[How high is the rate of spontaneous healing of sudden deafness? Comments on the contribution "Spontaneous healing of sudden deafness"].
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Biomedical subjects
Publications and source records attributed to P Weinaug.
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Sixty patients suffering from an acute inner ear disease were treated by a combination of acetylsalicylic acid (Micristin), an inhibitor of platelet aggregation, and meclofenoxate (Cerutil), a nootropic drug. The success rate in 26 patients with acute isolated unilateral vestibular disorder was 73% (69% with complete recovery), and 83% (57% complete remission) in 34 patients with sudden deafness, with an average hearing improvement of 22.4 dB. The success rate of this therapy was similar to that achieved by the usual therapy or no treatment in subjects with sudden deafness and vestibular disorder which we reported in 1984.
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The evaluation of therapeutic success in sudden hearing loss (90 publications), and in sudden unilateral isolated vestibular loss (9 publications) showed unvarying results, obtained by the most various forms of treatment, which were within the range of the spontaneous remission rate established by us. The efficacy of the forms of treatment applied so far is doubted. The early treatment will remain as in the past, since therapeutic methods more successful in the future will be effective only in those cases in which diseased sensory cells were not degenerating. At the present stage of therapeutic possibilities the therapeutic advantage to be expected for all measures to be taken should be considered by rule and line as for therapeutic complications and detriments. Therapeutic nihilism must be rejected same as any adherence to a rigid conception of therapy, an individual critical approach seems to be necessary.
49% of 111 patients with sudden hearing loss had pre-existing inner ear damage to a greater extent than would be expected in a population of the same age. The same age-independent hearing loss of inner ear type was seen in 44% of 72 patients with a sudden unilateral isolated vestibular loss. The accumulated occurrence of diseases of the cardial-vascular system, metabolism, and cervical spine is suggested as the reason for the greater extent of inner ear damage with respect of age and the acute disorders in this area. The high proportion of a pre-existing noise deafness in patients (in 38% of men) with sudden hearing loss suggests an increased vulnerability of the inner ear in pre-existing hearing loss.
In a group of 63 patients (average age 50.5 years) with a sudden hearing loss the result was an improvement in 89% of cases, and a complete remission without any treatment in 68%. For the whole group the average hearing improvement was 25.6 dB (based on an analysis of single frequencies at 0.5, 1, 2 and 5 kHz). Patients with minor hearing difficulty had the same rate of improvement as those with medium and severe loss of hearing, but a greater number of complete remissions. The rate of spontaneous remission decreased with age. 89% of 28 patients younger than 50 years showed an improvement in 96% of cases and a complete remission in 89%. The occurrence of tinnitus or previous damage to the affected inner-ear have no influence on the prognosis of spontaneous remissions in hearing loss. The comparison of different published methods used in the treatment of sudden hearing loss shows almost the same hearing improvement, and this does not differ essentially from the improvement due to spontaneous remissions.
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