ACYCLOVIR COMBINED WITH STEROIDS ACTS TO RESTORE SUDDEN HEARING LOSS
Internal ear inflammations caused by viruses is the most common reason for sudden sensorineural hearing loss. The drug used to treat herpes simplex is found to be effective in restoring normal hearing.
Washington, DC -- Inflammation of the labyrinth (the internal ear) is the most common cause assigned to sudden sensorineural hearing loss. No treatment for this disorder has been universally accepted. Two Egyptian otolaryngologist--head and neck surgeons have now determined that acyclovir, a treatment for herpes simplex and Epstein Barr virus, combined with the prednisolone, is highly effective in restoring hearing loss due to inner ear inflammation.
The authors of the study, "Idiopathic Sudden Sensorineural Hearing Loss: Role of Antiviral Treatment (Acyclovir)" are Hesham S. Zaghloul MD and Mohamed R. Ghonim MD, PhD, both from the Department of Otolaryngology--Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt. Their findings will be presented Monday, September 25 at the Annual Meeting of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: The prospective study was conducted with 50 patients with idiopathic sudden sensorineural hearing loss (ISSNHL) during April 1997 to November 1999. Patients selected had: (1) a recent upper respiratory tract infection; (2) presented within ten days of hearing loss onset; (3) unilateral SNHL (one ear only); (4) no history of ear diseases; (5) minimal follow-up period of four weeks.
Patients were randomly classified into two groups. Group A received a corticosteroid (prednisolone) in combination with the antiviral drug, acyclovir; Group B received prednisolone only. The prednisolone was given orally in a dose of 80 mg/day for four days, 60 mg/day for four days, 40 mg/day for four days, and 20 mg/day for four days. Acyclovir was given orally, 600 mg/day in 3 divided doses for seven days.
Complete patient histories and medical examinations were recorded. Additional testing included an otoscopic examination, pure-tone audiometry, speech audiometry, tympanometry and acoustic reflex threshold measurements, a complete laboratory work-up, and an MRI with gadolinium for posterior fossa to exclude space-occupying lesion.
Eight patients were excluded from the study (one from Group A, seven from Group B) because they failed to meet the minimum follow-up period of four weeks.
Results: Forty-two patients were assessed for this study, 23 males and 19 females. The age range was 23 to 55. There was no statistically significant difference between the mean age of both groups. Other findings included:
-- Overall hearing improvement was found in 24 patients. In patients who received acyclovir/prednisolone hearing was improved in 20 of 24 patients (83.3 percent). Patients taking prednisolone only achieved an improvement rate of 22.2 percent (four of 18 patients). Hearing improvement was more apparent at lower frequencies; the differences in speech and SRT scores between the two groups were statistically significant.
-- Vertigo was found in 17 patients. However, vertigo was not a significant factor in those who achieved hearing improvement.
-- The mean duration of hearing loss was six days, and there was a statistically significant correlation between the start of the treatment and the hearing improvement, i.e. early treatment carried a good prognosis.
Conclusions: Sudden sensorineural hearing loss is a common expression of inner ear problems such as viral infection, vascular osculation, or rupture of the internal ear membrane. Viral inflammation is the most commonly accepted cause for the condition. Consequently, adding antiviral such as a acyclovir to steroids increases chance of recovery, especially when treatment is early.
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