Vlado Petric

Doppler ultrasonography of the vertebrobasilar circulation in patients with sudden sensorineural hearing loss

BACKGROUND The etiology of sudden sensorineural hearing loss (SSNHL) is still unclear and is most probably diverse. OBJECTIVE To determine the relationship between vertebrobasilar circulation and hearing in patients with SSNHL treated with pentoxifylline. DESIGN Case-control study of 32 consecutive patients with SSNHL. METHODS Patients with onset of SSNHL within 72 hours were treated with pentoxifylline infusions for 10 days. Transcranial Doppler (TCD) ultrasonography of vertebrobasilar circulation and hearing levels were examined at the onset of SSNHL (before treatment), after 10 days of therapy, and after 3 months. MAIN OUTCOME MEASURES Hearing levels and TCD ultrasonographic findings at the onset of SSNHL, after 10 days, and after 3 months. RESULTS Patients with SSNHL had more frequent pathologic TCD ultrasonographic findings compared with a normal population. Thirteen patients with SSNHL had normal TCD ultrasonographic findings, eight had borderline findings, and six had pathologic findings, and in five patients, initially, pathologic TCD ultrasonographic findings improved during therapy. Patients with normal TCD ultrasonographic findings had an average hearing improvement of 17 dB, whereas patients with borderline and pathologic TCD ultrasonographic findings had 3 and 0 dB of average hearing improvement, respectively. The greatest improvement (28 dB) was noticed in patients who showed improvement in TCD ultrasonographic findings. CONCLUSION Although the number of patients is small, our results led to the conclusion that SSNHL has vascular etiology, at least in some patients. Consequently, the therapy for SSNHL should depend on etiology; that is, vasoactive medications should be reserved for patients with supposed vascular etiology. TCD ultrasonography could have a role in the decision regarding the optimal treatment of SSNHL.