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Robert W Baloh - One of the best experts on this subject based on the ideXlab platform.
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Sudden Deafness in vertebrobasilar ischemia clinical features vascular topographical patterns and long term outcome
Journal of the Neurological Sciences, 2005Co-Authors: Hyung Lee, Robert W BalohAbstract:Abstract Background and purpose The aim of this study is to document the clinical features and natural history of Sudden Deafness associated with vertebrobasilar ischemia (VBI) and to describe the vascular topographic patterns of ischemic lesions on brain MRI associated with Sudden Deafness based on data collected from a prospective acute stroke registry. Methods From 364 consecutive cases of VBI diagnosed by clinical features and brain MRI between January 2000 and September 2003, 29 patients were identified as having Sudden Deafness as a symptom of VBI. Results In our series, the incidence of Sudden Deafness following VBI is 8.0% (29/364). Hearing loss occurred unilaterally (n=27) or bilaterally (n=2). All but one had vertigo as an associated symptom. Nine patients (31%) presented with an isolated audiovestibular loss initially and subsequently had delayed neurological deficits. Nearly a half of patients (14/29: 48%) showed cochlear features of hearing loss. Seventeen (81%) of 21 patients who were followed for at least 1 year after onset of Sudden Deafness had a recovery of hearing partially (n=10) or completely (n=7). The improvement rate of hearing loss in patients with profound hearing loss was significantly lower than that in patients with less than profound hearing loss (40% vs. 89%, P Conclusion An isolated Sudden Deafness with cochlear audiometric features can be the initial presentation of VBI. Sudden Deafness due to VBI often has a good outcome. There is topographic heterogeneity of ischemic lesions on brain MRI in patients with Sudden Deafness due to VBI.
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Sudden Deafness with vertigo as a sole manifestation of anterior inferior cerebellar artery infarction
Journal of the Neurological Sciences, 2004Co-Authors: Robert W BalohAbstract:Abstract Sudden Deafness without associated neurological symptoms and signs is typically attributed to a viral inflammation of the labyrinth. Although Sudden Deafness occurs with anterior inferior cerebellar artery (AICA) infarction, the Deafness is usually associated with other brainstem or cerebellum signs such as crossed sensory loss, lateral gaze palsy, facial palsy, Horner syndrome or cerebellar dysmetria. An 84-year-old woman Suddenly developed right-sided tinnitus, hearing loss, vertigo and vomiting. Audiometry and electronystagmography documented absent auditory and vestibular function on the right side. T2-weighted and diffusion-weighted MRI showed a tiny infarct in the right lateral inferior pontine tegmentum. AICA occlusion can cause Sudden Deafness and vertigo without brainstem or cerebellar signs.
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Sudden Deafness and anterior inferior cerebellar artery infarction
Stroke, 2002Co-Authors: Hyung Lee, Sung Il Sohn, Dookyo Jung, Yongwon Cho, Jeonggeung Lim, Seongryong Lee, Chul Ho Sohn, Robert W BalohAbstract:Background and Purpose— Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness, and gait ataxia. Few reports have carefully examined the Deafness associated with the AICA infarction. Furthermore, previous neurological reports have not emphasized the inner ear as a localization of Sudden Deafness. The aim of this study was to investigate the incidence of Deafness associated with the AICA infarction and the sites predominantly involved in Deafness. Methods— Over 2 years, we prospectively identified 12 consecutive patients with unilateral AICA infarction diagnosed by brain MRI. Pure-tone audiogram, speech discrimination testing, stapedial reflex testing, and auditory brainstem response were performed to localize the site of lesion in the auditory pathways. Electronystagmography was also performed to evaluate the function of the vestibular system. Results— The most common affected site on brain MRI was the ...
Tsutomu Nakashima - One of the best experts on this subject based on the ideXlab platform.
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3 tesla magnetic resonance imaging obtained 4 hours after intravenous gadolinium injection in patients with Sudden Deafness
Acta Oto-laryngologica, 2010Co-Authors: Mitsuhiko Tagaya, Masaaki Teranishi, Shinji Naganawa, Tomoyuki Iwata, Tadao Yoshida, Hironao Otake, Seiichi Nakata, Michihiko Sone, Tsutomu NakashimaAbstract:Conclusion: 3 Tesla (3T) magnetic resonance imaging (MRI) performed 4 h after intravenous gadolinium (Gd) injection provides sufficient anatomic resolution of the inner ear fluid spaces in Sudden Deafness. The signal intensity ratio (SIR) between the cochlea and cerebellum may be a good indicator of disruption of the blood–labyrinthine barrier. Objectives: We evaluated the inner ear 4 h after intravenous Gd injection to determine whether 3T MRI enables the acquisition of images of the affected inner ear in Sudden Deafness. Methods: Ten patients underwent 3T MRI scanning 4 h after intravenous Gd injection. Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI was performed. Results: The SIR varied from 0.45 to 2.17 in 11 affected ears and from 0.43 to 1.48 in 9 unaffected ears. The difference of contrast (affected ear vs unaffected ear) could be detected in five of the nine patients with unilateral Sudden Deafness. The Gd distribution was recognized in the vestibule of 10 affected ears and i...
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thirty year trends in Sudden Deafness from four nationwide epidemiological surveys in japan
Acta Oto-laryngologica, 2007Co-Authors: Masaaki Teranishi, Naomi Katayama, Yasue Uchida, Mitsuo Tominaga, Tsutomu NakashimaAbstract:Conclusions. The estimated annual number of patients with Sudden Deafness treated in Japan has increased during the last 30 years, especially in the elderly population. Hypertension and diabetes mellitus could contribute to the etiology of this disorder. Objectives. To investigate the epidemiological trends of Sudden Deafness in Japan over the past 30 years by analyzing data from national surveys. Materials and methods. Nationwide epidemiological surveys on Sudden Deafness were conducted four times by the Research Committee of the Ministry of Health and Welfare in Japan. The first, second, third, and fourth surveys were performed in 1972, 1987, 1993, and 2001, respectively. Results. The estimated annual numbers of patients with Sudden Deafness treated in Japan were 4000 in 1972; 16 700 in 1987; 24 000 in 1993, and 35 000 in 2001.The average ages of patients at onset were 39.1, 45.4, 49.3, and 51.3 years, respectively. Thus, both the number of patients and the average age of patients with Sudden Deafness h...
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cochlear modiolus and lateral semicircular canal in Sudden Deafness
Acta Oto-laryngologica, 2007Co-Authors: Ieda Maria Ishida, Shinji Naganawa, Masaaki Teranishi, Makoto Sugiura, Tsutomu NakashimaAbstract:Conclusion. This study demonstrated that precise analysis shows that the inner ear shape in Sudden Deafness (SD) is different from that in controls in that the fluid-filled area of SD labyrinths is significantly larger than that of controls. Reduced cochlear modiolus area and inner area of the lateral semicircular canal (LSCC) may be associated with insufficient maturation of the inner ear. Objective. The aim of this study was to quantify the morphologies of the cochlea and LSCC using magnetic resonance imaging (MRI) and to evaluate their relationships with clinical symptoms in SD. Subjects and methods. Twenty-six unilateral SD patients with vertigo, 26 unilateral SD patients without vertigo and a matched control group without hearing loss were studied. The areas of cochlear modioli and LSCCs were traced on the MRI console and compared between SD patients with or without vertigo and control subjects. The ratio of the LSCC fluid-filled area to the total LSCC area was used to index the degree of dysplasia. Results. The cochlear modiolus area was significantly less in SD ears (4.190.2 mm 2 ) than in controls (4.390.4 mm 2 ). The LSCC inner area was significantly less in SD ears (6.99 1.7 mm 2 ) than in controls (9.191.8 mm 2 ). These results suggest that the fluid-filled area of SD labyrinths is significantly larger than controls. Morphology did not differ between affected and contralateral sides or between ears with or without vertigo in SD patients.
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Sudden Deafness long term follow up and recurrence
Clinical Otolaryngology, 2002Co-Authors: Atsushi Furuhashi, K Matsuda, Kiyomitsu Asahi, Tsutomu NakashimaAbstract:We examined the long-term outcome for patients with idiopathic Sudden sensorineural hearing loss (Sudden Deafness), including the incidence of recurrence of Sudden Deafness. The subjects were 1,798 individuals who came to Nagoya University hospital within 2 weeks of the onset of unilateral Sudden Deafness. Only 14 of the patients had a history of being diagnosed with Sudden Deafness. After their visit to our hospital, one patient had a recurrence in the ipsilateral ear and four patients experienced Sudden Deafness in the contralateral ear. We performed hearing examinations on 88 patients who revisited our hospital more than 10 years after unilateral Sudden Deafness. Of these patients, there was one with a recurrence in the ipsilateral ear and one with Sudden Deafness in the contralateral ear. Thus, in this series the recurrence of Sudden Deafness was rare.
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japanese and western diet and risk of idiopathic Sudden Deafness a case control study using pooled controls
International Journal of Epidemiology, 2001Co-Authors: Mieko Nakamura, Tsutomu Nakashima, Nobuo Aoki, Tomoyuki Hoshino, Tetsuji Yokoyama, Seiji Morioka, Takashi Kawamura, Heizo Tanaka, Gary Whitlock, Tsutomu HashimotoAbstract:Background One of the proposed aetiological mechanisms for idiopathic Sudden Deafness is vascular disease. However, it is not known whether traditional cardiovascular risk factors, such as particular dietary factors, are associated with this condition. Methods A case-control study using pooled controls was conducted in Japan to investigate the relationship between idiopathic Sudden Deafness and diet. An m:n matchedpairs method was used to obtain age-, gender- and residential district-matched controls from a nationwide database of pooled controls. Food intake was assessed from a self-administered usual food frequency questionnaire that asked about intake of 35 foods (including four drinks). Participants were classified according to the frequency of intake of Western foods and the frequency of intake of traditional Japanese foods. Subgroup analyses were performed using audiometric subtypes of idiopathic Sudden Deafness. Results Data were obtained for 164 cases and 20 313 controls. An increased risk of Sudden Deafness was observed among participants who frequently consumed Western foods (OR = 1.82, 95% CI : 1.14‐2.89), and a decreased risk of this condition was observed among participants who frequently consumed Japanese foods (OR = 0.52, 95% CI : 0.33‐0.82). A direct association of Sudden Deafness with Western food intake was evident for flat-type hearing loss. Conclusions This study suggests that a largely Western diet might be a risk factor for idiopathic Sudden Deafness, a traditional Japanese diet might be a preventive factor for this condition, or both. These findings are consistent with the hypothesis that vascular factors are an important cause of idiopathic Sudden Deafness, although the possibility of residual confounding by unmeasured confounders such as socioeconomic status cannot be ruled out.
Juenhaur Hwang - One of the best experts on this subject based on the ideXlab platform.
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risks of tinnitus sensorineural hearing impairment and Sudden Deafness in patients with non migraine headache
PLOS ONE, 2019Co-Authors: Yichun Chen, Shiangjiun Tsai, Jincherng Chen, Juenhaur HwangAbstract:Tinnitus and hearing impairment are prevalent among headache patients. This study aims to investigate the risk of tinnitus, sensorineural hearing impairment, and Sudden Deafness in patients with non-migraine headache. Participants included 43 294 patients with non-migraine headache (non-migraine headache cohort) and 173 176 patients with no headache of any type (control cohort) frequency-matched with respect to 10-year age interval and sex from the Longitudinal Health Insurance Database 2005 of the Taiwan National Health Insurance Research Database. The mean age of the non-migraine headache cohort was 28.4 ± 14.9 years, and 58.5% of this cohort was male. The incidence rates of tinnitus, sensorineural hearing impairment, and Sudden Deafness were compared between cohorts using the Kaplan-Meier method with the log-rank test. A Cox proportional hazard model was used to examine the association of tinnitus, sensorineural hearing impairment, and Sudden Deafness with non-migraine headache, with adjustment for all covariates. The combined risk of either tinnitus, sensorineural hearing impairment, or Sudden Deafness was higher in the non-migraine headache cohort than in the control cohort (adjusted odds ratio [aHR], 2.73; 95% confidence interval [95% CI], 2.62-2.84; p < 0.0001). Subgroup analysis showed that patients in the non-migraine headache cohort were at significantly higher risk of developing tinnitus (aHR, 3.05; 95% CI, 2.91-3.19; p < 0.0001), sensorineural hearing impairment (aHR, 1.89; 95% CI, 1.74-2.05; p < 0.0001), and Sudden Deafness (aHR, 2.14; 95% CI, 1.77-2.59; p < 0.0001) than were controls. In this population-based study, the risks of tinnitus, sensorineural hearing impairment, and Sudden Deafness were found to be significantly higher in patients with non-migraine headache than in those without headache.
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risk of peripheral artery occlusive disease in patients with vertigo tinnitus or Sudden Deafness a secondary case control analysis of a nationwide population based health claims database
PLOS ONE, 2016Co-Authors: Malcolm Koo, Jincherng Chen, Juenhaur HwangAbstract:Background Cochleovestibular symptoms, such as vertigo, tinnitus, and Sudden Deafness, are common manifestations of microvascular diseases. However, it is unclear whether these symptoms occurred preceding the diagnosis of peripheral artery occlusive disease (PAOD). Therefore, the aim of this case-control study was to investigate the risk of PAOD among patients with vertigo, tinnitus, and Sudden Deafness using a nationwide, population-based health claim database in Taiwan. Methods We identified 5,340 adult patients with PAOD diagnosed between January 1, 2006 and December 31, 2010 and 16,020 controls, frequency matched on age interval, sex, and year of index date, from the Taiwan National Health Insurance Research Database. Risks of PAOD in patients with vertigo, tinnitus, or Sudden Deafness were separately evaluated with multivariate logistic regression analyses. Results Of the 5,340 patients with PAOD, 12.7%, 6.7%, and 0.3% were diagnosed with vertigo, tinnitus, and Sudden Deafness, respectively. In the controls, 10.6%, 6.1%, and 0.3% were diagnosed with vertigo (P < 0.001), tinnitus (P = 0.161), and Sudden Deafness (P = 0.774), respectively. Results from the multivariate logistic regression analyses showed that the risk of PAOD was significantly increased in patients with vertigo (adjusted odds ratio = 1.12, P = 0.027) but not in those with tinnitus or Sudden Deafness. Conclusions A modest increase in the risk of PAOD was observed among Taiwanese patients with vertigo, after adjustment for comorbidities.
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risk of peripheral artery occlusive disease in patients with vertigo tinnitus or Sudden Deafness a secondary case control analysis of a nationwide population based health claims database
PLOS ONE, 2016Co-Authors: Jincherng Chen, Juenhaur HwangAbstract:Background Cochleovestibular symptoms, such as vertigo, tinnitus, and Sudden Deafness, are common manifestations of microvascular diseases. However, it is unclear whether these symptoms occurred preceding the diagnosis of peripheral artery occlusive disease (PAOD). Therefore, the aim of this case-control study was to investigate the risk of PAOD among patients with vertigo, tinnitus, and Sudden Deafness using a nationwide, population-based health claim database in Taiwan.
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Multivariate logistic regression analysis of the risk of peripheral artery occlusive disease among patients with vertigo, tinnitus, or Sudden Deafness.
2016Co-Authors: Malcolm Koo, Jincherng Chen, Juenhaur HwangAbstract:Multivariate logistic regression analysis of the risk of peripheral artery occlusive disease among patients with vertigo, tinnitus, or Sudden Deafness.
Yi-ho Young - One of the best experts on this subject based on the ideXlab platform.
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Sudden Deafness a comparison between age groups
International Journal of Audiology, 2021Co-Authors: Weichen Hung, Powen Cheng, Kueiyou Lin, Yi-ho YoungAbstract:This study compared Sudden Deafness (SD) cases in 20-year age bands to investigate their causes and treatment outcome.Retrospective study.178 unilateral SD patients were divided into four 20-year a...
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geriatric Sudden Deafness
American Journal of Otolaryngology, 2021Co-Authors: Bangyan Zhang, Yi-ho YoungAbstract:Abstract Purpose Sudden sensorineural hearing loss, briefly Sudden Deafness (SD), in the elderly remains less investigated despite rapidly aging population in most countries around the world. This study investigated whether aging process affects the treatment outcome of SD in the elderly. Patients and methods Eighty patients with SD, comprising 40 geriatric patients aged >65 years and 40 non-geriatric patients aged 55–64 years, were enrolled in this study. All patients underwent an inner ear test battery including audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP), and caloric tests. Results Pre-treatment mean hearing level in the geriatric group (94 ± 16 dB) did not significantly differ from non-geriatric group (89 ± 20 dB). After treatment for 3 months, mean hearing gain in the geriatric group (22 ± 18 dB) with an improvement rate of 65%, did not significantly differ from non-geriatric group (21 ± 28 dB) with 58% improvement rate. Both inter-subject and intra-subject analyses revealed that the aging process greatly influenced the cVEMP and oVEMP responses, while less influenced the caloric responses. Conclusion The treatment outcome of SD in geriatric patients aged >65 years did not significantly differ from that in non-geriatric patients aged 55–64 years, indicating that aging process did not affect treatment outcome of SD. Unlike treatment outcome for the presbycusis is unsatisfactory, treatment outcome for the elderly with SD could be favorable.
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declining prevalence of pediatric Sudden Deafness during the past two decades
International Journal of Pediatric Otorhinolaryngology, 2019Co-Authors: Bangyan Zhang, Yi-ho YoungAbstract:Abstract Objective This study compared the prevalence of Sudden Deafness (SD) in children to investigate the evolution of pediatric SD during the past two decades. Methods From 1996 to 2005, totaling 358 SD patients were experienced. Of them, 25 patients (7%) aged Results The measles-mumps-rubella (MMR) vaccination reached to 95% vaccination rate in Taiwan after 1994. As 1994 (MMR vaccination years) + 11 (mean age of pediatric SD) equals 2005, this study found that declining prevalence of pediatric SD was from 7% (1996–2005) to 2% (2006–2015) at our hospital, consistent with declining annual cases of SD in Taiwan during the past decades. A significantly higher abnormality rate of mean hearing level (93%) than abnormal caloric responses (20%) was identified indicating that pediatric SD predominately affected the cochlear partition. Conclusion The prevalence of pediatric SD cases has significantly declined during the past 20 years, probably due to global vaccination policy. Other causal factors such as growing numbers of hospital and advancement in radiological diagnostic technique may also contribute to the declining prevalence.
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Sudden Deafness during antepartum versus postpartum periods
Operations Research Letters, 2017Co-Authors: Bangyan Zhang, Yi-ho YoungAbstract:Objective This study reviewed our experience in treating Sudden Deafness in antepartum (pregnant) and postpartum women during the past 2 decades. Methods From 1997 to 2016, we have recorded Sudden Deafness in 16 antepartum (mean age, 32 years) and 3 postpartum (mean age, 31 years) women. Sudden Deafness occurred during the 1st, 2nd, and 3rd trimesters in 5, 4, and 7 antepartum women, respectively. In contrast, the mean interval between giving birth and symptom onset in the 3 postpartum women was 18 days. Each patient underwent an inner ear test battery. Results In 8 antepartum women treated by dextran infusion, the outcome as regards hearing was improved in 7 patients (88%) and unchanged in 1 patient. In contrast, the other 8 antepartum women selected no treatment, and only 1 patient (12%) achieved hearing improvement, exhibiting a significantly better outcome when receiving dextran treatment. For the postpartum women, 2 patients had hearing improvement when treated by antioxidants, while 1 patient retained unchanged hearing without treatment. Conclusion Medication is needed in Sudden Deafness in antepartum or postpartum women rather than waiting for a natural course. No adverse effects have been identified in any of the mothers or offspring 1 year after delivery.
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N-acetylcysteine as a single therapy for Sudden Deafness
Acta oto-laryngologica, 2016Co-Authors: Chao-hsien Chen, Yi-ho YoungAbstract:AbstractConclusion: Like NAC ameliorates hearing loss from acoustic trauma in the inner ear, NAC may also rescue hearing loss from Sudden Deafness confined to the inner ear.Objective: This study assesses the effect of N-acetyl-L-cysteine (NAC) as a single therapy for Sudden Deafness.Methods: Thirty-five Sudden Deafness patients with neither systemic disorders nor central signs in electronystagmography were treated with NAC alone and assigned to Group A. For comparison, another 35 Sudden Deafness patients treated by corticosteroids and plasma expander were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and pre-treatment mean hearing level. All patients underwent an inner ear test battery comprising audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests.Results: Groups A and B did not significantly differ in the pre-treatment mean hearing level, and percentages of abnormal oVEMP, cVEMP...
Tatsunori Sakamoto - One of the best experts on this subject based on the ideXlab platform.
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a randomized controlled clinical trial of topical insulin like growth factor 1 therapy for Sudden Deafness refractory to systemic corticosteroid treatment
BMC Medicine, 2014Co-Authors: Takayuki Nakagawa, Kozo Kumakawa, Shinichi Usami, Naohito Hato, Keiji Tabuchi, Mariko Takahashi, Keizo Fujiwara, Akira Sasaki, Shizuo Komune, Tatsunori SakamotoAbstract:Background To date, no therapeutic option has been established for Sudden Deafness refractory to systemic corticosteroids. This study aimed to examine the efficacy and safety of topical insulin-like growth factor-1 (IGF-1) therapy in comparison to intratympanic corticosteroid therapy.
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a randomized controlled clinical trial of topical insulin like growth factor 1 therapy for Sudden Deafness refractory to systemic corticosteroid treatment
BMC Medicine, 2014Co-Authors: Takayuki Nakagawa, Kozo Kumakawa, Shinichi Usami, Naohito Hato, Keiji Tabuchi, Mariko Takahashi, Keizo Fujiwara, Akira Sasaki, Shizuo Komune, Tatsunori SakamotoAbstract:To date, no therapeutic option has been established for Sudden Deafness refractory to systemic corticosteroids. This study aimed to examine the efficacy and safety of topical insulin-like growth factor-1 (IGF-1) therapy in comparison to intratympanic corticosteroid therapy. We randomly assigned patients with Sudden Deafness refractory to systemic corticosteroids to receive either gelatin hydrogels impregnated with IGF-1 in the middle ear (62 patients) or four intratympanic injections with dexamethasone (Dex; 58 patients). The primary outcome was the proportion of patients showing hearing improvement (10 decibels or greater in pure-tone average hearing thresholds) 8 weeks after treatment. The secondary outcomes included the change in pure-tone average hearing thresholds over time and the incidence of adverse events. In the IGF-1 group, 66.7% (95% confidence interval [CI], 52.9-78.6%) of the patients showed hearing improvement compared to 53.6% (95% CI, 39.7-67.0%) of the patients in the Dex group (P = 0.109). The difference in changes in pure-tone average hearing thresholds over time between the two treatments was statistically significant (P = 0.003). No serious adverse events were observed in either treatment group. Tympanic membrane perforation did not persist in any patient in the IGF-1 group, but did persist in 15.5% (95% CI, 7.3-27.4%) of the patients in the Dex group (P = 0.001). The positive effect of topical IGF-1 application on hearing levels and its favorable safety profile suggest utility for topical IGF-1 therapy in patients with Sudden Deafness. UMIN Clinical Trials Registry Number UMIN000004366 , October 30th, 2010.
