Predictive Factors for Recovery in Idiopathic Sensory Neural Hearing Loss

Patient and methods Study design The study will be conducted as across sectional observation study. Study setting ENT Department Assiut University Hospital outpatient clinic in the period between the 1st July 2019 end of June 2021.

Inclusion criteria All cases above 6 years presented with unilateral or bilateral ISSNHL Exclusion criteria Patient below 6 years old.

Data Collection

After fulfilling all inclusion and exclusion criteria all the patient will be subjected to:

• Full History taking including : the residency, occupation, duration of the clinical symptoms , associated symptoms like tinnitus , vertigo and aural fullness, the presence of previous episodes of hearing loss, the presence of any chronic medical condition especially diabetes and hypertension and neurological history, the medication history and surgical history specially ear surgeries, in addition to family history if relevant.
• Full medical examination including general examination with special emphasizing upon blood pressure measurements, full neurological examination, full ENT examination with vestibular testing especially in cases presented with vertigo
• Laboratory investigation Complete blood count test with differential to detect neutrophil lymphocyte monocyte ratio.

Renal function test Liver function test. Random blood sugar, oral glucose testing, HbA1c

audiological evaluation upon recruitment, all the patient will be subjected to audiological evaluation using audiogram where the hearing loss will be graded into mild, moderate, , sever and profound. speech discrimition will be graded into good ,fair and poor upon recruitment, all the patient will be subjected to audiological evaluation using ABR to asses retrocochlear pathology

Management plan

1. If the patient come at first two weeks of onset of hearing loss the patient will be manged by oral corticosteroid in the form of ,prednisolone60mg in two divided doses for 2 weeks.
2. Patient will be manged by 5 sessions of intratympanic steroid after failure of systemic steroid and patient who come after 2 weeks of onset of hearing loss , each session will be 3 days apart. The injectable material will be 1ml of hydrocortisone 8ml. The injection will be done under local anesthesia and microscope magnification. A pack of lidocaine gel will be applied in the external canal for 10 minutes in EAC to induce anesthesia by using insulin syringe 1ml bore.

An 8 ml of hydrocortisone will be injected in the ME through posteroinferior part of TM All patients will receive antiviral therapy in the form of acyclovir,valcyclovir All the patient will receive vasodilator.

Follow up All the patient will be subjected to audiological evaluation using the audiogram 2 weeks and one month after the initiation of the therapy to detect the treatment outcome.

Statistical analysis

• Factors affecting the treatment outcome will be grouped into

  1. Age.
  2. Onset of the disease.
  3. . tinnitus.
  4. vertigo.
  5. audiogram to detect the degree of hearing loss mild,moderate severe profund .speech discrimition low frequencies versus high frequencies.
  6. Complete blood count test with differential to detect neutrophil lymphocyte monocyte ratio.

  7. Comorbidities as hypertension cardiac All those factors will be compared to each other and to the final hearing outcome using correlation coefficient, regression analysis using the SPSS 20 software.

     Ethical consideration:

     . The Study will be reviewed by the Assiut University medical ethical committee as a study applied on humans to get their final approval.

     The aim of the study will be explained to each patient before the beginning of theprocess Written consent will be obtained from those who are willing to participate in thestudy.

     Privacy and confidentiality of all data will be assured .

• The aim of the study will be explained to each patient before the beginning of theprocess.

Written consent will be obtained from those who are willing to participate in the study.

Privacy and confidentiality of all data will be assured .

• Privacy and confidentiality of all data will be assured .
• . The Study will be reviewed by the Assiut University medical ethical committee as a study applied on humans to get their final approval.

The aim of the study will be explained to each patient before the beginning of theprocess Written consent will be obtained from those who are willing to participate in thestudy.

Privacy and confidentiality of all data will be assured .

• The aim of the study will be explained to each patient before the beginning of theprocess.

Written consent will be obtained from those who are willing to participate in the study.

Privacy and confidentiality of all data will be assured .

• Privacy and confidentiality of all data will be assured .