Scientists evaluate oral, injection therapies for sudden deafness

By Russell Rian

UT Southwestern is one of 16 medical centers selected by the National Institutes of Health to help evaluate therapies for sudden deafness, a condition in which patients lose much or all of their hearing in one ear within a 72-hour period, sometimes without warning or earlier symptoms.

The cause of sudden sensorineural hearing loss remains a mystery, but sudden deafness is considered a medical emergency. Patients may have muffled hearing or complete hearing loss, and usually need proper diagnosis and treatment within 14 days of its onset. Sudden deafness can also be accompanied by ringing in the ear, dizziness or vertigo, or upper respiratory infection.

Dr. Brandon Isaacson is the principal investigator for the North Texas arm of the NIH study of sudden sensorineural hearing loss.

“It can be very frightening for the patient,” said Dr. Brandon Isaacson, assistant professor of otolaryngology — head and neck surgery. “Sometimes you don’t have any symptoms at all, and you simply wake up one day and can’t hear.”

Brian Jones awoke one day with ringing and a sensation of pressure in his ear.

“I would compare it to being in 10 feet of water without clearing your ears,” said Mr. Jones, a 42-year-old financial analyst.

It began with a mild ringing in his ear on a Tuesday and by Thursday, he had no hearing at all in his left ear. That prompted a visit to the doctor, where a test revealed he had already lost 80 percent of his hearing.

“That’s a pretty scary diagnosis,” said Mr. Jones, a husband and the father of a 4-year-old. “I was wondering, am I going to lose my hearing forever? Am I going to have to learn sign language?”

Due mostly to his decision to seek medical attention right away, and his general practitioner’s decision to send him to a specialist, he was able to get on medication quickly. He recovered his hearing over the next two weeks.

“It was the scariest two weeks I’ve ever been through,” Mr. Jones said.

Sudden deafness is believed to affect 1 in 5,000 people annually, but it is sometimes not properly diagnosed as an inner ear problem; instead, it is mistaken as a common middle ear infection, for which patients don’t seek specialized treatment. A special hearing test is needed to determine whether the problem is with the inner ear.

Fresh research presented at the 2008 American Academy of Otolaryngology — Head and Neck Surgery Foundation meeting in September showed that patients with sudden hearing loss receive inconsistent care due to a lack of established treatment guidelines.

“Typical treatment is high-dose steroids, taken by mouth, but recent studies show that steroids injected behind the middle ear can also be effective,” said Dr. Isaacson, who is principal investigator for the North Texas arm of the national  study, which includes Johns Hopkins University, The Cleveland Clinic, New York University School of Medicine, the University of California, San Diego, and Massachusetts Eye & Ear Infirmary, the head center for the study.

Only about 20 percent of patients with sudden hearing loss regain some hearing without therapy, but nearly 60 percent regain some hearing if treated promptly with oral corticosteroids, according to the National Institutes of Health.

The trial is comparing the efficacy of oral prednisone to methylprednisolone injected into the middle ear. Anecdotal evidence suggests that the injectable form may work as well or better, according to the NIH.

“There can be significant side effects from either treatment,” Dr. Isaacson said. “So we’re also trying to see whether one has fewer side effects than the other.”

Side effects can include elevated blood sugar, insomnia, agitation or weight gain.

Funded by the National Institute for Deafness and Other Communication Disorders, the study is the first randomized, head-to-head national trial of these two treatments.

To be considered for the study, participants must have hearing loss of 50 decibels in one ear, have lost hearing within the past 14 days, and have received less than 10 days of steroid therapy, but preferably none.

Participants will undergo a screening evaluation and an audiogram — a hearing test — to determine if they are eligible. Selected participants will be assigned randomly to either the oral or injectable steroid therapies for about two weeks. Four treatments and two follow-up visits will occur within the following six months, along with blood and urine tests and an audiogram.

Referring physicians or patients can contact Dr. Isaacson at 972-326-1695 or visit www.suddendeafness.org for more information.

 

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