1) Comparative study of 60 cases of sudden deafness treated at Keio University Hospital and 72 cases treated at Münich University Hospital was made from the clinical standpoint, including audiogram pattern and methods of treatment and prognosis. Sudden deafness treated in Keio University Hospital and also in other university hospitals in Japan is most frequently found in patients in their twenties and forties, while in Münich University Hospital and other foreign clinics it is found most in those in their forties and fifties. These differences might be related to general factors, such as psychosomatic or hormonal disturbances, or autonomic nervous dysfunction, which could cause cochlear damages. 2) No definite relationship between age and audiogram pattern was demonstrated in either university clinic. No severe hearing impairment tended to be confined to older age groups alone. 3) Difference in the severity of hearing loss in the two clinics was not essentially a matter of racial differences. 4) As to progress of the hearing disturbances and prognosis, no differences between the two clinics were found. 5) Early treatment has greater influence than any other factor on good prognosis of hearing, irrespective of the treatment, including stellatum blocking. 6) In the therapy of sudder deafness, not only treatment for vascular disturbances, but also investigations for extralabyrinthine factors should be performed. Furthermore, viral infection and endolymphatic hydrops should also, to some extent, be considered as one of the possible pathogeneses. For these cases, admission would be most advisable.
We have studied 23 cases of subden deafness, and some considerations are as follows. There were 12 males, and 11 females in our cases; 21 cases were affected in our side, and only 2 cases in both sides. The audiogram at the first visit showed that severe hearing loss type were the most, flat type the second, and hightone loss type the third. There revealed more flat type and hightone loss type as the day of first visit were delayed. Therefore, we found out that the sudden deafness had a tendency of spontaneous recovery to a certain degree. As to the prognosis, 8 cases showed improvement, but 11 cases showed no changes at all. The most effective treatment so far found was using steroids combined with ATP, Vit. B, and vasodilators.
15 cases with sudden deafness were treatad by conservative therapies, and fair improvement of hearing was obtained in 2 cases, and slight improvement in one case. All of improved 3 cases were adequately administrated at least within 10 days after the attack of sudden deafness. The initial audiogram showed flat type in 2 cases and deaf type in one. In 2 cases with fair improvement of hearing, their prognosis were followed up during 2.5 or 1.5 years respectively. The improvement of hearing of both cases was lapid in initial stage, and then gradual. In one case, Békésy audiograms revealed the transit from Jerger's type II to type I along with the fair improvement of hearing at 2.5 years after the onset of hearing loss. In other case, although initial fair improvement, Békésy audiograms still showed Jerger's type II and standard audiometry revealed progressive deterioration on high frequencies, at 1.5 years after the onset of hearing loss.
1. We have followed 53 cases of sudden deafness during past 2 years to investigate if there is any improvement of hearing. Most of them gained hearing in some extent to show audiometic patterns of either an abrupt high tone loss or a gradual high tone loss. Four cases showed a W or a U type audiogram after hearing improvement. We were of the opinion that two lesions in the cochlea produce a W type audiogram. 2. Two cases of sudden deafness were documented, who showed an interesting audiogram in the course of time. Case 1 lost his hearing eventually. Case 2 developed sudden deafness of both ears after each of skin diving. He suffered from sudden deafness of the left ear with vertigo and vomiting after skin diving. He had an improvement of hearing and showed an abrupt type of audiogram when he visited our clinic. Two years later, he developed severe hearing loss of the right ear 3 hours after skin diving. There was no vertigo this time. It took about a week for complete recovery. Pathogenesis of sudden deafness in this cases was Seemingly similar to that of the caisson disease.
Three cases of bilateral sudden deafness having simultaneous loss of hearing in both ears were reported. Whole course of deafness was observed in detail in case 1, and her hearing loss was improved to the normal level in both ears. In case 2, hearing loss was improved only in the left ear. These results suggest that hearing loss in sudden deafness can be improved in fresh cases in binaural cases as well as in monaural cases. In case 1, Coxsackie virus was identified in the cerebrospinal fluid. Then the authers discucced pat hogenesis of simultaneous bilateral sudden deafness and concluded that viral infection might play an important role particularly in bilateral cases.
Seventeen cases with perceptive deafness which occured suddenly under some unusual conditions (symptomatic sudden deafness) were reported and the clinical futures were discussed with special references to the so-called “sudden deafness”. The conditions were listed as follows: noise induced deafness (6 cases), Hunt's syndrome (4), common cold (3), diabetes (1), mumps (1), lues (1) and puerperal fever (1). Between these two different groups, so-called “sudden deafness” and the symptomatic sudden deafness, the author could not find definite differences in the general, and audiological findings with exceptions of the following three items. First, bilateral impairment was appeared more frequently in the symptomatic appeared more frequently in the symptomatic sudden deafness than in the other. Second, vestibular disturbances were found more frequently in the caseswith symptomatic sudden deafness than in the other. Lastly, in the respect of the grade of hearing impairment, the “sudden deafness” was more severe than the other. These findings are, however, not conclusive yet because of the various kinds of etiological factors included in the group of the cases with symptomatic sudden deafness. Henceforth, they must be discussed separately. The author believe that it will be an important mean in the solving etiological problems of the “sudden deafness” which is yet obscure.
The vestibular disorder in a case of “Sudden deafness” was discussed. Its Process was divided into three stages as follows: i) The irritative stage It was observed within three days after the onset of this disease. In this stage, spontaneous nystagmus or “directional preponderance” to the affected side could be observed. ii) The paralytic stage Directional preponderance to the opposit side could be observed by Cupulometry. Hallpike's calorigram revealed “canal paresis” in the affected side. iii) The compensatory stage Vestibular asymmetry could not be detected by Cupulometry. In this stage the patient has never complained of vertigo. However, “canal paresis” has remained in the calorigram. The central mechanism might compensate the peripheral vestibular disorder.
Literatures of vasodilator therapy in inner ear diseases were reviewed. Effects of various vasodilating agents on cochlear blood flow were studied in the guinea pig utilizing an electrical impedance plethysmograph. The animal experiment indicated α-adrenergic blocking agents, carbon dioxide, nitrites, papaverine, dipyridamole and hydralazine as effective vasodilators of the inner ear vessels. Beta-adrenergic agents, parasympathomimetic agents and nicotinic acid were not favorable vasodilators in the inner ear. A restriction was suggested in use of plasma kinins, histamine and betahistine in inner ear vasodilating therapy.
Recent our observation on patients with sudden deafness indicates that the treatment must be done as soon as possible. If the treatment is started on the 5th to 14th day after the onset of deafness, the recovery of hearing can be expected, but chronic cases show poor prognosis. In order to obtain a further information concerning this sickness, several biochemical and physiological observations were made: 1) the dètermination of pH, Po2 Pco2 and electrolytes in cerebrospinal fruid, 2) the vestibular function test, and 3) study of the recovery of hearing. As far as the biochemical study of cerebrospinal fluid is concerned, the pH tended to decrease without the alternation of the levels of Po2, Pco2 and electrolytes. The relationship between the clinical picture and the pH of cerebrospinal fluid may be useful to evaluate this deafness. Follow up study of the vestibular function is also useful for the evaluation of the clinical picture. Finally, the recovery rate of hearing must be carefully studied. Follow up observation of the sudden deafness's hearing in some cases show some difference between the recovery of tonal acuity and the improvement of supra-threshold tests. In some cases, initial low score of SISI test gradually gained high score with the recovery of tonal acuity. Unilateral cases sometimes showed high SISI score in the contralateral normal ear. Follow up study of these factors are very useful to assess the clinical picture and the prognosis of this disease.
We conceive sudden deafness is an acutely developing nerve deafness without any apparent causes. In this paper, we report a statistic evaluation of this illness in the otolaryngology department of Osaka University Hospital and discuss about some problems. 1) The male and female, unilateral and bilateral incidence, and the age distribution were analysed and compaired between 6 years from 1954 to 1959 and 4 years from 1966 to 1969. 2) Data of the treatments in 2 years from 1967 to 1968 revealed the immediate need of treatment for sever sudden deafness, and the methods and results of treatment in 1969 were shown. 3) Our definition of sudden deafness is a nerve deafness with acute onset and unknown cause, with or without vertigo, and without remissions. The prognosis depends highly on the duration between the onset of the symptoms and the start of the therapy, and the severity of deafness. If this concept is correct, we want to propose to call “sudden deafness” limited to the cases, coming to the hospital within 10 days after the onset of the symotoms and in cases of 11 to 30 days, rather name it “delayed sudden deafness”, and not include the cases more than 1 month. 4) The incidence of bilateral sudden deafness is not clear. Reviewing the past literatures, the variation in frequency appeared 5% at minimum and 42% at the maximum, dut to the different concepts of sudden deafness whether including the unliateral cases with the past histry of the same disorder in the other side as bilateral. Some universal criteria are required. 5) The universal standard to evaluate the effects of the treatments is also necessary.
Es wird über die Behandlungsergebnisse von 30 Fällen der akuten Ertaubung berichtet. Einundzwanzig Fälle davon wurden hauptsächlich mit Stellatum-Blockade erfolgreich behandelt. Andere Fälle, z. B. solche mit hochgradigen Befunden des Augenhintergrundes oder Blutung, mit schwrer Herzbeschwerden oder solche, die nicht jeden Tag ambulant behandelt werden konnten, wurden mit Viatminen (B1, B6, B12), blutgefässdilatierenden Mitteln und Sedativa kombiniert behandelt. Durch die Stellatum-Blockadé gewannen 11 Personen aus 21 ihr Gehör bis zu 30dB wieder. Drei weitere Fälle konnten ihr Gehör bis zu 30-40dB wiedergewinnen. Auf Grund obengenannter Behandlungen und deren Ergebnisse kamen die Verfasser zu folgendem Schluss: 1. Je früher die Behandlung begonnen wird, desto höher ist der Heilungsquotient. 2. Audiogramme beim Krankheitsbeginn lassen auf eine Prognose dieser Krankheit schliessen. Die Fälle, die in jeden Frequenz eine hochgradige Verminderung aufweisen, geben Anlasszu einer schlechteren Prognose, auch wenn der Krankheitsbeginn noch jüngeren Datum ist. 3. Die Stellatum-Blockade ist für die, akute Ertaubung eine sehr erfolgreiche Behandlungsmethode.
The author investigated the 135 ears of sudden deafness, to make clear the therapeutic method and prognosis of this disease. In various therapeutic methods, the effect of the stellate ganglion block is the most remarkable. 80 ears of sudden deafness, within one month from the onset divided to two groups, 41 ears were treated with stellate ganglion block and 39 ears were without block. The improvement of hearing are observed in 25 ears (61.0%) and in 9 ears (23.1%) respectively. The presumption of prognosis of sudden deafness is very significant. In 80 ears of sudden deafness within one month from the onset, the improvement of hearing are observed in 34 ears (42.5%). But, in 55 ears of more than one month, the improvement is observed only one ear (1.8%) and it was so slight (15dB), the author concluded that the possibility of hearing improvement is limited within one month from the onset of hearing loss. In various hearing types, the prognosis of low frequency impairement type is the most advantage. In 35 ears of improved cases 14 ears are recovered to normal hearing, and 8 ears of these 14 show the low froquency impairement type during their progress.
The threshold of hearing for pure tones were studied in a population in noise area around a air port compare with another population in control area in the suburbs of Fukuoka. An age stratified sample of subjects were drawn from both populations on a total 840 subjects deviled into decades from 20 to 60 years. Audiometric measurment at 500, 1000, 2000, 4000, and 8000Hz were made in three years repeatedly. In both areas women have more sensitive hearing than men in high frequencies and this sex difference was especially demonstrable at 4000Hz in all decades. Therefore the audiograms of men showed a type of C5 dip and the one of women a typical high tone hearing loss of presbyacusis without a dip formation. According to the results of statistical examination with t-test, the sex difference at 4000Hz in noise area were significant in all decades, although in control area insignificant in all decades. To the causes of this sex difference at 4000Hz in both areas, the extrinsic factors such as firings in the second world war, occupational noise and direct head trauma, were attributed from the results of questionaire survey on the audiological characteristics. The fact that the sex difference at 4000Hz was significant in noise ayes and insignificant in control area indicates that there might be a difference in noise susceptibility between women and men, especially a intrinsic difference in C5 dip formation.