Comparison between Bilateral and Unilateral Sudden Sensorineural Hearing Loss

Background：Bilateral sudden sensorineural hearing loss （BSSHL） is rare and assumed to be a different clinical entity compared to unilateral SSHL （USSHL）.This study examined the differences between the idiopathic BSSHL and USSHL.Methods：Forty-six sequential BSSHL patients （Se-BSSHL） and 68 simultaneous BSSHL （Si-BSSHL） were consecutively admitted between June 2008 and December 2015.Two sets of patients served as control groups：（1） USSHL patients with healthy contralateral ear and （2） USSHL patients with contralateral preexisting hearing loss （USSHLwCHL）.We retrospectively analyzed differences among four cohorts using analysis of variance,Kruskal-Wallis test,Welch＇s t-test,and Chi-square test as appropriate before and after propensity score matching （PSM） based on age,gender,and body mass index （BMI）.Results：The prevalence of idiopathic BSSHL was 8.6% （114/1329） among the total SSHL patients.In the total cohort,USSHL patients tended to be younger,female,and tended to have lower BMI,renal parameters,and total cholesterol in addition to higher high-density lipoprotein compared to the other three groups.Most routine blood indicators,some coagulation markers,and immunoglobulin M （H =13.4,P =0.004） were significantly different among the study groups.After PSM,the major significant differences were found in audiometric characteristics.Si-BSSHL and Se-BSSHL patients demonstrated similar hearing thresholds as USSHL but were significantly better than the USSHLwCHL patients across most frequencies before and after treatment （H =30.0,P 〈 0.001 for initial hearing and H =12.0,P =0.007 for final hearing）.Moreover,the BSSHL patients showed different hearing loss distribution patterns （more descending type,x2 =33.8,P =0.001） with less hearing gain （H =17.5,P 〈 0.001） compared to the USSHL patients.Conclusions：Idiopathic BSSHL is a relatively rare subtype of SSHL with a higher rate of descending audiogram type and inferior hearing outcome rather than being classified as a completely different disease entity compared to USSHL.

Recurrent glomangioma("true"glomus tumor)of the middle ear and mastoid

Objective:To review current literature and experience with glomangiomas,or true glomus tumors of the middle ear and mastoid as well asto report on the exceptionally rare case of a glomangiomastemming from the middle ear space with multiple recurrences.Methods:Review of existing world literature and description of personal experience with rare cases of a glomangioma of the middle ear and mastoid.Results:Review of existing literature revealed two cases of patients presenting with tinnitus and hearing loss refractory to medical management.Both patients were ultimately diagnosed with glomangioma on histopathology.Complete surgical excision is thought to be curative.Patient:A 36-year-old woman presented with a rare case of a glomangioma of the middle ear presenting with unilateral hearing loss.She was noted to have a mass behind the tympanic membrane.Imaging revealed a diffuse mass filling the mastoid air cells.Imaging characteristics and histology were consistent with a glomangioma.Intervention:Initial resection via mastoidectomy using a postauricular approach.The tympanic membrane was reconstructed with temporalis tissue.Follow-up revision tympanomas-toidectomy was performed upon recurrence of disease.The chorda tympani were sacrificed due to tumor involvement.The incus and head of the malleus were removed to gain better access to the tumor.The ossicular chain was reconstructed with a Goldenberg Total Ossicular Prosthesis.Main outcome measure:Recurrence of disease.Follow-up:In the 67 months since her most recent surgery,there has been no evidence of recurrence by CT or physical exam.Conclusion:Glomangioma of the middle ear represents an exceptionally rare entity that can present in a similar fashion to a paraganglioma.