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Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Paediatric Sudden Sensorineural Hearing Loss: Pooled Analysis and Systematic Review
Jacob C S Reading1, Andrew Hall2, Robert Nash2
1Buckinghamshire Healthcare NHS Trust.
Insights
Sudden sensorineural hearing loss (SSNHL) in children is rare but serious. While 56% of children experience some hearing recovery, outcomes are worse for bilateral cases, highlighting the need for better pediatric management guidelines.
Area of Science:
- Pediatric Otolaryngology
- Neuroscience
- Public Health
Background:
- Sudden sensorineural hearing loss (SSNHL) is a critical condition in children, potentially leading to lifelong developmental issues.
- Limited guidance exists for pediatric SSNHL prognosis and management.
- SSNHL is defined as a rapid loss of hearing across contiguous frequencies.
Purpose of the Study:
- To systematically review the literature on pediatric SSNHL.
- To analyze the prognosis and management of SSNHL in children.
- To identify factors influencing hearing recovery in pediatric patients.
Main Methods:
- A systematic literature review was conducted using PubMed, EMBASE, and Cochrane CENTRAL.
- Studies were selected based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Data from 14 studies involving 732 pediatric patients were analyzed.
Main Results:
- Most pediatric SSNHL cases were idiopathic; other causes included viral infections, trauma, and ototoxic drugs.
- Overall hearing recovery was 56%, with unilateral SSNHL showing 61% recovery and bilateral SSNHL showing 29% recovery.
- Systemic steroids were the primary treatment, with intratympanic steroids used as salvage therapy.
Conclusions:
- Pediatric SSNHL has a generally poorer prognosis than in adults, particularly for bilateral cases.
- While systemic steroids are common, treatment comparisons are difficult due to inconsistent outcome reporting.
- Further research is needed to establish optimal management strategies and standardized outcome measures for pediatric SSNHL.
Abstract:
Sudden sensorineural hearing loss (SSNHL) is defined as hearing loss of ≥30 dB in one or both ears, developing within 3 days, affecting ≥3 contiguous frequencies. It is rare in children, but if untreated can cause significant morbidity. During the critical developmental period, it may cause lifelong social, behavioral, and mental sequelae. Currently, little guidance exists on prognosis and management within a pediatric population. A systematic literature review of pediatric SSNHL on PubMed, EMBASE, and the Cochrane CENTRAL database was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A total of 620 papers met the Medical Subject Headings criteria, of which 14 met analysis criteria-13 were level 4 and 1 was level 2b evidence. A population of 732 individuals was analyzed. Most reported cases of pediatric SSNHL were idiopathic. Other etiologies included viral infection, trauma, ototoxic drugs, and structural abnormalities. Recovery was defined as any improvement in hearing after the initial loss, from "slight" to "complete." Recovery ranged from 20% to 100%, with a pooled rate of 56%. Systemic steroids were the mainstay of treatment, although salvage intratympanic steroid therapy had a role after the failure of systemic steroids. Children with bilateral SSNHL had poorer outcomes than those with unilateral loss, with 29% showing improvement. Two studies reported outcomes with no treatment, for which recovery rate was 7%. This analysis of SSNHL shows that 61% of children with unilateral and 29% of children with bilateral SSNHL demonstrate some recovery, a worse prognosis than adults. Multiple treatment regimens exist, although comparison is challenging owing to inconsistently reported improvement parameters.
