head and Neck Surgery, Hebei Provincial People's Hospital were selected as the research group. During the same period, 33 cases of low frequency type, full frequency type, total deafness and 26 cases of high frequency type were treated as control group.Thirty-three cases of inpatients without history of middle ear and inner ear diseases were treated as normal control group. The levels of fibrinogen（FIB）, D-Dimer（D-D）, Prothrombin Time（PT）, Activated Partial Thrombin Time（APTT） between the research group and the control group were analyzed, and the therapeutic effects of different types of sudden deafness patients were analyzed. Results:FIB and D-D of total deafness with vertigo were 2.50（2.11, 2.95）and 0.27（0.16, 0.51） respectively, which were higher than 2.31（1.92, 2.50） and 0.17（0.12, 0.21） of normal group. APTT was 25.2（23.1, 28.1）, lower than 27.3（26.4, 29.7） in the normal group, the differences were statistically significant（P<0.01）. ② FIB of total deafness with vertigo was 2.50（2.11, 2.95）, which was higher than that of low frequency group 2.37（1.81, 2.68）. D-D was 0.27（0.16, 0.51）, higher than low frequency group 0.16（0.12, 0.25）, high frequency group of 0.13（0.11, 0.23）, the whole frequency group 0.16（0.11, 0.28）, total of 0.18（1.45, 0.30）. APTT was 25.75±3.18/25.2（23.1, 28.1）, lower than 27.72±2.22 in low frequency group and 26.7（25.8, 28.7） in full frequency group, with statistical significance（P<0.05）. ③ The total deafness with vertigo group had the worst curative effect（ineffective rate was 63.6%）, and the low frequency group had the best curative effect（recovery rate was 75.8%）. The difference of curative effect among different types of sudden deafness groups was statistically significant（P<0.05）. Conclusion:Hypercoagulability and thrombosis may be one of the influencing factors of total sudden deafness. The hypercoagulable state of sudden deafness patients with total deafness and vertigo is more serious than that of total deafness and other types of sudden deafness, and the prognosis is the worst.

Functional Magnetic Resonance Imaging Reveals Early Connectivity Changes in the Auditory and Vestibular Cortices in Idiopathic Sudden Sensorineural Hearing Loss With Vertigo: A Pilot Study

The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo has yet to be identified. The aims of the current study were (1) to elucidate whether there are functional changes of the intrinsic brain activity in the auditory and vestibular cortices of the ISSNHL patients with vertigo using resting-state functional magnetic resonance imaging (rs-fMRI) and (2) whether the connectivity alterations are related to the clinical performance associated with ISSNHL with vertigo. Twelve ISSNHL patients with vertigo, eleven ISSNHL patients without vertigo and eleven healthy subjects were enrolled in this study. Rs-fMRI data of auditory and vestibular cortices was extracted and regional homogeneity (ReHo) and seed-based functional connectivity (FC) were evaluated; the chi-square test, the ANOVA and the Bonferroni multiple comparison tests were performed. Significantly decreased ReHo in the ipsilateral auditory cortex, as well as increased FC between the inferior parietal gyrus and the auditory cortex were found in the ISSNHL with vertigo groups. These findings contribute to a characterization of early plastic changes in ISSNHL patients with vertigo and cultivate new insights for the etiology research.

Overview of Dizziness in Practice

The evaluation of dizziness as a chief complaint can be exceptionally challenging to otolaryngologists. The critical piece in evaluating dizzy patients is to have a plan for how to screen and schedule, how to gather data, and to develop a workflow for testing that allows clinical efficiency. This article provides an overview of evidence-based practices on how to screen dizzy patients before being scheduled, how to efficiently move patients through the otolaryngologist's clinic, and strategies for managing a dizzy practice.

A Review of Adult-Onset Hearing Loss: A Primer for Neurologists

Purpose of the Review

The goal of this review is to highlight current approaches to diagnosis and treatment for adult-onset hearing loss in patients likely to present to a neurologist's office. The review will discuss primary and secondary causes of acute and chronic hearing loss, and will discuss common situations that can be managed by a neurologist as well as situations that require immediate care and referral for further management by an otolaryngologist-head and neck surgeon.

Recent Findings

Hearing screening assessments using mobile applications and tablet devices are now available and can be integrated into many clinical practice settings, including in the evaluation of hearing concerns related to various neurological pathologies. For patients presenting with a sudden worsening in hearing, bedside evaluation, including with objective measures of hearing, can inform neurologists about diagnosis and subsequent management. For patients who present with gradual worsening in hearing, particularly those related to neurologic disorders, hearing care can be an important adjunct to ongoing neurologic care. More commonly encountered, age-related hearing loss is highly prevalent among older adults and may affect overall neurological assessment, including neurocognitive testing, as well as patient-provider communication, patient satisfaction, and care outcomes. Hearing loss is increasingly recognized as a potentially modifiable risk factor for dementia. Neurologists can support the hearing health of their patients through the routine use of communication strategies and by integrating simple, low-cost technology with their current clinical practices.

Summary

Both acute and chronic hearing loss can be a symptom of many conditions managed by neurologists. Few conditions are emergent, requiring immediate referral to and treatment by an otolaryngologist-head and neck surgeon. Despite the range of hearing interventions available, including hearing aids, over-the-counter devices, and aural rehabilitation, hearing loss is a common and under-treated chronic health condition. By promptly addressing a patient's hearing concerns, neurologists can improve patients' awareness of the deficit and support the overall importance of maintaining sensory health across the life course.

Sensorineural hearing loss and risk of stroke: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis study was to clarify the effects of sensorineural hearing loss (SNHL) on the incidence of stroke. In line with this, PubMed, Scopus, Web of Science, and ScienceDirect databases were searched using related keywords and MeSH terms from inception to March 1, 2020. Out of the 1961 initial records, eight cohort studies comprising 4,564,202 participants were included, and their qualities were assessed using the Newcastle-Ottawa Scale (NOS). Then, the random-effects model was used to pool HR (95% CI) for risk of stroke; and heterogeneity was presented with I² index. Subgroup analysis and publication bias tests were performed, and the pooled HR (95% CI) of stroke in SNHL was estimated as 1.31 (1.08, 1.53) for the unadjusted model and 1.33 (1.18, 1.49) for the adjusted model. Subgroup analysis indicates a significantly higher risk of stroke in patients with sudden SNHL (SSNHL) in comparison to age-related HL (ARHL) both in the unadjusted model, [HR = 1.46; 95% CI (1.08, 1.63)] versus [HR = 1.14; 95% CI (0.64, 1.65)], and in the adjusted model, [HR = 1.44; 95% CI (1.15, 1.74)] versus [HR = 1.29; 95% CI (1.24, 1.34)]. Our study showed that patients with SNHL face a higher risk of stroke than those without SNHL. It is necessary to perform hematologic and neurological examinations to help clinicians detect patients who are potentially at risk for stroke.

Episodic Spontaneous Dizziness

PURPOSE OF REVIEW

Conditions causing recurrent spontaneous episodes of dizziness or vertigo span several medical specialties, making it challenging for clinicians to gain confidence in evaluating and managing the spectrum of episodic vestibular disorders. Patients are often asymptomatic and have normal examinations at the time of evaluation. Thus, diagnosis depends heavily on eliciting key features from the history. Overreliance on symptom quality descriptions commonly leads to misdiagnosis. The goal of this article is to provide the reader with a straightforward approach to the diagnosis and management of conditions that cause episodic spontaneous dizziness.

RECENT FINDINGS

Consensus diagnostic criteria have been established for vestibular migraine, Ménière disease, vestibular paroxysmia, and hemodynamic orthostatic dizziness/vertigo. Vertigo has been recognized as a common symptom in vertebrobasilar ischemia, cardiogenic dizziness, and orthostatic hypotension. Treatment recommendations for vestibular migraine still lack high-quality evidence, but controlled trials are occurring.

SUMMARY

The evaluation should start with a detailed description of the episodes from the patient and any observers. Rather than focusing first on whether the symptom quality is most consistent with vertigo, dizziness, lightheadedness, or unsteadiness, the clinician should clarify the timing (episode frequency and duration), possible triggers or circumstances (eg, position changes, upright posture), and accompanying symptoms. History should identify any auditory symptoms, migraine features, posterior circulation ischemic symptoms, vascular risk factors, clues for anxiety, and potentially relevant medications. Carefully selected testing can help secure the diagnosis, but excessive and indiscriminate testing can lead to more confusion. Treatments for these conditions are vastly different, so an accurate diagnosis is critical.

Risk of Stroke and Myocardial Infarction After Sudden Sensorineural Hearing Loss: A Meta-Analysis

OBJECTIVES/HYPOTHESIS

The pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown, but labyrinthine artery infarction has been proposed. The objective of this study was to perform a systematic review and conduct a meta-analysis assessing the risk of developing stroke and myocardial infarction after presentation with ISSNHL.

METHODS

A systematic literature review was conducted using Pubmed, Embase, Web of Science, and Cochrane Libraries. All studies investigating an association between ISSNHL and stroke and/or myocardial infarction (MI) were included. Adhering to the MOOSE guideline, two independent reviewers extracted data, assessed risk of bias, and evaluated the relevance and quality of evidence.

RESULTS

Three observational studies evaluating the risk of stroke in ISSNHL were included (n = 6,521 patients). All individual study results indicated an increased relative risk of stroke after ISSNHL (unadjusted relative risk range 1.21-1.63). Pooled adjusted hazard ratios revealed a 1.42-fold increased risk of stroke after ISSNHL (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.15-1.75, I² = 55%). Subgroup analysis of one study demonstrated that the increased risk is only present in adults aged above 50 years (HR 1.23; 95% CI 1.07-1.42). Five observational studies evaluating the risk of MI in patients with ISSNHL were included (n = 61,499 patients). Pooled analyses demonstrated that ISSNHL was not associated with MI (HR 1.08, 95% CI 0.87-1.34).

CONCLUSION

ISSNHL may be an independent risk factor for the subsequent development of stroke especially in a subgroup of elderly patients. More studies are needed to confirm this association and to assess whether such patients would benefit from cardiovascular risk assessment and management to prevent future strokes. Laryngoscope, 131:1369-1377, 2021.

Metabolic syndrome and idiopathic sudden sensori-neural hearing loss

The purpose of this study was to evaluate the association between the presence of Metabolic Syndrome (MetS) and idiopathic sudden sensorineural hearing loss (ISSHL) and the impact of MetS on recovery of patients with ISSHL. 39 Patients with ISSHL and 44 controls were enrolled in this study. Demographic, clinical characteristics and hearing recovery were evaluated. MetS was defined according to the diagnostic criteria of International Diabetes Federation (IDF) consensus definition. Patients affected by ISSHL presented a body mass index (BMI), waist circumference, waist hip ratio (WHR), fasting glucose and blood pressure significantly higher compared to controls. Considering patients with central obesity, 5 controls and 15 ISSHL patients met the criteria of MetS. According to Siegel criteria, a complete or partial recovery was observed in 60% of patients with MetS and in 91,66% of patients without MetS. MetS was associated with ISSHL and this association negatively influenced the hearing recovery of these patients.

Vascular vertigo: updates

Discriminating strokes in patients with acute dizziness/vertigo is challenging especially when other symptoms and signs of central nervous involvements are not evident. Despite the developments in imaging technology over the decades, a significant proportion of acute strokes may escape detection on imaging especially during the acute phase or when the lesions are small. Thus, small strokes causing isolated dizziness/vertigo would have a higher chance of misdiagnosis in the emergency department. Even though several diagnostic algorithms have been advanced for acute vascular vertigo, we still await more comprehensive and sophisticated ones that can also be applied to transient vestibular symptoms due to vascular compromise. In this respect, vascular and perfusion imaging would be informative. Application of artificial intelligence and tele-consultation may be future perspectives for real-time decision in acute dizziness and vertigo. Several new constellations of ocular motor and vestibular findings have been added to the strokes involving the brainstem and cerebellum. Defining these characteristics would help understanding the function of central vestibular structures and allow more accurate localization of the strokes involving these structures.

Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss

INTRODUCTION

Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss.

OBJECTIVES

To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL.

MATERIAL AND METHODS

After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers.

RESULTS

Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months.

CONCLUSION

By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.