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DGDispatch
Patients with Sudden Sensorineural Hearing Loss Respond to Steroid and Antiviral Therapy: Presented at AAO-HNSF
By Paula Moyer
Special to DG News
SAN DIEGO, CA -- September 23, 2002 -- Patients with sudden sensorineural hearing loss (SSNHL) respond well to a combination course of steroids and antiviral therapy, and those with vertigo have an even more favourable prognosis than those without vertigo, according to Dr. Mani Zadeh.
Although steroid therapy is used routinely for SSNHL, antiviral therapy has been controversial, said Dr. Zadeh, chief resident of otolaryngology at Columbia University in New York. He also noted that SSNHL patients with vertigo typically have a worse prognosis than those without.
Collaborating with him in the research, presented here at the 106th annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, were Dr. Ian Storper and Jaclyn B. Spitzer, PhD, both professors of otolaryngology at Columbia University.
The investigators reviewed the charts of 51 patients, 30 men and 21 women, who had presented to the otology service over the past eight years. All patients in the chart review had been seen and had begun treatment within seven days of onset of SSNHL, which was defined as at least a 10-decibel loss that occurred in at least three frequencies. At the time of treatment, the patients' average age was 49 years. Among these patients, 11 (22 percent) had vertigo as well as SSNHL.
All patients received a course of dexamethasone 4 mg four times daily for a week and then tapered for two weeks. In addition, they simultaneously received two antiviral medications, a one-week course of valcyclovir (Valtrex) and a three-week course of famotidine.
The investigators defined recovery of hearing, based on the pre- and post-treatment audiogram, as the main outcome measure. Among the 51 patients, 37 (73 percent) reported complete recovery of hearing at follow-up. These self-reports were confirmed by audiograms. The investigators found that all patients who had mid-frequency hearing loss and an up-sloping audiogram had a complete response to treatment.
The recovery rate of 73 percent, exceeds the typical spontaneous recovery rate of 67 percent, said Dr. Madeh. In the 11 patients with vertigo, the recovery rate was 91 percent; 67 percent of those without vertigo recovered completely.
"There may be a viral component to SSNHL," Dr. Zadeh said. We may have had a better response than is typically seen because the therapy course was more aggressive than is typically seen."
The results were surprising, he said, because the literature has shown that patients with vertigo have a poor outcome. "Vertigo is no longer a poor prognosticator," he said. On the basis of their findings, he and his co-investigators are planning a prospective study that will compare different doses of antivirals and steroids in order to find the optimal dosages.
The research was not funded by any pharmaceutical company.
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