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December 5, 2002

New Therapy For Sudden Sensorineural Hearing Loss

From: Doctor's Guide, Canada - 05 Dec 2002


By Harvey McConnell

Single fibrinogen/LDL apheresis could be an effective therapeutic option in treatment of sudden hearing loss , a multi-centre German trial has found.

The remission rate of speech perception in the patients given apheresis was significantly higher than in those given standard treatment, reports Dr M Suckfill, Klinikum Gro hadern, Minchen and colleagues in the Hearing Loss Study Group. The trial was among 201 patients with sudden hearing loss at four otorhinolaryngology clinics.

Incidence of sudden sensorineural hearing loss (SSHL) has been attributed to disturbance of cochlear microcirculation, viral infection, an immunopathological process, or an overlap of such mechanisms, the clinicians note. It is characterized by sudden-onset hearing loss that can resolve within hours or days, and unilateral symptoms indicate vascular disturbance.

Patients were randomly allocated to single fibrinogen/LDL apheresis lasting for two hours, or standard treatment of 250 mg prednisolone reduced by 25 mg per day, 500 mL 6 % hydroxyethyl starch, 400 mg pentoxifylline per day.

The clinicians found that overall improvement of pure-tone thresholds was slightly but not significantly better in patients given apheresis than in those given standard treatment. However, the mean sound level at which 50 percent of recorded digits were recognized was significantly lower after 48 hours in the apheresis group. At six weeks, the mean 50 percent speech perception was at 13.6 dB in the apheresis group and at 20.8 dB in those on standard treatment.

At 48 hours, among patients with plasma fibrinogen concentrations of more than 295 mg/dL, speech perception was improved much more in those on apheresis than in those on standard treatment.

Dr Suckfill and colleagues said their finding that patients with LDL concentrations above 3.49 mmol/L or fibrinogen concentrations above 8.68 micromol/L, or both "benefit significantly more from apheresis treatment than do than those with lower concentrations lends support to the notion that SSHL has several causes and is not caused just by vascular disturbances. We assume that, in patients with high plasma fibrinogen or LDL cholesterol, vascular events are the main reason for SSHL and therefore apheresis treatment is especially effective."

They conclude that their results suggest that both fibrinogen and LDL cholesterol should be considered important compounds for diagnosis and treatment of SSHL.
Lancet 2002; 360: 1811-17.

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