Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

다국어 초록 (Multilingual Abstract)

Background and Objectives: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone.


Subjects and Methods: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen.


Results: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week).


Conclusions: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

참고문헌 (Reference)

1 Wilson WR, "Why treat sudden hearing loss" 5 : 481-483, 1984

2 Tucci DL, "Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir" 23 : 301-308, 2002

3 Westerlaken BO, "The treatment of idiopathic sudden sensorineural hearing loss using pulse therapy: a prospective, randomized, double-blind clinical trial" 117 : 684-690, 2007

4 Wilson WR, "The relationship of the herpesvirus family to sudden hearing loss: a prospective clinical study and literature review" 96 : 870-877, 1986

5 Fisch U, "Sudden hearing loss: circulatory" 5 : 488-491, 1984

6 O’Malley MR, "Sudden hearing loss" 41 : 633-649, 2008

7 Wei BP, "Steroids for idiopathic sudden sensorineural hearing loss" CD003998-, 2006

8 Haug O, "Stellate ganglion blocks for idiopathic sensorineural hearing loss" 102 : 5-8, 1976

9 Cook TG, "Stellate ganglion block for sudden profound hearing loss" 54 : 421-423, 1981

10 Yue WL, "Role of low-molecular-weight heparins in the treatment of sudden hearing loss" 24 : 328-333, 2003

11 Garcia Callejo FJ, "Non-interventional study on blood filterability changes in the clinical onset of sensorineural sudden deafness" 52 : 556-564, 2001

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

13 McKay GA, "Low molecular weight heparins--a safer option than unfractionated heparin?" 20 : 256-276, 2001

14 Takinami Y, "Evaluation of effectiveness of stellate ganglion block (SGB) treatment of sudden hearing loss" 132 : 33-38, 2012

15 Nomura Y, "Diagnostic criteria for sudden deafness, mumps deafness and perilymphatic fistula" 456 : 7-8, 1988