Acute low-tone sensorineural hearing loss (ALHL) has a relatively good prognosis; however, cases of recurrent cochlear symptoms and cases of transition to Meniere's disease have also been reported. In this study, we investigated cases of relapse of ALHL and cases of transition from ALHL to Meniere's disease among patients with ALHL who visited our department.
The subjects were 38 patients with ALHL who had undergone otolaryngology-head and neck surgery at Nippon Life Hospital during the 2-year period from July 2016 to June 2018.
There were six cases of ALHL relapse (atypical cases of Meniere's disease-cochlear type), the hearing prognosis after the relapse improved in three cases and remained unchanged in the remaining three cases. There were seven cases of transition to Meniere's disease (cases definitively diagnosed as Meniere's disease), and the hearing prognosis after the transition improved in three cases and deteriorated in the remaining four cases. In addition, the symptom of dizziness noted at the time of the transition disappeared following the improvement in five cases, while mild subjective dizziness persisted in the remaining two cases.
In clinical practice, ALHL is considered as acute sensorineural hearing loss, similar to sudden hearing loss at the first onset, as an atypical case of Meniere's disease when the hearing loss recurs, and as a certain case of Meniere's disease when recurrent dizziness occurs. It is useful to understand the disease as a spectrum of pathological conditions.
With regard to treatment, initial ALHL can be managed with the same approaches as those for acute sensorineural hearing loss, and steroid use according to the usual treatment for sudden hearing loss. On the other hand, both cases of recurrence and those of transition involve endolymphatic hydrops, and it would be appropriate to administer diuretics containing isosorbide for these cases.
ALHL has not received much attention until now, because of its good prognosis in Japan. We expect that the overall picture of this condition, including its pathophysiology, will be further investigated.
