Intended for healthcare professionals

Practice Rational Testing

Investigating sudden hearing loss in adults

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4347 (Published 12 November 2018) Cite this as: BMJ 2018;363:k4347

Re: Investigating sudden hearing loss in adults

We thank the authors, De Ru and Bayoumy, for their letter dated 24 November 2018 in response to our article1.

We agree with the authors that sudden sensorineural hearing loss is an ENT emergency and this has been emphasised in our article. Such patients should be dealt with promptly with the aim of preserving cochlear function. We also agree with the authors that additional therapies are warranted for this devastating condition. New drugs are currently being tested in clinical trials that target hair cell regeneration, such as the REGAIN (REgeneration of inner ear hair cells with GAmma-secretase INhibitors) trial currently underway in our Institution, which offers hope for the future.2

As part of the management of patients with idiopathic sudden sensorineural hearing loss (ISSHL), De Ru and Bayoumy advocate the use of early hyperbaric oxygen (HBO) therapy in the treatment of such patients. While the American guidelines promote greater awareness of HBO therapy as an intervention for ISSHL3, it is not widely available in the UK and the Cochrane data indicates that a physician would need to treat 5 patients with HBO therapy to improve 1 person’s hearing by 25%.4 Whether this is truly clinically significant is debatable as studies are heterogeneous with regard to patient selection, treatment methodologies and reporting of outcome measures used to assess benefit.

While the authors argue that the aetiology of ISSHL is acute oxygen shortage, this likely only holds true for a proportion of cases and also partly explains the heterogeneous results obtained in the literature regarding the use of HBO therapy in such settings. Rigorous randomised clinical trials are required in future to define the optimal criteria for patient selection, to define and standardise optimal regimens for HBO therapy and to investigate the maximal treatment benefits.

Jonathan M Fishman, ENT Consultant, The Royal National Throat, Nose & Ear Hospital, University College London Hospitals NHS Foundation Trust, London, UK

Laura M Cullen, GP Partner, Heathfielde Medical Centre, London, UK

References
1 Fishman JM, Cullen L. Investigating sudden hearing loss in adults. BMJ 2018;363:k4347. 10.1136/bmj.k4347
2 https://www.regainyourhearing.eu/trial/
3 Stachler RJ, Chandrasekhar SS, Archer SM, et al. AAO-HNS clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012;146 (suppl): S1-35.
4 Bennett MH, Kertesz T, Perleth M, Yeung P, Lehm JP. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2012;10: CD004739.

Competing interests: No competing interests

06 December 2018
Jonathan M Fishman
ENT Consultant Surgeon
Laura M Cullen, GP Partner, Heathfielde Medical Centre, London, UK
The Royal National Throat, Nose & Ear Hospital, University College London Hospitals NHS Foundation Trust, London, UK
The Royal National Throat, Nose & Ear Hospital, University College London Hospitals NHS Foundation Trust, London, UK