Furrukh Younus.
Clinical Applicability of Diagnostic and Prognostic Factors in Determining Treatment Outcomes and Prognosis for Sudden Sensorineural Hearing Loss.
Int J Rehab Sci Jan ;06(01):39.

Background: Sudden sensorineural hearing loss is a multifaceted condition defined as sensorineural hearing loss of 30dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hour period. Objectives: The aim of this study is to critically evaluate clinical applicability of different diagnostic and prognostic factors for patients with sudden sensorineural hearing loss and outline their influence on treatment outcome and prognosis of SSNHL. Methods: Data Sources: A MEDLINE search and hand search were conducted to identify RCTs published between 2007 and February 2014 in the English language on the diagnosis, treatment outcome and prognosis of SSHL. Prospective RCTs on Sudden sensorineural hearing loss (SSNHL). One independent observer extracted study data. Validity was evaluated using standard criteria. Characteristics and results were reviewed systematically. Material: This is a systematic review that followed the precepts of Cochrane Handbook as the formulation of the question, location, selection and evaluation of the articles and also from Swedish national database for SSNHL. Patient evaluation done with regard to diagnostic protocol and treatment and by information gathered using questionnaires for important prognostic factors including epidemiologic, demographic, neurotologic and audiometric factors. Other important predictors used were age, past medical history, potential precipitating events, family medical history, severity of hearing loss, vertigo and any current disease at their first follow-up done and correlation with serial audiograms for each patient on follow-up. Results: Initial hearing loss appears to be related to the hearing recovery. 32%to 65% of patients with idiopathic SSNHL, in some studies, have shown to recover their hearing, typically within 2 weeks of onset, which suggests a relatively high spontaneous resolution rate in the natural history even without treatment. Factors including older age, presence of associated vertigo, and a flat pattern of hearing loss across frequencies (as opposed to only low and mid frequencies) appear to have negative effect on recovery. In another study evaluating diagnostic tests 65% of the patients underwent hematological tests and 40% had an imaging CT/MRI. 13.75% of MRI cases revealed pathological findings, 75% of the patients were evaluated as idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological tests. No significant correlation was found between either the MRI findings or the laboratory findings with regard to either treatment or hearing recovery in patients with ISSNHL. Conclusion: No correlation between laboratory findings, treatment and outcome was demonstrated in results from a database for SSNHL. Also, for the majority of patients an etiologic factor is not identified. The patients with pathological tests were not treated differently from those with normal tests or no tests taken. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. Treatment for SSNHL of etiology is directed toward that agent, with poor hearing outcomes characteristic for discoverable etiologies that cause inner ear hair cell loss. The prognosis for hearing recovery for idiopathic SSNHL is dependent on a number of factors including the severity of hearing loss, age, presence of vertigo, and shape of the audiogram.

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