Critical Evaluation of Round Window Membrane Sealing in the Treatment of Idiopathic Sudden Unilateral Hearing Loss
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Objectives. Rupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL. Methods. The clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature. Results. Intraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery. Conclusion. The results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.
Abstract
Objectives. Rupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL. Methods. The clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature. Results. Intraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery. Conclusion. The results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.
참고문헌 (25)
- Sudden deafness, "National Institute of Health", Bethesda (MD): National Institutes of Health, ~, pp.NIH publication 00-4757 (2000)
- De Kleyn A, "Sudden complete or partial loss of function of the octavus-system in apparently normal persons", Acta Otolaryngol, 32(5-6), pp.407~429 (1944)
- Hallberg OE, "Sudden deafness of obscure origin", Laryngoscope, 66(10), pp.1237~1267 (1956)
- Kanzaki J, "Incidence and prognosis of acute profound deafness in Japan", Auris Nasus Larynx, 13(2), pp.71~77 (1986)
- Klemm E, "A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss", Laryngorhinootologie, 88(8), pp.524~527 (2009)
- Simmons FB, "The double-membrane break syndrome in sudden hearing loss", Laryngoscope, 89(1), pp.59~66 (1979)
- Goodhill V, "Sudden deafness and labyrinthine window ruptures. Audio-vestibular observations", Ann Otol Rhinol Laryngol, 82(1), pp.2~12 (1973)
- Kanzaki J, "Idiopathic sudden progressive hearing loss and round window membrane rupture", Arch Otorhinolaryngol, 243(3), pp.158~161 (1986)
- Mertens J, "Sudden deafness caused by rupture of the round window membrane. Surgical indications, course and prognosis", HNO, 34(8), pp.320~324 (1986)
- Tigges G, "Prognostic factors in hearing recovery following sudden unilateral deafness", HNO, 51(4), pp.305~309 (2003)
- Maier W, "Results of exploratory tympanotomy following sudden unilateral deafness and its effects on hearing restoration", Ear Nose Throat J, 87(8), pp.438~451 (2008)
- Gedlicka C, "Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss", Am J Otolaryngol, 30(3), pp.157~161 (2009)
- Kanzaki J, "Sudden deafness", Otorhinolaryngol Nova, 9(5), pp.198~202 (1999)
- Mattox DE, "Natural history of sudden sensorineural hearing loss", Ann Otol Rhinol Laryngol, 86(4 Pt 1), pp.463~480 (1977)
- Weinaug P, "Spontaneous remission in sudden deafness", HNO, 32(8), pp.346~351 (1984)
- Heiden C, "Hoing R. Spontaneous remission of sudden deafness", HNO, 48(8), pp.621~623 (2000)
- Labus J, "Meta-analysis for the effect of medical therapy vs. placebo on recovery of idiopathic sudden hearing loss", Laryngoscope, 120(9), pp.1863~1871 (2010)
- Veldman JE, "Diagnostic and therapeutic dilemmas in rapidly progressive sensorineural hearing loss and sudden deafness. A reappraisal of immune reactivity in inner ear disorders", Acta Otolaryngol, 113(3), pp.303~306 (1993)
- Stroud MH, "Spontaneous perilymph fistulas", Laryngoscope, 80(3), pp.479~487 (1970)
- House JW, "Putter JS. Perilymphatic fistula: surgical experience in the United States", Otolaryngol Head Neck Surg, 105(1), pp.51~61 (1991)
- Shelton C, "Perilymph fistula: the Stanford experience", Ann Otol Rhinol Laryngol, 97(2 Pt 1), pp.105~108 (1988)
- Muntarbhorn K, "Labyrinthine window rupture with round window predominance: a long-term review of 32 cases", Clin Otolaryngol Allied Sci, 12(2), pp.103~108 (1987)
- Vartiainen E, "Perilymph fistula: a diagnostic dilemma", J Laryngol Otol, 105(4), pp.270~273 (1991)
- Nagai T, "Labyrinthine window rupture as a cause of acute sensorineural hearing loss", Eur Arch Otorhinolaryngol, 269(1), pp.67~71 (2012)
- Pappas DG, "Perilymphatic fistula in pediatric patients with a preexisting sensorineural loss", Am J Otol, 10(6), pp.499~501 (1989)