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La meningitis bacteriana aguda es una emergencia infectológica ya que puede ocasionar secuelas graves o incluso la muerte. Es rara la presentación de este cuadro con sordera súbita y ataxia. Se presenta el caso de una adolescente del sexo femenino de 14 años, que presentó meningitis bacteriana por meningococo serogrupo C con ataxia vestibular y sordera súbita, que fue tratada con corticoides y pentoxifilina, además de antibióticos para la infección de base. La recuperación de la audición no fue adecuada y persistió con sordera e hipoacusia severa unilateral y ataxia vestibular persistente e inhabilitante.

Acute bacterial meningitis is an infectious emergency as it can lead to serious sequelae or even death. The presentation of this condition with sudden deafness and ataxia is rare. We present the case of a 14-year old female adolescent, who presented with vestibular ataxia and sudden deafness and was subsequently diagnosed with bacterial meningitis due to serogroup C meningococcus. She was treated with corticosteroids and pentoxifylline, in addition to antibiotics, for the baseline infection. Hearing recovery was not adequate; she persisted with severe deafness, unilateral hearing loss and persistent and disabling vestibular ataxia.

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ABSTRACT INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

Resumo Introdução: A surdez súbita é caracterizada por uma perda abrupta da audição de pelo menos 30 dB em três frequências sequenciadas no audiograma tonal de rotina ao longo de três dias, oumenos. O tratamento é fundamentado em sua etiologia e corticosteroides orais são amplamenteutilizados. A terapia com corticosteroide intratimpânico foi incluída como tratamento primárioou secundário nos casos em que não houve melhora com o uso de corticosteroides orais. Objetivo: Determinar a eficácia da terapia intratimpânica com esteroides em casos de surdez súbita. Método: Foi realizada uma revisão sistemática das publicações sobre o tópico no banco dedados Pubmed/Medline, com as palavras-chave: surdez súbita, perda súbita da audição e corticosteroides. Resultados: Foram analisados 30 estudos científicos. Com relação aos objetivos dos estudos analisados, 76,7% procuravam avaliar o uso da terapia intratimpânica em seguida ao insucesso com o tratamento convencional; a terapia intratimpânica foi empregada como tratamento primário em 23,3% dos estudos. Conclusão: A terapia com corticosteroide intratimpânico é prescrita primariamente nos casos de insucesso com a terapia convencional e quando há limitação para o uso de corticosteroides sistêmicos, como ocorre com o paciente diabético.

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INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

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La sordera súbita es una condición de hipoacusia neurosensorial aguda usualmente unilateral, de instalación en un período menor o igual a 72 horas, que en la mayoría de los casos es idiopática; sin embargo, causas infecciosas, autoinmunes y vasculares, se han propuesto como los principales mecanismos involucrados. La sordera súbita es considerada una urgencia otorrinolaringológica, sin embargo el tratamiento de ésta continúa siendo un tema controvertido.

Sudden deafness is usually a condition of acute unilateral sensorineural hearing loss, installation less than or equal to 72 hours period, which in most cases are idiopathic; however, infectious, autoimmune and vascular causes, have been proposed as key mechanisms involved. Sudden deafness is considered an ENT urgency, however this treatment remains controversial.

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Se realizó una revisión bibliográfica sobre sordera súbita, por constituir esta una grave pérdida auditiva, que se presenta en unas horas. Cada año, una de cada cinco mil personas sufre sordera repentina, siendo esta por la general grave. Sin embargo, las personas pueden recuperar completa o parcialmente la audición cuando se realiza un diagnóstico y tratamiento precoz. Por tener esta entidad amplia repercusión en la esfera social, y a la vez ser poco estudiada, se consideró la necesidad de profundizar y actualizar el tema, siendo este el objetivo del trabajo. Se puntualizaron sus causas, fisiopatología, cuadro clínico y formas de presentación, así como diversas formas para su tratamiento, insistiendo en un diagnóstico precoz que garantice el mayor por ciento de recuperación audiológica en los pacientes que la sufren.

We made a bibliographic review on sudden deafness because it is a serious auditive lost developed in few hours. Every year one of each five thousand people suffers sudden deafness, being it serious in general. Nevertheless, people can completely or partially recover the audition when it is precocious diagnosed and treated. Because this entity has a wide repercussion in the social sphere and also is scarcely studied, we considered the need of extending and updating the theme, being it the objective of our work. We documented its causes, physiopathology, characteristics and presentation form, and also the different forms of treatment, insisting in a precocious diagnosis to warrant the highest percent of audiological recuperation in the patients suffering it.

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Introducción: La sordera brusca es una pérdida súbita de audición a nivel neuro-sensorial, por causas desconocidas, y con mal pronóstico funcional. Las causas son desconocidas, lo que genera múltiples hipótesis y discusiones sobre esta patología. Objetivo: Evaluar los factores asociados al pronóstico y determinar los aspectos terapéuticos que influyen en el pronóstico de estos pacientes. Material y método: Revisamos las historias clínicas de los pacientes diagnosticados de sordera brusca durante un período de estudio de 4 años, y calculamos las frecuencias de las diferentes variables consideradas como relevantes; realizamos análisis bivariante y una comparación de las distribuciones mediante test de ANOVA y un análisis multivariante con regresión logística y lineal múltiple. Resultados: Analizamos 40 casos. Consideramos factores como el oído afectado, antecedentes cardiovasculares, HTA, diabetes, dislipemia, tabaco, hemoglobina, hematocrito, las circunstancias temporales y geográficas, de las que ninguna de ellas resultaron significativas para la recuperación. Tras el análisis de otros factores, encontramos un predominio de casos en verano y otoño (90 por ciento) frente a invierno y primavera (10 por ciento). El uso del famciclovir estuvo asociado a mayor probabilidad de recuperación completa OR 21,164 [1,265-374,47]. Por el contrario, estuvieron ligados a una menor probabilidad de recuperación completa: el tratamiento con medicina hiperbárica OR 0,013 [0,001-0,433], la curva audiométrica descendente OR 0,164 [0,032-0,533], y la presencia de vértigo asociada a acúfenos OR 0,158 [0,08-1,015]. La aspirina mejoró la recuperación de decibelios media 24,3 db IC 95 por ciento [1,00-47,61]. Conclusiones: El estudio es una serie retrospectiva cuyo análisis multivariante muestra que el famciclovir y el AAS tienen un efecto estadísticamente beneficioso en el tratamiento de la sordera súbita...

Introduction: The sudden deafness is a sudden loss of hearing at the neuro-senso-rial, for unknown reasons, and bad functional prognosis. The cause is unknown, generating multiple hypotheses and discussions on this topic. Aim: To evaluate the factors associated with prognosis and determine therapeutic aspects that influence the prognosis of these patients. Matherial and method: We reviewed the medical records ofpatients diagnosed with sudden hearing loss during a study period of 4 years, and calculate the frequencies of the different variables considered relevant; performed bivariate analysis and a comparison of the distributions byANOVA and a multivariate analysis with logistic regression and multiple lineal. Results: We analyzed 40 cases. We consider factors like the affected ear, cardiovascular history, hypertension, diabetes, dyslipidemia, snuff, hemoglobin, hematocrit, temporal and geographical, of which none were significant for recovery. After analysis of other factors, we found a predominance of cases in summer and autumn (90 percent) compared to winter and spring (10 percent). Use of famciclovir was associated with greater likelihood of complete recovery OR 21.164 [1.265 to 374.47]. On the contrary, were linked to a lower linked to a lower likelihood of full recovery: treatment with hyperbaric OR 0.013 [0.0010.0433] OR descending audiometric curve [0.164 0.032 to 0.533] and the presence of vertigo associated with tinnitus OR o.158 [0.08 to 1.015]. Aspirin improved recovery of 24.3 db decibel half 95 percent CI [1.00 to 47.61]. Conclusions: The study is a retrospective multivariate analysis which shows that famciclovir and aspirin have a statisfically beneficial in the treatment of sudden deafness, which in our sample is more frequent in summer and autumn. Biased studies are needed on these results may provide new hypotheses for treatment.

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OBJECTIVES: The aim of the present study was to establish the frequency of metabolic disorders among patients with sudden deafness and to compare this frequency with data from population surveys. INTRODUCTION: No consensus has been reached regarding the prevalence of metabolic disorders among sudden deafness patients or their influence as associated risk factors. METHODS: This cross-sectional study enrolled all sudden deafness patients treated in the Otolaryngology Department of the University of São Paulo between January 1996 and December 2006. Patients were subjected to laboratory exams including glucose and cholesterol levels, low-density lipoprotein cholesterol fraction, triglycerides, free T4 and TSH. RESULTS: The sample comprised 166 patients. We observed normal glucose levels in 101 (81.5 percent) patients and hyperglycemia in 23 (18.5 percent) patients, which is significantly different (p < 0.0001) compared to the diabetes mellitus prevalence (7.6 percent) in the Brazilian population. Cholesterol levels were normal in 78 patients (49.7 percent) and abnormal in 79 (50.3 percent) patients, which is significantly different compared to the Brazilian population (p = 0.0093). However, no differences were observed in low-density lipoprotein cholesterol fraction (p = 0.1087) or triglyceride levels (p = 0.1474) between sudden hearing loss patients and the Brazilian population. Normal levels of thyroid hormones were observed in 116 patients (78.4 percent), and abnormal levels were observed in 32 (21.6 percent) patients. Compared with the prevalence of thyroid disorders in the general population (10 percent), statistical analysis revealed a significant difference (p = 0.0132) between these two groups. DISCUSSION: Among sudden deafness patients, we observed frequencies of hyperglycemia and thyroid disorders that were more than twice those of the general population. CONCLUSIONS: Hyperglycemia and thyroid disorders are much more frequent in patients with sudden deafness than in the general population and should be considered as important associated risk factors.

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The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference inthresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.

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A surdez súbita sensorioneural é uma perda auditiva súbita ou rapidamente progressiva. Na maioria dos casos a etiologia não é descoberta. Uma das causas possíveis de surdez súbita é a hemorragia intralabiríntica que, antes do surgimento da ressonância magnética, não era corretamente diagnosticada. O objetivo deste trabalho é relatar um caso de surdez súbita causada por hemorragia intralabiríntica e realizar uma revisão da literatura sobre este assunto.

Sudden sensorineural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding, which was difficult to diagnose before the advent of magnetic resonance imaging. The purpose of this paper is to report a case of sudden hearing loss caused by a labyrinthine hemorrhage, and to present a review of the literature on this topic.

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O schwannoma vestibular, também conhecido como neuroma ou neurinoma do acústico, é o tumor mais freqüente do ângulo pontocerebelar correspondendo a aproximadamente a 9 por cento de todos os tumores intracranianos. APRESENTAÇÃO DO CASO: Os autores apresentam um relato de caso de surdez súbita e zumbido unilateral com melhora dos sintomas através de tratamento clínico com Prednisona e Pentoxifilina e posterior diagnóstico por exame de imagem de schwannoma vestibular. DISCUSSÃO: A surdez súbita pode ser descrita como uma perda neurossensorial abrupta e intensa. Costuma ser acima de 30 dB, em três ou mais freqüências contíguas e se desenvolve em menos de três dias. CONCLUSÃO: É de grande importância a pesquisa da etiologia nos casos de surdez súbita para a boa condução do caso e orientação terapêutica.

Vestibular schwannoma, also known as acoustic neurinoma, is the most frequent tumor of the cerebellopontine angle, and represents 9 percent of all intracranial tumors. CASE REPORT: The authors report a case of sudden deafness with unilateral tinnitus. The patients responded to therapy with Prednisone and Pentoxifylline after the diagnosis of acoustic neurinoma by imaging exams. DISCUSSION: Sudden deafness can be described as an intense and abrupt sensorineural loss. Usually it is higher than 30 dB at three or more frequencies and develops in less than three days. CONCLUSION: Investigation of the etiology of sudden deafness is extremely important to establish the adequate strategy for the case.

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