Rheopheresis for sudden sensorineural hearing loss

Area of Science:

• Otolaryngology
• Cardiovascular Medicine
• Nephrology

Background:

• Sudden sensorineural hearing loss (SSHL) requires novel therapeutic strategies, particularly for cases resistant to conventional infusion treatments.
• Existing treatments for SSHL often prove insufficient for refractory cases, highlighting the need for alternative interventions.

Purpose of the Study:

• To evaluate the efficacy of fibrinogen-lowering treatments, specifically fibrinogen-LDL-apheresis (Rheopheresis/HELP-apheresis), as a therapeutic option for sudden sensorineural hearing loss (SSHL).
• To assess the effectiveness of fibrinogen-LDL-apheresis in patients with SSHL who are refractory to first-line standard treatments.

Main Methods:

• Two randomized controlled trials, each involving over 200 patients, investigated fibrinogen-LDL-apheresis for SSHL.
• The study examined the impact of fibrinogen-LDL-apheresis on plasma and whole blood viscosity, hypothesizing improved microcirculatory recovery.

Main Results:

• Fibrinogen-LDL-apheresis demonstrated effectiveness in SSHL patients, including those refractory to standard therapy.
• The procedure induces an immediate reduction in blood viscosity, potentially leading to sustained microcirculatory improvements.
• German SSHL guidelines acknowledge fibrinogen-lowering treatments as a potential component of multimodal therapy.

Conclusions:

• Fibrinogen-LDL-apheresis is a viable therapeutic option for SSHL, offering benefits particularly for treatment-resistant patients.
• While not generally superior to first-line treatments, its effectiveness in refractory cases is significant.
• Patients may need to seek individual reimbursement or cover costs due to current insurance policies.