4. PathogenesisPathogenesis for idiopathic sudden sensory hearing loss (ISSHL) has 4 lines of theoretical, as follows: 3Virus infectionSudden sensorineural hearing loss was found in cases of mumps, measles, rubella, and influenza caused by infection with adenovirus and cytomegalovirus (CMV). Serological examination of patients with idiopathic sensorineural hearing loss showed an increase in antibody titers against several viruses. Between 25-30% of patients reported a history of upper respiratory tract infection within one month of the onset of hearing loss.Histopathologic examination of the temporal bone yan patients experienced sudden deafness showed atrophy of the organ of Corti, atrophy of the stria vaskularis and tektorial membrane and hair cell loss and cell backer of the cochlea.The cause of vascularCochlear blood vessels are end arteries (end artery), so if there is interference with the cochlear blood vessels are very prone to damage, in the case of embolism, thrombosis, vasospasm, and hypercoagulable or ischemia meningkat.terjadi viscosity which results in extensive degeneration of cellsganglion, spiral ligament and stria vaskularis. Then followed by the formation of connective tissue and ossification.Ruptured membranes labyrinthRuptured membranes labyrinth sensorineural hearing loss can potentially cause sudden, basement membrane and the membrane is a thin membrane reissner endolimfe and perilimfe limit. Rupture of the membrane one or both can cause sudden deafness.Autoimmune inner ear diseaseSensorineural hearing loss caused by the autoimmune process of the inner ear is unclear, but immunologic activity of the cochlea to the fact that high.
Sudden deafness can also be caused by drugs ototoksik. Deafness is usually preceded by tinnitus.
5. DiagnosisDiagnosis obtained by anamnesis and physical examination and audiological and laboratory investigation.AnamnesisA careful history regarding the occurrence of deafness, as well as the symptoms that accompany an important predisposing factor for direct diagnosis. Physical examination including blood pressure is necessary. On examination found no abnormalities in otoskopi ear sakit.1A. Sudden hearing loss is usually one ear is not clear why, take place in less than 3 days.2. Patients are usually given with a clear exactly when their hearing loss, patients like to hear a "click" or "pop" then the patient's hearing loss.3. The first symptom is a form of tinnitus, a few hours or even days in advance may be preceded by a viral infection, head trauma, drugs ototoksik, and acoustic neuroma.4. Sudden dizziness (vertigo) is an early symptom of most sudden deafness caused by ischemic cochlear and viral infections, and will be more severe vertigo in Meniere's disease, but the vertigo was not found or rare in sudden deafness caused by acoustic neuroma, a drug ototoksik
5. Nausea and vomiting6. High fever and seizures7. History of viral infections such as mumps, measles, herpes zooster, CMV, influenza B8. History of hypertension9. History of metabolic diseases like diabetes10. Ears feel full, usually in Meniere's disease11. A history of traveling by plane or dive to the seabed12. History of head trauma and loud noiseb. Physical examinationAt the hearing, the tuning fork test: positive Rinne, Weber lateralization to the normal ear, Schwabach shortened, suggesting sensorineural deafness.On pure tone audiometry showed mild to severe sensorineural deafness. Said tone audiometric examination gave results sensorineural deafness while there is an impression on impedance audiometry cochlear sensorineural deafness. In children, Bera test can be performed where the results showed mild sensorineural deafness berat.5Examination penunjang1?? Special audiometric- Test SIDE (Short Increment Sensitivity Index) with a score of: 100% or less than 70%- Tone decay test reflexes fatigue or negative.Impression: It's not deaf retrokoklea?? Speech audiometry (speech audiometry)- SDS (speech discrimination score): less than 100%Impression: sensorineural deafness?? Impedance audiometry:Timpanogram type A (normal) ipsilateral stapedius reflex negative or positive, while positive collateral.Impression: sensorineural deafness Cochlear?? Bera (Responce Audiometry Brainstem Evolved)Show sencori neural deafness of mild to severe.d. Examination Laboratorium1Uemeriksaan laboratory can be used to examine the possibility of viral, bacterial, hyperlipidemia, hiperfibrinogen, hypothyroidism, autoimmune diseases, and physiology hemostasit.To determine whether there is blood in the patient's hypercoagulable sudden deafness can be carried out inspection and test filter hemostasis physiology of blood clotting.Patients need to be consulted to subsections Hematology Internal Medicine and Cardiology section to determine the presence of blood disorders and the things that cause blood vessel blockage.
6. ManagementTreatment for sudden deafness to date is a matter of controversy, the high rate of spontaneous improvement to normal or near-normal direction complicate the evaluation of treatment for deafness mendadak.Tak no controlled studies done to prove that a significant drug cure sudden deafness. As is known to spontaneously healing rates sudden deafness occurs between 40-70% kasus.Ada expert opinion stating that most cases of sudden deafness had partial healing process, especially during the first 14 days after the onset illness.2
Therapy for sudden deafness is: 1Perfect bed rest (total bed rest) both physical and mental rest for 2 weeks to eliminate or reduce the stress of great influence on the state of neovascular failure.Vasodilator that is strong enough for example injectable komplamin3xd1200 mg (4 vials) for 3 days3 × 900 mg (3 vials) for 3 days3 × 600 mg (2 ampoules) for 3 days3 × 300 mg (1 ampoule) for 3 daysAccompanied by administering peroral tablet komplamin 3 × 2 tablets orally / dayPrednisone 4 × 10 mg (2 tablets), tappering off every 3 days (with caution in patients with DM)Vitamin C 500 mg 1 × 1 tablet / dayNeurobion 3 × 1 tablet / dayDiit low salt and low cholesterolOxygen inhalation 4 × 15 minutes (2 liters / minute), antiviral drugs in accordance with the virus that causesHyperbaric oxygen therapy (HB)Definition of hearing improvement in sudden deafness is: 2Said to be cured when the improvement of hearing threshold of less than 30 db at a frequency of 250 Hz, 500 Hz, 1000 Hz and below 25 db at a frequency of 4000 Hz.Very good improvement occurs when the repairs are more than 30 db at 5 frequenciesGood repair when the average improvement ranging between 10-30 db at 5 frequenciesThere was no improvement when the improvement is less than 10 db at 5 rate and
7. Prognosis2Series of reports for the spontaneous recovery rate in patients with SHL ranges from 47% to 63%. This discussion is combined with patients with partial and complete recovery as well as patients with any type of audiogram.Four variables that affect the recovery of ISSNHL: (1) time since the onset of type, (2) audiogram, (3) vertigo, and (4) age. In 1984, Byl published a prospective study conducted over 8 years were evaluated from 225 patients with SHL. Factors evaluated included age, tinnitus, vertigo, audiogram pattern, time elapsed from the onset of hearing loss until the initial visit, and the erythrocyte sedimentation rate with respect to recovery.REFERENCESJenny B and Indro S. , 2007. Sudden deafness. In Textbook of Health Sciences Ear Nose Throat Head and Neck Surgery. Issue 6: New York: FK UI.Muller C. Of 2001. Sudden Sensorineural hearing loss. Grand Rounds Presentation, UTMB, Dept. of Otolaryngology. Retrieved from http://www.utmb.edu/otoref/grnds/SuddenHearingLoss-010613/SSNHL.htm on 19 September 2011.Supriyono. Sudden Deafness 2009. Downloaded from http://nawalahusada.wordpress.com/2009/01/11/tuli-mendadak/ on 19 September 2011.Neeraj N Mathur. Of 2011. Sudden deafness. Retrieved from http://emedicine.medscape.com/article/856313-overview on September 19, 2011.Anonymous. Of 2011. Sudden deafness. Retrieved from http://www.klikpdf.info/?p=423 on September 19, 2011.
Sudden deafness can also be caused by drugs ototoksik. Deafness is usually preceded by tinnitus.
5. DiagnosisDiagnosis obtained by anamnesis and physical examination and audiological and laboratory investigation.AnamnesisA careful history regarding the occurrence of deafness, as well as the symptoms that accompany an important predisposing factor for direct diagnosis. Physical examination including blood pressure is necessary. On examination found no abnormalities in otoskopi ear sakit.1A. Sudden hearing loss is usually one ear is not clear why, take place in less than 3 days.2. Patients are usually given with a clear exactly when their hearing loss, patients like to hear a "click" or "pop" then the patient's hearing loss.3. The first symptom is a form of tinnitus, a few hours or even days in advance may be preceded by a viral infection, head trauma, drugs ototoksik, and acoustic neuroma.4. Sudden dizziness (vertigo) is an early symptom of most sudden deafness caused by ischemic cochlear and viral infections, and will be more severe vertigo in Meniere's disease, but the vertigo was not found or rare in sudden deafness caused by acoustic neuroma, a drug ototoksik
5. Nausea and vomiting6. High fever and seizures7. History of viral infections such as mumps, measles, herpes zooster, CMV, influenza B8. History of hypertension9. History of metabolic diseases like diabetes10. Ears feel full, usually in Meniere's disease11. A history of traveling by plane or dive to the seabed12. History of head trauma and loud noiseb. Physical examinationAt the hearing, the tuning fork test: positive Rinne, Weber lateralization to the normal ear, Schwabach shortened, suggesting sensorineural deafness.On pure tone audiometry showed mild to severe sensorineural deafness. Said tone audiometric examination gave results sensorineural deafness while there is an impression on impedance audiometry cochlear sensorineural deafness. In children, Bera test can be performed where the results showed mild sensorineural deafness berat.5Examination penunjang1?? Special audiometric- Test SIDE (Short Increment Sensitivity Index) with a score of: 100% or less than 70%- Tone decay test reflexes fatigue or negative.Impression: It's not deaf retrokoklea?? Speech audiometry (speech audiometry)- SDS (speech discrimination score): less than 100%Impression: sensorineural deafness?? Impedance audiometry:Timpanogram type A (normal) ipsilateral stapedius reflex negative or positive, while positive collateral.Impression: sensorineural deafness Cochlear?? Bera (Responce Audiometry Brainstem Evolved)Show sencori neural deafness of mild to severe.d. Examination Laboratorium1Uemeriksaan laboratory can be used to examine the possibility of viral, bacterial, hyperlipidemia, hiperfibrinogen, hypothyroidism, autoimmune diseases, and physiology hemostasit.To determine whether there is blood in the patient's hypercoagulable sudden deafness can be carried out inspection and test filter hemostasis physiology of blood clotting.Patients need to be consulted to subsections Hematology Internal Medicine and Cardiology section to determine the presence of blood disorders and the things that cause blood vessel blockage.
6. ManagementTreatment for sudden deafness to date is a matter of controversy, the high rate of spontaneous improvement to normal or near-normal direction complicate the evaluation of treatment for deafness mendadak.Tak no controlled studies done to prove that a significant drug cure sudden deafness. As is known to spontaneously healing rates sudden deafness occurs between 40-70% kasus.Ada expert opinion stating that most cases of sudden deafness had partial healing process, especially during the first 14 days after the onset illness.2
Therapy for sudden deafness is: 1Perfect bed rest (total bed rest) both physical and mental rest for 2 weeks to eliminate or reduce the stress of great influence on the state of neovascular failure.Vasodilator that is strong enough for example injectable komplamin3xd1200 mg (4 vials) for 3 days3 × 900 mg (3 vials) for 3 days3 × 600 mg (2 ampoules) for 3 days3 × 300 mg (1 ampoule) for 3 daysAccompanied by administering peroral tablet komplamin 3 × 2 tablets orally / dayPrednisone 4 × 10 mg (2 tablets), tappering off every 3 days (with caution in patients with DM)Vitamin C 500 mg 1 × 1 tablet / dayNeurobion 3 × 1 tablet / dayDiit low salt and low cholesterolOxygen inhalation 4 × 15 minutes (2 liters / minute), antiviral drugs in accordance with the virus that causesHyperbaric oxygen therapy (HB)Definition of hearing improvement in sudden deafness is: 2Said to be cured when the improvement of hearing threshold of less than 30 db at a frequency of 250 Hz, 500 Hz, 1000 Hz and below 25 db at a frequency of 4000 Hz.Very good improvement occurs when the repairs are more than 30 db at 5 frequenciesGood repair when the average improvement ranging between 10-30 db at 5 frequenciesThere was no improvement when the improvement is less than 10 db at 5 rate and
7. Prognosis2Series of reports for the spontaneous recovery rate in patients with SHL ranges from 47% to 63%. This discussion is combined with patients with partial and complete recovery as well as patients with any type of audiogram.Four variables that affect the recovery of ISSNHL: (1) time since the onset of type, (2) audiogram, (3) vertigo, and (4) age. In 1984, Byl published a prospective study conducted over 8 years were evaluated from 225 patients with SHL. Factors evaluated included age, tinnitus, vertigo, audiogram pattern, time elapsed from the onset of hearing loss until the initial visit, and the erythrocyte sedimentation rate with respect to recovery.REFERENCESJenny B and Indro S. , 2007. Sudden deafness. In Textbook of Health Sciences Ear Nose Throat Head and Neck Surgery. Issue 6: New York: FK UI.Muller C. Of 2001. Sudden Sensorineural hearing loss. Grand Rounds Presentation, UTMB, Dept. of Otolaryngology. Retrieved from http://www.utmb.edu/otoref/grnds/SuddenHearingLoss-010613/SSNHL.htm on 19 September 2011.Supriyono. Sudden Deafness 2009. Downloaded from http://nawalahusada.wordpress.com/2009/01/11/tuli-mendadak/ on 19 September 2011.Neeraj N Mathur. Of 2011. Sudden deafness. Retrieved from http://emedicine.medscape.com/article/856313-overview on September 19, 2011.Anonymous. Of 2011. Sudden deafness. Retrieved from http://www.klikpdf.info/?p=423 on September 19, 2011.
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