1.What is sudden deafness
Sudden deafness is the sudden onset of 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 cause of sudden deafness is unknown and may be related to many factors, currently it is believed that there are two main categories.
(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) Inner ear blood supply disorder (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 disorder occurs in the inner ear blood vessels 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 excitement, etc., can cause vascular dysfunction or microcirculation disorders in some important parts of the body, which can lead to sudden 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, 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 at the same time 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 feeling of obstruction or pressure in the ear or in the ear, peri-peri-peri numbness.
5.What tests are generally required for sudden deafness
(1)General otologic examination: external auditory canal and tympanic membrane are normal.
(2)Electrical audiometric examination: sensorineural deafness is present, and the hearing loss curve can be ascending, steeply 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 relief of vertigo symptoms; normal results of CT and MRI examination of the internal auditory tract and cranial brain when they belong to normal results; normal results of blood examination and laboratory tests.
6.How to distinguish sudden deafness from Meniere’s disease when the same tinnitus, deafness and vertigo are present?
Both sudden deafness and Ménière’s disease have tinnitus, deafness, and vertigo symptoms.
(1) Different medical history. 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. During 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 enhancement after treatment; while Meniere’s disease detects hearing 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, the degree of its hearing loss becomes more severe.
7.What diseases should be distinguished from sudden 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 the sudden onset of deafness, which may or may not have a definite cause, and the nature of the deafness may or may not be sensorineural. 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 disorders cannot be considered sudden deafness.
(1) Membrane vagus rupture: Sudden deafness that occurs after a change in head pressure due to diving, diving, blowing, sneezing, trauma, and many other causes that produce a rupture of the membrane vagus in the inner ear.
(2) Meniere’s disease.
(3)Intracranial tumor.
(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 (e.g., mumps, herpes zoster).
(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 doctor can decide whether a differential examination is needed based on the corresponding suspicious circumstances, among which, especially when intracranial lesions need to be excluded, the doctor 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 habitually include such patients into the category of “sudden deafness”. The clinicians usually treat these patients under the category of “sudden deafness”.
8. Sudden deafness is an otologic emergency, and early hospitalization is recommended.
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) tissue and organs, which 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 early hospitalization is recommended for comprehensive treatment to save hearing.
9.The treatment principle of sudden deafness: early comprehensive treatment and active search for the cause
The most serious danger of sudden deafness is the different and often 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 the 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.
The so-called “early” means that the disease should be treated within 2 weeks of its onset as much as possible; the so-called “comprehensive therapy” means the integrated use of multiple methods, including.
(1) General treatment: pay attention to rest, appropriate sedation (especially when tinnitus is severe), and actively treat related diseases, such as diabetes and hypertension.
(2) Drug treatment: 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 hyperbaric oxygen, physiotherapy, Chinese herbal medicine, acupuncture therapy, Chinese herbal medicine, or combined Chinese and Western medicine, etc.
However, there is no uniform specification 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, and are classified as “optional” or “recommended” in the latest U.S. medication guidelines for sudden deafness. It is mainly used for early treatment (within 2 weeks of the disease); secondly, it is administered locally (tympanic chamber), mainly for those who have poor results after early treatment.
11.What is the applicability of antiviral drugs in the treatment of sudden deafness?
Antiviral drugs are mainly used for the early treatment of patients with possible viral infection factors (often with a history of cold or upper respiratory tract infection before the onset of sudden deafness). Glucocorticoids are used in combination with these drugs to enhance their efficacy.
12. What is the applicability of medications 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 for improving inner ear microcirculation, and different drugs have different characteristics, and each drug 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 among the drugs of choice in Europe for the treatment of this disease and acute tinnitus.
(2) Low molecular dextrose (injection).
(3) Prostaglandins: such as prostaglandin (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 preparations: there are extremely many such drugs, such as compound danshen injection, geranoside injection, Chuanxiongzin injection, pulsatilla injection, live brain injection, haemosiderin (injection, oral agent), lanugenia (lanugenia fine spice) preparation (injection, oral agent), ginkgo biloba preparation, panax quinquefolium 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 such as: viper antithrombin, Dongling antithrombin, fibrin-lowering enzyme, urokinase, etc.
14.What is the applicability of neurotrophic drugs in the treatment of sudden deafness?
The site of sudden deafness is mainly in the cochlea, which is the end organ of the auditory nerve tissue. It is often treated with neurotrophic drugs. These drugs include vitamin B, ATP (adenosine triphosphate), CTP (cytidine triphosphate), coenzyme A, sodium cytarabine, cerebrolysin (also known as cardiac cerebrolysin, cardiac cerebrolysin, cerebrolysin, cerebrolysin, etc.), nerve growth factor (sulforaphane), etc.
15.How to apply mixed oxygen and hyperbaric oxygen to treat sudden deafness and what is the effect?
The inner ear (cochlea) is particularly sensitive to hypoxia, and prolonged hypoxia can easily lead to irreversible necrosis. Mixed oxygen (oxygen containing 2-6% carbon dioxide; when inhaled in a high-pressure chamber, it is called high-pressure mixed oxygen) or hyperbaric oxygen (100% pure oxygen, inhaled at a pressure higher than 1 atmosphere) treatment can increase the oxygen content in the blood, thus normalizing the inner ear tissues from a hypoxic state to ensure normal metabolism and normal function of inner ear tissues. Mixed oxygen or hyperbaric oxygen treatment for this disease can significantly improve the patient’s hearing or achieve a cure with high efficiency, the earlier the treatment (within 2 weeks) the better the effect, and the disease duration in 1-6 months, the effect decreases significantly. Mixed oxygen therapy (continuous inhalation of mixed oxygen under atmospheric pressure for 30 minutes, rest for 30 minutes, then 30 minutes again) or hyperbaric oxygen therapy (special hospital equipment required), once a day, 10 times for a course of treatment, generally more than 3 courses of treatment, the obvious effect is visible at the end of the first course of treatment, the most significant effect of the third treatment, the longer the course of treatment, the more significant effect, the more consolidated the effect.
16.Is Chinese medicine treatment effective for sudden onset deafness?
Chinese medicine is a basic method to treat this disease. 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, which emphasizes on the identification and treatment based on the disease mechanism, or using a certain basic method and applying a certain empirical formula or making necessary changes in the addition and subtraction of medicine. (for deafness with tinnitus, dry mouth and throat, irritability and other evidence of liver fire, gentian diarrhea of liver soup with added flavor), the method of tonifying deficiency (mainly tonifying the kidney), the method of resolving blood stasis (commonly used to tonify Yang and return the fifth soup with addition and reduction), the method of opening the orifice (prescription contains musk), etc., which are not only effective for those with short duration of illness, but also for those 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 needle running techniques are generally based on the diarrhea of the real and the 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.
17.What are the advantages of combining Chinese and Western medicine in the treatment of 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. However, the mechanism of the improvement is unknown, and there is no report on the study.
18.Is the cure rate of sudden deafness high? What factors affect the prognosis?
There is no definite data on the cure rate of sudden deafness. The disease has a tendency to heal on its own (it can improve or return to normal without treatment), and about 50%-60% of patients reported abroad have some degree of improvement in hearing within 15 days, while many patients reported in China are far less likely to become permanently deaf if left untreated. The main factors affecting 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) degree of hearing loss: hearing loss is more severe than hearing loss is less effective; high frequency area (4KHZ, 8KHZ) hearing loss is less effective than low frequency area hearing loss.
(4) Concomitant symptoms: those with vertigo are less effective.
19.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 damaged frequency hearing is restored to normal or to the level of the healthy ear, or to the level before the disease.
(2) Significant effect: 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 15dB.
20.What else can be done if sudden deafness is not cured and what kind of sequelae 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, tinnitus, or recurrent attacks.
For those with poor outcomes, severe deafness with no or very poor outcomes, appropriate hearing aids, or cochlear implants may be considered to help improve hearing.