Takayuki Nakagawa1, Michio Yamamoto2, Kozo Kumakawa3, Shin-Ichi Usami4, Naohito Hato5, Keiji Tabuchi6, Mariko Takahashi7, Keizo Fujiwara8, Akira Sasaki9, Shizuo Komune10, Norio Yamamoto11, Harukazu Hiraumi11, Tatsunori Sakamoto11, Akira Shimizu12, Juichi Ito11. 1. Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan. Electronic address: tnakagawa@ent.kuhp.kyoto-u.ac.jp. 2. Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto 606-8507, Japan. 3. Department of Otolaryngology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo 105-8470, Japan. 4. Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan. 5. Department of Otolaryngology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan. 6. Department of Otolaryngology, Graduate School of Comprehensive Human Science, University of Tsukuba, 305-8575 Tsukuba, Japan. 7. Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya 467-8601, Japan. 8. Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan. 9. Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan. 10. Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. 11. Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan. 12. Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto 606-8507, Japan.
Abstract
OBJECTIVE: To determine the prognostic factors for hearing recovery in patients with sudden sensorineural hearing loss (SSHL) refractory to systemic corticosteroids following salvage treatment. METHODS: This is a retrospective observational study at nine tertiary referral hospitals. A total of 120 patients with sudden deafness refractory to systemic corticosteroids were enrolled. The patients were randomly assigned to receive topical application of recombinant human IGF-1 or intratympanic injection of dexamethasone as salvage treatment. Multiple regression analysis was performed to identify determinants of hearing recovery using pure tone audiometry results at 8 weeks after treatment. Clinical predictors that were evaluated included age, sex, pretreatment hearing level, presence of vertiginous symptoms, days to study entry from symptom onset and salvage treatment assignment (IGF-1 vs. dexamethasone). RESULTS: The linear regression model identified age (P=0.001), pretreatment hearing level (P<0.001), days to study entry from symptom onset (P=0.011) and treatment assignment (P=0.033) at 8 weeks after treatment as significant variables influencing the recovery of pure tone audiometry average thresholds. Younger age (<60 years), early initiation of salvage treatment and treatment with topical IGF-1 therapy had significant effects on hearing recovery. CONCLUSION: The results indicate that early initiation and choice of treatment modalities for salvage treatment may be important for the prognosis of patients with refractory SSHL. The positive effect of topical IGF-1 therapy on hearing recovery indicates its utility as salvage treatment.
OBJECTIVE: To determine the prognostic factors for hearing recovery in patients with sudden sensorineural hearing loss (SSHL) refractory to systemic corticosteroids following salvage treatment. METHODS: This is a retrospective observational study at nine tertiary referral hospitals. A total of 120 patients with sudden deafness refractory to systemic corticosteroids were enrolled. The patients were randomly assigned to receive topical application of recombinant humanIGF-1 or intratympanic injection of dexamethasone as salvage treatment. Multiple regression analysis was performed to identify determinants of hearing recovery using pure tone audiometry results at 8 weeks after treatment. Clinical predictors that were evaluated included age, sex, pretreatment hearing level, presence of vertiginous symptoms, days to study entry from symptom onset and salvage treatment assignment (IGF-1 vs. dexamethasone). RESULTS: The linear regression model identified age (P=0.001), pretreatment hearing level (P<0.001), days to study entry from symptom onset (P=0.011) and treatment assignment (P=0.033) at 8 weeks after treatment as significant variables influencing the recovery of pure tone audiometry average thresholds. Younger age (<60 years), early initiation of salvage treatment and treatment with topical IGF-1 therapy had significant effects on hearing recovery. CONCLUSION: The results indicate that early initiation and choice of treatment modalities for salvage treatment may be important for the prognosis of patients with refractory SSHL. The positive effect of topical IGF-1 therapy on hearing recovery indicates its utility as salvage treatment.
Authors: Linda Bieniussa; Baran Kahraman; Johannes Skornicka; Annemarie Schulte; Johannes Voelker; Sibylle Jablonka; Rudolf Hagen; Kristen Rak Journal: Front Neurol Date: 2022-06-03 Impact factor: 4.086
Authors: Jared H Hara; Julia A Zhang; Krupa R Gandhi; Anna Flaherty; Wayne Barber; Marcia A Leung; Lawrence P Burgess Journal: Laryngoscope Investig Otolaryngol Date: 2018-03-25