Critical Evaluation of Round Window Membrane Sealing in the Treatment of Idiopathic Sudden Unilateral Hearing Loss

다국어 초록 (Multilingual Abstract)

Objectives. Rupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL. Methods. The clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature. Results. Intraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery. Conclusion. The results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.

참고문헌 (Reference)

1 Simmons FB, "The double-membrane break syndrome in sudden hearing loss" 89 (89): 59-66, 1979

2 Hallberg OE, "Sudden deafness of obscure origin" 66 (66): 1237-1267, 1956

3 Mertens J, "Sudden deafness caused by rupture of the round window membrane. Surgical indications, course and prognosis" 34 (34): 320-324, 1986

4 Goodhill V, "Sudden deafness and labyrinthine window ruptures. Audio-vestibular observations" 82 (82): 2-12, 1973

5 National Institute of Health, "Sudden deafness" Bethesda (MD): National Institutes of Health 2000

6 Kanzaki J, "Sudden deafness" 9 (9): 198-202, 1999

7 De Kleyn A, "Sudden complete or partial loss of function of the octavus-system in apparently normal persons" 32 (32): 407-429, 1944

8 Weinaug P, "Spontaneous remission in sudden deafness" 32 (32): 346-351, 1984

9 Stroud MH, "Spontaneous perilymph fistulas" 80 (80): 479-487, 1970

10 Maier W, "Results of exploratory tympanotomy following sudden unilateral deafness and its effects on hearing restoration" 87 (87): 438-451, 2008

11 House JW, "Putter JS. Perilymphatic fistula: surgical experience in the United States" 105 (105): 51-61, 1991

12 Tigges G, "Prognostic factors in hearing recovery following sudden unilateral deafness" 51 (51): 305-309, 2003

13 Pappas DG, "Perilymphatic fistula in pediatric patients with a preexisting sensorineural loss" 10 (10): 499-501, 1989

14 Shelton C, "Perilymph fistula: the Stanford experience" 97 (97): 105-108, 1988

15 Vartiainen E, "Perilymph fistula: a diagnostic dilemma" 105 (105): 270-273, 1991

16 Mattox DE, "Natural history of sudden sensorineural hearing loss" 86 (86): 463-480, 1977

17 Labus J, "Meta-analysis for the effect of medical therapy vs. placebo on recovery of idiopathic sudden hearing loss" 120 (120): 1863-1871, 2010

18 Muntarbhorn K, "Labyrinthine window rupture with round window predominance: a long-term review of 32 cases" 12 (12): 103-108, 1987

19 Nagai T, "Labyrinthine window rupture as a cause of acute sensorineural hearing loss" 269 (269): 67-71, 2012

20 Kanzaki J, "Incidence and prognosis of acute profound deafness in Japan" 13 (13): 71-77, 1986

21 Kanzaki J, "Idiopathic sudden progressive hearing loss and round window membrane rupture" 243 (243): 158-161, 1986

22 Heiden C, "Hoing R. Spontaneous remission of sudden deafness" 48 (48): 621-623, 2000

23 Veldman JE, "Diagnostic and therapeutic dilemmas in rapidly progressive sensorineural hearing loss and sudden deafness. A reappraisal of immune reactivity in inner ear disorders" 113 (113): 303-306, 1993

24 Gedlicka C, "Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss" 30 (30): 157-161, 2009

25 Klemm E, "A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss" 88 (88): 524-527, 2009