Ani İsitme Kayıplı Hastalarda Prognozu Belirlemede Kalorik Testin Değeri Var mı?

Amaç: Bu çalısmada amaç ani isitme kaybı yakınması ile basvuran ve yatırılarak tedavi edilen hastalarda kalorik test sonuçlarının prognozu belirlemedeki önemi değerlendirmektir. Gereç ve yöntem: Bu çalısmada yatırılarak tedavi edilen 23 ani isitme kayıplı hasta incelendi. Yas, cinsiyet, etyoloji, eslik eden tinnitus, vertigo, tedavi ve prognostik faktörler değerlendirildi. Tüm hastalara akustik nörinomu ekarte etmek için temporal Manyetik Rezonans Görüntüleme (MRG) çekildi. Hastalara kalorik test uygulandı. Hastalar tedavi öncesi ve sonrası odyogramlar ile değerlendirildi. Bulgular: Hastaların yas ortalaması 41.2±12.01 idi. Hastalarının ortalama basvuru süresi ani isitme kaybının ortaya çıkısından yaklasık 9 gün sonra idi. Odyogramlara göre 8 (%34.8) hastada hafif ,2 (%8.7) hastada orta, 5 (%17.4) hastada ileri, 8 (%34.8) hastada total isitme kaybı vardı. Odyogram konfigurasyonlarına göre 4 (%17.4) hastada yükselen eğri, 1 (%4.3) hastada inen eğri, 10 (% 43.5) hastada flat, 8 (%34.8) hastada total tip odyogram saptandı. 14 (%60.9) hastada isitme kaybına tinnitus eslik ederken 6 hastanın (%26.1) isitme kaybına vertigo eslik etmekteydi. Hastaların tümü yatırılarak farklı kombinasyonlarda steroid, dextran, ürografin ve destek tedavisi ile tedavi edildi. Tedavi sonrası düzelme oranı % 48.3 olarak saptandı. 4 hastada (%17.4) kalorik testte patoloji saptandı. Bu hastalar aynı zamanda siddetli vertigo tarifliyorlardı. Tedavi sonrası bu dört hastanın üçünde isitmede düzelme olurken 1 hastada isitmede düzelme olmadı. Sonuç: Kalorik test patolojisi olan grup ile, patoloji olmayan grup arasında düzelme oranı açısından anlamlı fark saptanmadı.

Do Caloric Test Results Affect the Prognosis of Sudden Hearing Loss?

Aim: The aim of this study is to evaluate the prognostic value of caloric test results in patients with sudden hearing loss. Material-Method: We evaluated 23 patients with sudden hearing loss who were hospitalized. Age, sex, etiology, accompanying pathologies and prognostic factors were examined. Temporal Magnetic Resonance Imaging (MRI) was used to exclude all patients with acoustic neurinoma. Audiological assessment of the patients were performed before and after treatment and also caloric tests were performed to all of the patients. Results: The mean age of patients were 41.2±12.01 and the mean covering of disease was found to be 9 days. According to the pure-tone audiograms of the patients at administration to our clinic with sudden sensorineural hearing loss, 8 patients (34.8%) had mild sensorineural hearing loss, 2 (8.7%) had moderate sensorineural hearing loss, 5 (21.7%) had severe sensorineural hearing loss and 8 (34.8%) had profound sensorineural hearing loss. According to the configurations of the audiogram, 4 cases (17.4%) had up-sloping type, 1 (4.3%) had downsloping type, 10 (60.9%) had flat type, and 8 (34.8%) had total hearing loss. Type 14 patients (60.9%) had tinnitus, and 6(26.1%) had vertigo. The treatment protocol included different combinations of bed rest, salt restriction, steroids, plasma expander dextrans and urografin administration. Complete recovery was achieved in 48.3 % of the patients. Four patients (17.4%) had positive caloric test pathology. These patients also had vertigo. Three of these patients had perfect hearing recovery after treatment. Conclusion: We found no significant difference between groups of those with a positive caloric test and negative caloric test.

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1. Byl M.Frederick. Sudden hearing loss eight years experience and suggested prognostic table. Laryngoscope. 1984;94: 647-661.
2. Moskowitz Dan., Lee K, J. Smith Wh. Steroid use in idipathic sudden sensory hearing loss. Laryngoscope 1985; 94:664-666.
3. Babin RW. Effects of Aging on the Auditory and Vestibular Systems. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology Head & Neck Surgery. St Louis: Mosby Year Book, 1993: 3020- 3030.
4. Wilson R.W, Gulya J. Sudden sensory hearing loss. In: Cummings CW, Adam JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology Head & Neck Surgery. St Louis: Mosby Year Book, 1993:3103-3112.
5. Perlman HB, Kimura R , Fernandez C. Experiments on temporary obstruction of the internal auditory artery. Laryngoscope. 1959; 69: 591-613.
6. Moskowitz D, Lee KJ, Smith HW. Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope. 1984; 94: 664-666.
7. Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope. 1976 ;86:389-398.
8. Sano H, Okamoto M, Shitara T, et al. Hearing recovery and its process from the time of onset in sudden deafness. Acta Otolaryngol Suppl .1996; 524: 36-38.
9. Yamamoto M, Kanzaki J, Ogawa K, et al. Hearing recovery and vestibular symptoms in patients with sudden deafness and profound hearing loss. Acta Otolaryngol Suppl.1994; 514: 41-44.
10. Linssen O, Schultz-Coulon HJ. Prognostic criteria in sudden deafness. HNO.1997; 45: 22-29.
11. Laurikainen E, Aantaa E, Kallinen J. Electronystagmographic findings and recovery of cochlear and vestibular function in patients suffering from sudden deafness with a special reference to the effect of anticoagulation. Audiolog. 1989; 28: 262-267.
12. Moskowitz D, Lee KJ, Smith HW. Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope. 1984; 94(5 Pt 1): 664-666.
13. Grandis JR, Hirch BE, Wagener MM. Treatment of idiopathic sudden sensorineural hearing loss. Am J Otol. 1993; 14: 183-185.
14. Schuknecht HF, Donovan ED. The pathology of idiopathic sudden sensorineural hearing loss. Arch Otorhinolaryngol. 1986; 243: 1-15.