Page 1006 - TNFlipTest
P. 1006
OT20 Otolaryngology
Sudden SNHL may easily be confused with ischemic brain events. It is important to keep a high index of suspicion especially with elderly patients presenting with sudden SNHL as well as vertigo
Steroids for Treatment of Sudden Sensorineural Hearing Loss: A Meta-Analysis of RCTs Laryngoscope. 2015;125(1):209
Summary: A meta-analysis of randomized controlled trials does not support the use of steroids over placebo in this condition, a finding consistent with previous analyses.
Diseases of the Inner Ear Toronto Notes 2019 Sudden Sensorineural Hearing Loss
Clinical Features
• presentsasasuddenonsetofsignificantSNHL(usuallyunilateral)±tinnitus,auralfullness • usuallyidiopathic,ruleoutothercauses
■ autoimmune causes (e.g. ESR, rheumatoid factor, ANA)
■ MRI to rule out tumour and/or CT to rule out ischemic/hemorrhagic stroke if associated with any
other focal neurological signs (e.g. vertigo, ataxia, abnormality of CN V or VII, weakness)
Treatment
• intratympanicororalcorticosteroidswithin3dofonset:prednisone1mg/kg/dfor10-14d
Prognosis
• dependsondegreeofhearingloss
• 70%resolvewithin10-14d
• 20%experiencepartialresolution
• 10%experiencepermanenthearingloss
Autoimmune Inner Ear Disease
Etiology
• idiopathic
• maybeassociatedwithsystemicautoimmunediseases(e.g.rheumatoidarthritis,SLE),vasculitides
(e.g. GPA, polyarteritis nodosa), and allergies
Epidemiology
• mostcommonbetweenages20-50
Clinical Features
• rapidlyprogressiveorfluctuatingbilateralSNHL
• ±tinnitus,auralfullness,vestibularsymptoms(e.g.ataxia,disequilibrium,vertigo)
Investigations
• autoimmuneworkup:CBC,ESR,ANA,rheumatoidfactor
Treatment
• high-dosecorticosteroids:treatearlyforatleast30d
• considercytotoxicmedicationforsteroidnon-responders
Drug Ototoxicity
Aminoglycosides
• streptomycinandgentamicin(vestibulotoxic),kanamycin,andtobramycin(cochleotoxic)
• toxictohaircellsbyanyroute:oral,IV,andtopical(iftheTMisperforated)
• destroyssensoryhaircells:outerfirst,innersecond(therefore,otoacousticemissionsarelostfirst)
• highfrequencyhearinglossdevelopsearliest
• ototoxicityoccursd-wkpost-treatment
• mustmonitorwithpeakandtroughlevelswhenprescribed,especiallyifpatienthasneutropeniaand/or
history of ear or renal problems
• q24hdosingrecommended(withamountdeterminedbycreatinineclearance)
• aminoglycosidetoxicitydisplayssaturablekinetics,therefore,oncedailydosingpresentslessriskthan
divided daily doses
• durationoftreatmentisthemostimportantpredictorofototoxicity
■ treatment: immediately stop aminoglycosides
Salicylates
• hearinglosswithtinnitus,reversibleifdiscontinued
Antimalarials (Quinines)
• hearinglosswithtinnitus
• reversibleifdiscontinued,butcanleadtopermanentloss
Others
• manyantineoplasticagentsareototoxic(weighrisksvs.benefits) • loopdiuretics