Antiviral treatment of idiopathic sudden sensorineural hearing loss: A prospective, randomized, double-blind clinical trial

A subclinical viral labyrinthitis has been postulated in the literature to elicit Idiopathic Sudden Sensorineural Hearing Loss. An etiological role for the herpes virus family is assumed. Corticosteroids possess a limited beneficial effect on hearing recovery in ISSHL. In this study, the therapeutic value of the antiherpetic drug aciclovir (Zovirax(R)) on hearing recovery in 44 ISSHL patients receiving prednisolone is evaluated in a multicentre clinical trial. The study is designed prospectively, randomized, double-blind and placebo-controlled. Subjective parameters include hearing recovery, a pressure sensation on the affected ear, disequilibrium or vertigo and tinnitus. Audiometric parameters include pure tone and speech audiometry. A one-year follow up is obtained. Both the pressure sensation and disequilibrium or vertigo have a good prognosis, but tinnitus, occurring in most patients, has a poor prognosis. Hearing recovery prognosis depends on the severity of initial hearing loss, and not on vestibular involvement. No beneficial effect from combining aciclovir with prednisolone can be established in ISSHL

Magnetic resonance imaging of the inner ear in patients with idiopathic sudden sensorineural hearing loss

Although gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has been used to indicate the presence of a subclinical labyrinthitis in patients with idiopathic sudden sensorineural hearing loss (ISSHL), its sensitivity in daily clinical practice is unknown. We describe Gd-MRI findings in 27 ISSHL patients taking part in a prospective multicenter clinical trial. MRI findings were related to the severity of the hearing loss, vestibular involvement and the time interval between the occurrence: of ISSHL and imaging. Pathological enhancement of the cochlea indicating a labyrinthitis was found in one patient with ISSHL. In 26 cases, no pathological enhancement could be established. Study results indicate that the present sensitivity of Gd-MRI is low for detecting subclinical viral labyrinthitis in patients with ISSHL. To improve the sensitivity of MRI in ISSHL, we recommend that imaging is performed as early as possible, preferably before treatment is started