There have been suggestions that the natural course of the idiopathic sudden sensorineural hearing loss (ISSNHL) is not affected by intensive therapy. There is speculation as to whether unknown factors affect the treatment prognosis. This is a retrospective study of 301 patients seen over six years (57 patients at out-patients OPD and 301 as in-patients). Both groups were given treatment in the form of systemic steroids with or without intra-tympanic (IT) steroid injection. Mode of systemic and IT steroids was not uniformly defined in both groups. Also all patients were offered in-patient admission and only those refusing admission were treated on an OPD basis. Success rate was considered as 15dB improvement in hearing.

The conclusions included that admission must be strongly recommended for all patients with ISSNHL with the presumption that resting, social stress reduction and anxiety relief might be helpful to their hearing recoveries.

Some clinicians may debate the basis of the hypothesis of stress and anxiety reduction by inpatient admission. Also the obvious bias of the benefit of increased treatment compliance following hospital admission has not been mentioned in the paper. This study is a retrospective study with variability in treatment offered to the two groups. Also the length of time from onset of ISSNHL to treatment is ill-defined. An RCT on ISSNHL is difficult due to the huge variability in timing of presentation and patient groups. Despite the limitations, it is a useful study with large numbers with interesting conclusions – certainly food for thought and perhaps further research! 

Necessity of admission to improve the hearing-recovery rate in idiopathic sudden sensorineural hearing loss.
Kim MJ, Heo KW, Jeon PH, Lee JJ, Lee JH.
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Sangeeta Maini

FRCS ORL-HNS, Aberdeen Royal Infirmary, Forresterhill, Aberdeen, AB25 2ZN.

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Bhaskar Ram

Ain-Shams Faculty of Medicine, Cairo, Egypt.

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