Acute Idiopathic Auditory Failure: Prognosis: A Review of 65 Cases

Abstract

The prognostic value of some clinical otovestibular measures was evaluated in 40 cases of acute idiopathic hypoacusis and 25 cases of acute idiopathic anacusis (AIA) observed within 15 days of the onset. The mean PTA for the 500-, 1 000-, 2 000-Hz frequencies has great prognostic value. A mean PTA better than 70 dB HL was associated with a complete or good recovery in 86% of patients. A mean PTA poorer than 70 dB HL was associated with only a fair or poor recovery (76% of these patients). Only 1 subject out of 25 affected with AIA had a complete recovery; all the others showed a poor improvement in hearing. When the different severities of hearing loss have been allowed for, the audiometric contour has probably a slight prognostic value. Flat audiograms seem to have poorer recoveries than sloping (up or down) audiograms or those showing midfrequency losses. The presence or absence of the acoustic stapedius muscle reflex for the 500- to 1000-Hz frequencies and the presence or absence of pathological stapedius decay have also a great prognostic value. 83% of the patients from whom an acoustic stapedius reflex but no decay could be elicited had a complete or good recovery; 86% of the patients with absent acoustic stapedius reflex and/or pathological decay showed only a fair or poor recovery. Severe rotatory vertigo is a significant and dominant prognostic sign. All our patients who experienced severe rotatory vertigo showed a poor recovery. All our patients were treated according to a standard therapeutic protocol except the 5 who exhibited a spontaneous rapid and complete recovery at all frequencies. This therapy combined dextran, a complex substance with a flow-improving effect, and heparin, a drug which is not only thrombolytic but also anti-inflammatory. Our recovery results, similar to or slightly lower than those obtained by other authors, suggest that a therapy must be judged not only on the basis of the global recoveries but also on the comparison of patients with similar patterns and degrees of hearing loss, on the behaviour of the acoustic stapedius muscle reflex, as well as on the presence or absence of severe rotatory vertigo.

Un pronostic est-il possible dans les 15 jours qui suivent l'apparition d'une surdité idiopatique brusque? Nous le pensons, après l'observation de 40 patients sévèrement atteints et de 25 cas atteints de surdité totale. Pour cela doivent etre considérés: la forme de la courbe (le pronostic se dégrade dans l'ordre suivant: courbes en U, montantes, descendantes et plates), le déplacement moyen du niveau du seuil d'audition (le pronostic est meilleur si le déplacement ne dépasse pas 70 dB), la présence d'un réflexe stapédien pour les fréquences 500 et 1 000 Hz ainsi que l'absence de ‘tone decay» (ces deux faits constituant un bon pronostic), enfin l'existence d'un vertige rotatoire (mauvais pronostic). Notre thérapeutique a été basée sur la prescription de dextran et d'héparine; elle a donné des résultats à peu près semblables à ceux obtenus par d'autres auteurs mais qui nous ont paru particulièrement intéressants lorsqu'on les étudie en fonction des divers facteurs de pronostic que nous avons décrits.

Key Words:

• Auditory failure
• Acute hearing loss
• Sudden deafness
• Stapedial reflex
• Vertigo
• Dextran 40
• Heparin