GUIDELINE Sudden Hearing Loss - PDF Document

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  1. 8/5/2019 GUIDELINE Sudden Hearing Loss David R. Friedland MD, PhD Professor and Vice-Chair Chief, Division of Otology and Neuro- Otologic Skull Base Surgery August 8-11, 2019 | The American Club | Kohler, WI • SHL: Sudden hearing loss • SNHL: Sensorineural hearing loss • SSNHL: Sudden sensorineural hearing loss • ISSNHL: Idiopathic sudden sensorineural hearing loss • CNDHL: Conductive hearing loss August 8-11, 2019 | The American Club | Kohler, WI Evaluation • Strong  Recommendation • Recommendation • Strong  Recommendation  Against • Strong  Recommendation  Against August 8-11, 2019 | The American Club | Kohler, WI 1

  2. 8/5/2019 Strong Recommendation Exclusion of Conductive Hearing Loss (KAS 1) http://medlibes.com/entry/rinne‐test August 8-11, 2019 | The American Club | Kohler, WI Recommendation Retrocochlear Pathology (KAS 6) August 8-11, 2019 | The American Club | Kohler, WI Strong Recommendation Against Routine Computed Tomography (KAS 3) August 8-11, 2019 | The American Club | Kohler, WI 2

  3. 8/5/2019 Strong Recommendation Against Laboratory Testing (KAS 5) August 8-11, 2019 | The American Club | Kohler, WI Treatment • Option • Recommendation • Option • Recommendation  Against August 8-11, 2019 | The American Club | Kohler, WI Option Initial Corticosteroids (KAS 8) Within 2 Weeks of Onset (disagreement) August 8-11, 2019 | The American Club | Kohler, WI 3

  4. 8/5/2019 steady taper 9/5  7/6  1/8  5/5  3/14  3/6  10/0  7/7 9/3  4/10 August 8-11, 2019 | The American Club | Kohler, WI > > = 14d 60mg/d = 4 IT injections/2 weeks = August 8-11, 2019 | The American Club | Kohler, WI My Protocol: Prednisone 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 10 20 40 20 20 40 40 10 10 5 5 5 Shared Decision Making: Efficacy, cost, complications, outcomes, discomfort etc. August 8-11, 2019 | The American Club | Kohler, WI 4

  5. 8/5/2019 Recommendation Salvage Therapy (KAS 10) Garavello et al., 2012 August 8-11, 2019 | The American Club | Kohler, WI How Often? When? What? Dexamethasone,  methyprednisolone How? Needle perforation,  tube, catheter, carrier gel August 8-11, 2019 | The American Club | Kohler, WI 2‐7 days after oral >10 dB 45% vs 15% IT vs no IT; not IT steroid vs. IT saline August 8-11, 2019 | The American Club | Kohler, WI 5

  6. 8/5/2019 Option Hyperbaric Oxygen (KAS 9a and 9b) 9a: primary  treatment 9b: salvage 10‐20 dives; 1‐2 hours per dive; $600‐$700 per  dive August 8-11, 2019 | The American Club | Kohler, WI Recommendation Against Other Pharmacologic Therapy (KAS 11) except antioxidants August 8-11, 2019 | The American Club | Kohler, WI Recommendation Outcomes (KAS 12) Complete recovery Within 10 dB (PTA or SRT) of  premorbid hearing Partial Within 50% of premorbid  hearing (PTA or SRT in dB) No recovery Less than 50% of premorbid  hearing (PTA or SRT in dB) ?!?! 10 dB is significant ?!?! August 8-11, 2019 | The American Club | Kohler, WI 6

  7. 8/5/2019 Do: • Exclude conductive hearing loss • Rule out retrocochlear pathology • Consider the use of steroids for  treatment • Consider the use of hyperbaric oxygen • Consider IT steroids for salvage • Obtain follow‐up audiometry August 8-11, 2019 | The American Club | Kohler, WI Don’t do: • Order a CT scan • Order routine lab tests • Use antivirals or other medications August 8-11, 2019 | The American Club | Kohler, WI 7