Fatih YÜKSEL, Hilal YÜCEL, Ekrem ÖZSÖZ, Erkun TUNCER, Sinan KIR

Ani İdiyopatik Sensörinöral İşitme Kaybında Prognostik Faktörlerin Analizi

Amaç: Ani idiyopatik sensörinöral işitme kaybı (AİSNİK) odyolojik acil bir durum olarak tanımlanır. AİSNİK’te prognozu etkileyen faktörlerle ilgili pek çok çalışma yapılmış olmasına rağmen henüz fikir birliği yoktur. Bu çalışmanın amacı AİSNİK olan hastalarda klinik ve odyolojik faktörlerin prognostik değerinin analiz edilmesidir. Hastalar ve Yöntem: AİSNİK nedeniyle tedavi edilen 118’i erkek, 92’si kadın 210 hastanın verileri retrospektif olarak incelendi. Hastaların demografik verileri, odyometri bulguları, ek semptom ve hastalıkları kaydedildi. İşitme kaybının derecesi; saf ses odyometri testine göre hafif (26-40 dB), orta (41-55 dB), orta-şiddetli (56-70 dB), şiddetli (71-90 dB) ve derin (> 90 dB) olarak sınıflandırıldı. İşitme kaybının şekli saf ses odyometri testine göre inen tip, çıkan tip, çanak tip ve düz tip olarak belirlendi. Hastaların tedaviye başlama zamanına göre ilk 3 günde, 3-10 gün arası ve 10 günden sonra olacak şekilde üç gruba ayrıldı. Yaş, cinsiyet, odyometrik bulgular, ek semptom ve hastalıkların; tedavi öncesi ve tedavi sonrası işitme seviyesi ile işitme kazanç seviyesi üzerine etkileri değerlendirildi. Bulgular: Hastaların yaşlarının medyan değeri 46.0 (18.0) yıl idi. Odyometrini tipine göre en sık düz tip odyogram (%54.8) olduğu görüldü. Düz tip odyogramlara sahip hastalarda işitme kaybı seviyesi daha yüksek iken işitme kazançlarının daha az olduğu tespit edildi. Şiddetli işitme kaybı olan hastalarda işitme kazancının daha fazla olduğu belirlendi (p < 0.05). Tedaviye başlama sürelerine göre tedavi öncesi ve tedavi sonrası işitme seviyelerinde anlamlı fark yoktu (sırasıyla p; 0.051 ve 0.409) ancak işitme kazanç seviyelerinde anlamlı fark olduğu tespit edildi (p = 0.005). İlk 3 günde tedaviye başlanan hastalarda işitme kazanç seviyesi 4-10 gün ve 10 günden sonra başlananlara göre daha fazla idi. Hastalarda cinsiyet, etkilenen kulak yönü, ek bulgu ve hastalıkların varlığına göre tedavi öncesi ve tedavi sonrası işitme seviyeleri ile işitme kazanç seviyelerinde anlamlı fark olmadığı görüldü. Sonuç: Tedaviye erken başlamanın AİSNİK’te en önemli prognostik faktör olduğu görüldü. İşitme kayıplarında erken tanı ve tedavi için toplumun bilinçlendirilmesi AİSNİK nedeni ile oluşmuş sekelleri azaltacaktır.

Analysis of Prognostic Factors in Sudden Idiopatic Sensorineural Hearing Loss

Objective: Sudden idiopathic sensorineural hearing loss (SISHL) is defined as an audiological emergency and although many studies have been conducted on the factors affecting prognosis, there is no consensus yet. The aim of this study is to analyze the prognostic value of clinical and audiological factors in patients with SISHL. Patients and Methods: The data of 210 patients, 118 male and 92 female, who were treated for SISHL, were analyzed retrospectively. Demographic data, audiometry findings, additional symptoms and diseases of the patients were recorded. Degree of hearing loss; were classified as mild (26-40 dB), moderate (41-55 dB), moderate-severe (56-70 dB), severe (71-90 dB) and deep (> 90 dB) according to pure tone audiometry test. The type of hearing loss was determined as descending type, ascending type, midfrequency type and flat type. The patients were divided into three groups as those who started treatment in the first 3 days, between 3-10 days and after 10 days. The effects of age, gender, audiometric findings, additional symptoms and diseases on pre-treatment hearing level, post-treatment hearing level and hearing gain levels were evaluated. Results: The median age of the patients was 46.0 (18.0) years. The most common flat audiogram (54.8%) was seen in the patients. It was observed that patients with flat type audiograms had more hearing loss and less hearing gain. It was determined that hearing gain was higher in patients with severe hearing loss (p < 0.05). There was no significant difference in the pre-treatment and post-treatment hearing levels (p; 0.051 and 0.409, respectively) according to the treatment initiation time, but there was a significant difference in the hearing gain levels (p = 0.005). In patients who started treatment in the first 3 days, the gain was higher than those who started after 4-10 days and 10 days. It was observed that there was no significant difference in pre-treatment and post-treatment hearing levels and hearing gain levels according to gender, affected ear direction, additional findings and presence of diseases. Conclusion: Early initiation of treatment was found to be the most important prognostic factor in SISHL. Raising public awareness for early diagnosis and treatment will reduce the sequelae that may occur due to SISHL.

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