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Suggest Treatment For Hearing Loss

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Posted on Tue, 1 Apr 2014
Question: Hi Doctor, I am suffering from sudden hearing loss coupled with vertigo. It started on Feb26. I was in Munich Germany at that time. I went to the doctors there who gave me infusion fluids along with cortisone injections. I came back to bangalore on 5th and went to a normal doctor who prescribed some drugs.Later I realized that i have to go to an ENT specialist So on 10March, I went to an ENT specialist who also confirmed from audiometry tests that hearing loss is severe and I have to be on steroids.Today, i read about it online and I am totally in for a shock (Referene link:http://www.masseyeandear.org/for-patients/patient-guide/patient-education/diseases-and-conditions/sudden-deafness/). I am quite scared. I also wanted to take a second doctor's opinion. Please tell me frankly the position I could be and if there are any chance of revival of hearing in the right ear. The current medication which my doctor has prescribed is as follows. Ginkoba Betavert 16mg Drego-D Defcort 6mg tapering dose.
doctor
Answered by Dr. Sumit Bhatti (13 hours later)
Brief Answer: There is still time to salvage the hearing. Detailed Answer: Hi, Thank you for your query. 1. In the first 4-6 weeks of a SSNHL, there is a good possibility of recovery with aggressive treatment with high doses of intravenous steroids, anti-virals, blood thinners, vasodilators, neuroprotective drugs, anti-oxidants, multi-vitamins and carbogen therapy. Up to 3 months there may be excellent results with trams-tympanic steroid injections and with Hyper Baric Oxygen Therapy (HBOT). 2. If your PTA shows more than 20-30 dB hearing loss in three contiguous frequencies then it is defined as Sudden Sensori-Neural Hearing Loss (SSNHL). SSNHL is a medical emergency. In your case it may have been Labyrinthitis since you also had vertigo. 3. Now the question if there is any chance of revival of hearing in the right ear: a. The Therapeutic window is 4 to 6 weeks. b. It is usually unilateral (one sided) in over 95% cases. c. Spontaneous recovery occurs in 65% cases within 20dB or greater than 50% of total loss. d. Prognosis is always guarded e. It is Idiopathic in 85-90% cases (cause remains unknown) f. 50% recovery usually occurs in the 1st 2 weeks + (You have not mentioned if there has been any change in your hearing) g. Early detection is important (as in your case, since the treatment was started since 26th February). h. Most of the treatment is empirical. i. Side effects of Rx is an important consideration. j. No treatment is an option k. Treatment Cost is high. MRI Scanning is advised. 4. With steroids, the chances of the condition getting resolved is around 50%. Prognostic factors are: a. Timeline b. Age c. PTA (Pure Tone Audiogram) d. Vertigo (as in your case) e. Tinnitus f. Co-morbidity such as diabetes, hypertension and vascular blockages releasing clots or micro-embolic fragments. 5. I recommend the following (assuming that you do not have diabetes): a. IV Methylprednisolone (steroid): 1 gm/day x 3-5 days, then oral 1 mg/kg/day x 4 weeks, (tapered) followed by 6 bi-weekly steroid ear injections (dexamethasone). b. Acyclovir 800 mg 5 x / day (anti-viral) c. IV Lomodex 12 hrly (blood thinning agent) d. Tab Trental (Pentoxyfyiline) 400 mg OD (rheologic or blood flow improvement) e. Tab Nootropil (Piracteam) 400 mg OD (neural tonic) f. Cap Palsinuron (empirical ayurvedic) g. Tab Omez-DSR (anti acidity & reflux) h. Carbogen (vasodialtor) i. Hyperbaric Oxygen Therapy (HBOT), if available. 6. You may follow up with your reports. I hope that I have answered your queries. If you have any further questions, I will be available to answer them. Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti (3 hours later)
I truly appreciate your patience while answering to my question.However, I want to provide you with a clear picture with timeline of events.I have also attached the audio metry reports and blood test report.Request you to go through the timeline in details and answer my queries accordingly.Thanks a ton.Please dont mind that I might have repeated some stuff but it is purely because of my concern. In Munich,Germany ------------------ Feb,26--I wake up that morning and find that my right ear is blocked and I couldnot hear anything.That whole day i also had dizziness and vommitting. Feb,27--Went to local physician.Even vommitted in the clinic for 3 times.So doc there gave to infusion fluids and an injection to stop vomitting Feb28--Went to ENT specialist.For me vomitting and dizziness was the main thing so I paid less attention to the hearing loss.ENT specialist gave me infusion fluids,injection(solu decortin250mg). He did some audio metry tests and said that hearing loss is severe.I have attached those reports namely(feb28_1 and feb28) He said that you have to do magentic resonance scan. For the next couple of days, i was still getting vomitting and dizziness was still persisting so i just hanged on there for about 2 days.I used to vomit even tablet and medicines also March3-Again went to the local physician for takinginfusion fluids as that was my only means of food.After this infusion session, i didnot vommit at all.Finally one good thing atleast. So, the bottomline is , to be XXXXXXX I didnot know what the german doctors actually did to solve the problem , apart from stopping the vommitting.Also,i didnot concentrate on hearing loss as vomitting,dizziness and weakness overshadowed the hearing loss. In Bangalore,India ------------------- March5- Somehow, was not that convinced with german docs.So again went to the local physician in banglaore who gave basic tablets for dizziness and she told that if it doesnot subside within 3 days, visit an ENT specialist.I think the mistake i made was not visiting the ENT specialist immediately in India for which I regret.In India, there was no vomitting at all. March10-Went to ENT specialist in Bangalore,who told me to go through blood test. The blood test reports were normal which I have attached for your reference. In the evening,took audiometry tests and confirmed severe hearing loss. He gave the following medication which I have sent in the first query to you. Ginkoba Betavert 16mg Drego-D Defcort 6mg tapering dose. Some imp points ------------------- Hearing loss in only right ear. Vertigo feelign whe I rotate my head towards the right. I also get a ringing sound in my right ear. So, to be XXXXXXX I think according to me the hearing loss treatment started only on march10. So my queries are as follows. 1)What do you think is the exact problem.I mean i want to the know the exact medical condition(Labyrinthis or Sudden hearing loss) 2)Am I on the right track in my treatment?Wanted a second doctor's opinion that is why i am asking this question. 3)Are two weeks of delay in treatment a major setback? 3)After what timeline of treatment can we conclude the case as failure. 4)In worst case of not retaining hearing in right ear, are there any instruments that i could use. 5)Apart from alopathy are there any alternatives like ayurveda or homeopathy. 6)Till what time I should not lose hopes.
doctor
Answered by Dr. Sumit Bhatti (12 hours later)
Brief Answer: As below: Detailed Answer: Hi, Thank you for writing back. 1. The hearing loss is most likely an SSHNL. Labyrinthitis is one of the causes as both hearing and balance was affected. 2. Your treatment is on the right tract. However you may consider the regimen mentioned above. 3. In the first 4-6 weeks of a SSNHL, there is a good possibility of recovery with aggressive treatment with intravenous steroids, anti-virals, blood thinners, vasodilators, neuroprotective drugs, anti-oxidants, multi-vitamins and carbogen therapy. Up to 3 months there may be excellent results with trams-tympanic steroid injections and with Hyper Baric Oxygen Therapy (HBOT). 4. If the hearing does not return after three months, it is unlikely to recover. 5. Cap. Palsinuron mentioned in the previous answer is an ayurvedic medication. 6. You should not loose hope for recovery for at least 3 months to year. As mentioned before, there is always a chance of spontaneous recovery. 7. Rehabilitation includes the option of no treatment. a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent. b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment. These include Cochlear and Oticon. c. Sophono (Otomag) alpha 1 M is a new type of BAHA without an abutment. 8. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules. 9. Other blood tests include: a. Coagulogram b. Homocysteine levels c. VDRL d. RF (Rheumatoid Factor), Auto-immune panel e. HIV, Hepatitis panel f. Lipid Profile (high triglycerides). I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

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Suggest Treatment For Hearing Loss

Brief Answer: There is still time to salvage the hearing. Detailed Answer: Hi, Thank you for your query. 1. In the first 4-6 weeks of a SSNHL, there is a good possibility of recovery with aggressive treatment with high doses of intravenous steroids, anti-virals, blood thinners, vasodilators, neuroprotective drugs, anti-oxidants, multi-vitamins and carbogen therapy. Up to 3 months there may be excellent results with trams-tympanic steroid injections and with Hyper Baric Oxygen Therapy (HBOT). 2. If your PTA shows more than 20-30 dB hearing loss in three contiguous frequencies then it is defined as Sudden Sensori-Neural Hearing Loss (SSNHL). SSNHL is a medical emergency. In your case it may have been Labyrinthitis since you also had vertigo. 3. Now the question if there is any chance of revival of hearing in the right ear: a. The Therapeutic window is 4 to 6 weeks. b. It is usually unilateral (one sided) in over 95% cases. c. Spontaneous recovery occurs in 65% cases within 20dB or greater than 50% of total loss. d. Prognosis is always guarded e. It is Idiopathic in 85-90% cases (cause remains unknown) f. 50% recovery usually occurs in the 1st 2 weeks + (You have not mentioned if there has been any change in your hearing) g. Early detection is important (as in your case, since the treatment was started since 26th February). h. Most of the treatment is empirical. i. Side effects of Rx is an important consideration. j. No treatment is an option k. Treatment Cost is high. MRI Scanning is advised. 4. With steroids, the chances of the condition getting resolved is around 50%. Prognostic factors are: a. Timeline b. Age c. PTA (Pure Tone Audiogram) d. Vertigo (as in your case) e. Tinnitus f. Co-morbidity such as diabetes, hypertension and vascular blockages releasing clots or micro-embolic fragments. 5. I recommend the following (assuming that you do not have diabetes): a. IV Methylprednisolone (steroid): 1 gm/day x 3-5 days, then oral 1 mg/kg/day x 4 weeks, (tapered) followed by 6 bi-weekly steroid ear injections (dexamethasone). b. Acyclovir 800 mg 5 x / day (anti-viral) c. IV Lomodex 12 hrly (blood thinning agent) d. Tab Trental (Pentoxyfyiline) 400 mg OD (rheologic or blood flow improvement) e. Tab Nootropil (Piracteam) 400 mg OD (neural tonic) f. Cap Palsinuron (empirical ayurvedic) g. Tab Omez-DSR (anti acidity & reflux) h. Carbogen (vasodialtor) i. Hyperbaric Oxygen Therapy (HBOT), if available. 6. You may follow up with your reports. I hope that I have answered your queries. If you have any further questions, I will be available to answer them. Regards.