1.What is sudden deafness?
Sudden deafness is a sudden sensorineural hearing loss of unknown cause, referred to as sudden deafness, also known as idiopathic sudden deafness. The clinical characteristics of sudden deafness are that hearing loss occurs suddenly without any obvious cause, and most of the time, hearing drops to the lowest point within minutes or hours, and some patients may have tinnitus, vertigo, vomiting, etc.
2.How does sudden deafness occur?
The causes of sudden deafness are unknown and may be related to many factors, but currently there are two main categories: Li Fancheng, Department of Otolaryngology, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine
(1) Viral infections: Many viral infections, such as influenza virus (causing influenza), mumps virus (causing mumps), herpes virus (causing herpes), varicella-zoster virus (causing herpes zoster), etc., may cause sudden deafness by causing damage to the auditory nerve tissue or damage to the inner ear.
(2) Impaired blood supply to the inner ear (inner ear microcirculation disorder): The blood vessels supplying the inner ear are terminal blood vessels without the supply of collateral circulation blood vessels. Once the blood supply to the inner ear blood vessels is impaired due to various reasons, it leads to tissue ischemia or even irreversible necrosis due to the lack of blood supply to the inner ear, resulting in sudden deafness.
3.What are the common triggering factors of sudden deafness? Can they be prevented?
Clinically, these patients may have the following factors before the onset of the disease.
(1) A history of cold or flu (suggesting a possible viral infection).
(2) Overexertion, which may cause a decrease in immune function and other functions of the body.
(3) Mental depression, anxiety, emotional stress, etc., which can cause vascular dysfunction or microcirculation disorders in some important parts of the body, leading to sudden onset of deafness.
Based on the above, it can be seen that there is no special prevention method for this disease.
4.What are the main symptoms of sudden deafness?
The main symptoms of sudden deafness are
(1) Deafness: It is the first symptom, which occurs suddenly and can reach the lowest point of hearing loss in minutes, hours or within 3 days. The onset is mostly unilateral, but occasionally occurs bilaterally or sequentially.
(2) Tinnitus: It can be the earliest symptom and can occur simultaneously with or after deafness.
(3) Vertigo: It starts at the beginning of the disease, or after the onset of deafness, vertigo, nausea and vomiting may occur, and then gradually decreases without recurrent attacks.
(4) Other symptoms: Some patients may have a sensation of obstruction or pressure in the ear or in the ear, periarthral numbness.
5.What tests are usually required for sudden deafness?
(1) General otologic examination: The external auditory canal and tympanic membrane are normal.
(2) Electrical audiometric examination: sensorineural deafness is present, and the hearing loss curve can be ascending, steep descending, or flat; in mild cases, at least 2 adjacent frequencies drop up to 20dB or more, and most of them are moderate or above, even total deafness.
(3) Other examinations: The following examinations should be done if necessary (the main purpose is to exclude other pathologies): normal results of acoustic impedance examination; cochlear electrogram and auditory brainstem evoked potentials showing cochlear damage; normal or significantly lower results of vestibular function examination after the vertigo symptoms are relieved; normal results of CT and MRI examination of the internal auditory tract and cranium when they belong to normal results; normal results of blood examination and laboratory tests.
6.How should sudden deafness and Meniere’s disease be differentiated when they have the same tinnitus, deafness and vertigo?
Both sudden deafness and Ménière’s disease have tinnitus, deafness, and vertigo symptoms.
(1) The medical history is different. Meniere’s disease can recur, so there can be a history of recurrent tinnitus, deafness, and vertigo, whereas sudden deafness does not have a history of recurrence.
(2) The developmental pattern of deafness is different. In the onset of sudden deafness, it only takes minutes, hours, or within 3 days, hearing loss reaches its lowest point, and it can gradually improve or no improvement after treatment; while in Meniere’s disease, hearing can be detected at different times during the attack period, and it can be good (hearing up) and bad (hearing down), and as the number of recurrent attacks increases, its hearing loss becomes more severe.
7.What diseases should be distinguished from sudden onset deafness? Why is it sometimes necessary to do CT or MRI examination?
Sudden deafness (the name of the disease) and sudden deafness (the name of the symptom) are two different concepts. Sudden deafness refers to a sudden onset of deafness that may or may not have a definite cause and may or may not be sensorineural in nature. Clinically, many causes or diseases can cause sudden deafness and need to be ruled out before a diagnosis of sudden deafness can be made. Sudden deafness caused by any of the following diseases cannot be considered sudden deafness.
(1) Membrane vagus rupture: Sudden deafness that occurs after a change in head pressure due to many causes such as diving, scuba diving, blowing, sneezing, trauma, etc. that produce a rupture of the membrane vagus in the inner ear.
(2) Meniere’s disease.
(3) Intracranial tumors.
(4) Metabolic diseases (such as diabetes, hyperlipidemia, gout, etc.)
(5) Vascular and hematologic disorders (e.g., leukemia, intracranial arteriovenous malformations and tumors, etc.).
(6) Known viral infections (such as mumps, herpes zoster) caused by
(7) Autoimmune diseases.
(8) Those caused by ototoxic drug poisoning.
Of course, clinically, it is not necessary to identify each of these diseases for a specific patient, but the physician may decide whether a differential examination is needed based on the corresponding suspicious circumstances, among which, especially when intracranial lesions need to be excluded, the physician may request an ear or cranial CT or MRI examination to exclude the related diseases. Only on the basis of the exclusion of related diseases can it be finally clarified whether the deafness is sudden and treated as such.
Clinically, for patients with deafness of the above-mentioned causes, some of them need to be treated mainly for the primary disease (especially membrane vagus rupture and intracranial tumor); however, in more cases, they need to be treated both for the cause and to promote hearing recovery according to the treatment of sudden deafness, and clinicians usually customarily treat such patients under the category of “sudden deafness”. The clinicians usually treat these patients under the category of “sudden deafness”.
8. Is sudden deafness an otologic emergency and should be treated in hospital as soon as possible?
Sudden deafness has a rapid onset and progresses rapidly, with total hearing loss occurring within a few hours at most. Once the hearing is severely damaged, there is a risk of necrosis of the inner ear (cochlea) and it is difficult to recover. Clinical evidence suggests that the earlier the disease is treated, the better, and the later the treatment, the worse. Many doctors advocate that this disease should be considered an otologic emergency and that early hospitalization is recommended for comprehensive treatment to save hearing.
9.Treatment principle of sudden deafness: early comprehensive treatment and active search for the cause?
The most serious danger of sudden deafness lies in the different and often more serious damage to the hearing. This disease is a difficult disease to treat, mainly because: firstly, the cause of the disease is unknown, and thus there is a lack of targeted special treatment; secondly, if the course of sudden deafness reaches a certain stage, its pathological development has irreversible damage, and once this happens, it is difficult to restore hearing. Therefore, early comprehensive treatment and active search for the cause of the disease is the consensus of clinicians for the treatment of this disease.
By “early”, we mean that we should receive treatment within 2 weeks of the onset of the disease as much as possible; by “comprehensive treatment”, we mean a combination of multiple methods, including.
(1) General treatment: such as rest, appropriate sedation (especially when tinnitus is severe), and active treatment of related diseases, such as diabetes and hypertension.
(2) Drug therapy: such as adrenocorticosteroids (steroids), antiviral drugs, drugs to improve microcirculation in the inner ear, anticoagulant drugs and thrombolytic drugs, neurotrophic drugs, etc.
(3) Other treatments: such as physical therapy, Chinese herbal medicine, acupuncture and moxibustion, and combined Chinese and Western medicine.
However, there is no unified standard on how to reasonably cooperate with the use of these drugs or methods for comprehensive treatment.
In the treatment process, it is also necessary to actively search for the possible causes and carry out targeted medication. For example, further understanding or examination, whether there are metabolic diseases (such as diabetes, hyperlipidemia, gout, etc.), autoimmune diseases, etc., in order to confirm the diagnosis or enhance the treatment as early as possible.
10.What is the applicability of glucocorticoid therapy for sudden deafness?
Glucocorticoids are a commonly used treatment for sudden deafness and have various mechanisms of action. There are two basic methods of administration: first, systemic administration (oral and intravenous drip), which is mainly used for early treatment (within 2 weeks); second, local (tympanic chamber) administration, which is mainly used for those who have poor results after early treatment.
11.What is the applicability of antiviral drugs for the treatment of sudden deafness?
Antiviral drugs are mainly used for the early treatment of patients who may have viral infection factors (often with a history of cold or upper respiratory tract infection before the onset of sudden deafness). The combination of glucocorticoids with these drugs may enhance their efficacy.
12. What is the applicability of drugs to improve microcirculation in the inner ear in the treatment of sudden deafness?
According to the view that impaired blood supply to the inner ear (microcirculation disorder) causes sudden deafness, the application of drugs to improve microcirculation in the inner ear is a basic treatment for this disease. Depending on the mechanism of action, there are many different types of drugs to improve inner ear microcirculation, and different drugs have different characteristics, and each drug also has multiple effects at the same time. Clinically, different types of drugs can be used in combination with each other, and there is no clear or uniform specification for the specific combination method. Clinical application, suitable for intravenous administration, often for early treatment, oral administration is not subject to this limit. Such drugs are currently more commonly used are.
(1) Kinnado (injectable and oral, belonging to Ginkgo biloba extract), which has a good effect on enhancing ear function (hearing enhancement) and eliminating tinnitus. It is the drug of choice in Europe for the treatment of this disease and acute tinnitus.
(2) Low molecular dextrose (injectable).
(3) Prostaglandins: such as Prostil (injection).
(4) Ion channel blockers: such as nimodipine (injection, oral agent), nimoton (tablet), ciprofloxacin (capsule), etc.
(5) Histamine derivatives: such as betadine, min make Lang.
(5) Enzymes (bovine pox vaccine-inflammatory rabbit skin extract injection), improving peripheral circulation mainly.
(6) Lidocaine, stellate ganglion block administration, or intravenous administration.
(6) Chinese herbal medicine preparation: there are many such drugs, such as compound danshen injection, geranoside injection, Chuanxiongzin injection, pulsatilla injection, shu xinning injection, live brain injection, haemosiderin (injection, oral agent), ginkgo biloba preparation, panax ginseng preparation, etc.
13.What is the applicability of anticoagulant drugs and thrombolytic drugs in the treatment of sudden deafness?
These drugs have the effect of improving microcirculation in the inner ear. Commonly used drugs include: viper antithrombin, donglin antithrombin (bacitracin), fibrinogen, urokinase, etc.
14.What is the applicability of neurotrophic drugs for sudden deafness?
The site of sudden deafness is mainly in the cochlea, which is the end organ of the auditory nerve tissue. Neurotrophic drugs are often used for clinical treatment. These drugs include vitamin B, ATP (adenosine triphosphate), CTP (cytidine triphosphate), coenzyme A, sodium cytarabine, cerebrolysin (also known as heart and brain, heart and brain, brain pulse, heart and brain, etc.), nerve growth factor (sotrasen), etc.
15.Is Chinese medicine treatment effective for sudden deafness?
Chinese medicine treatment for this disease is a basic method. It is mainly herbal treatment and acupuncture treatment.
(1) Traditional Chinese medicine treatment: Traditional Chinese medicine treatment for sudden deafness is guided by the theory of traditional Chinese medicine, and emphasizes on the identification and treatment based on the disease mechanism, or the use of a certain basic method and the application of certain empirical formula or the necessary changes in the addition and subtraction of medicine. (for deafness and tinnitus, with bitter mouth and dry throat, irritability and other evidence of liver fire, add flavor to gentian diarrhea liver soup), tonic deficiency method (mainly to tonify the kidneys), method of resolving blood stasis (commonly used to tonify Yang and return to the fifth soup), method of opening the orifices (musk is included in the prescription), etc., which are not only effective for those with short duration of illness, but also for some with longer duration of illness.
(2) Acupuncture and moxibustion therapy: The acupuncture points are taken locally by the ear and combined with the identification and treatment of the meridian, and the acupuncture techniques are generally based on diarrhea of the real and supplementation of the deficiency. There are also electroacupuncture, auricular acupuncture, acupoint injection and other treatment methods. Some clinical studies have shown that acupuncture alone is sometimes more effective than Western medicine alone.
16.What are the advantages of combining Chinese and Western medicine to treat sudden deafness?
Combination of Chinese and Western medicine is a unique treatment method in China. At present, it is common to use the combination of Chinese and Western medicine in the clinical treatment of this disease, but there is no unified standard for the specific application method. Many clinical observation studies have shown that the effect of combining Chinese and Western medicine has significantly improved compared with that of Western medicine alone, but the mechanism of the improvement is unknown and there is no report on this study.
17. Is the cure rate of sudden deafness high? What factors affect the prognosis?
There is no definite data on how high the cure rate of sudden deafness is. There is a tendency for the disease to heal on its own (improve or return to normal without treatment), with foreign reports showing some degree of improvement in hearing within 15 days in about 50-60% of patients, but domestic reports are far from that high. The main factors that affect the outcome or prognosis of this disease are.
(1) Time of consultation: The earlier the treatment after the onset of the disease, the better the effect. The efficiency of hearing recovery (including complete recovery and different degrees of hearing improvement) can reach up to 90% or more for those who visit the clinic within 2 weeks, and some reports can reach 100%; the later the time of consultation (after 2 weeks of the disease or later), the worse the effect.
(2) Patient age: older age (over 50 years old), the efficacy is poorer.
(3) The degree of hearing loss: hearing loss is more severe than hearing loss is less effective; hearing loss in the high-frequency region (4KHZ, 8KHZ) is less effective than hearing loss in the low-frequency region.
(4) Concomitant symptoms: those with vertigo are less effective.
18.How to judge the effect of sudden deafness?
The assessment of the effectiveness of sudden deafness is based on the level of hearing recovery.
(1) Cured: The hearing of the damaged frequency is restored to normal or to the level of the healthy ear, or to the level before the disease.
(2) Effective: The average hearing of the damaged frequency is improved by 30 dB (decibels) or more.
(3) Effective: The average hearing of the damaged frequency is improved by 15-30 dB.
(4) Ineffective: the average hearing improvement of damaged frequency is less than 15 dB.
19.What else can be done if sudden deafness is not cured and what kind of after-effects will there be?
The common symptoms of sudden deafness are deafness, tinnitus and vertigo. Among them, vertigo usually disappears completely; after treatment, at least 2/3 of patients will have improved or normalized hearing; and tinnitus disappears, decreases, or is permanently present in all cases. There are usually no other after-effects or complications, and it does not cause contralateral deafness or tinnitus, or recurrent attacks.
For those with poor outcomes and severe deafness with no or very poor outcomes, appropriate hearing aids, or cochlear implants may be considered to help improve hearing.