Prognostic relevance of anamnestic and diagnostic parameters in low-frequency hearing impairment.
Low-frequency hearing impairment (LFHI) is mainly attributed to endolymphatic hydrops and has a great variety of possible outcomes. At present, no conservative therapeutic regimen has proven to be 'gold-standard', and information about the prognostic indicators of LFHI is scarce. In a retrospective investigation, we evaluated the records of 90 patients who had been treated with infusions improving blood perfusion. In patients lacking complete remission, dehydration infusion therapy was added. We also undertook audiometric follow up. We calculated the outcomes after infusion therapy, dehydration therapy and after long-time hearing follow up, and we determined the prognostic relevance of several parameters of anamnesis and clinical examination to outcomes, for both therapeutic interventions and long-time hearing. The prognosis of LFHI was significantly correlated to certain anamnestic and clinical parameters; a short duration of the disease, lack of vertigo and female gender implied a better outcome. The pretherapeutic hearing threshold was an important prognostic factor; the outcome was significantly worse in patients with distinct hearing impairment in low or high frequencies, compared with that in patients with little hearing loss. Whereas vertigo was a negative prognostic factor, the results of quantitative vestibular testing were irrelevant to the outcome. The glycerol test failed to predict the effectiveness of dehydration therapy and lacked any value in predicting prognosis. These results allow the clinician to focus the anamnesis and diagnostic examination on prognostically relevant parameters, thus enabling a better estimation of the long-term disease course and improved counselling of patients. Furthermore, these results help to distinguish valuable from irrelevant diagnostic procedures.
Maier
W
W
Department of Oto-Rhino-Laryngology, University of Freiburg Medical School, Freiburg, Germany. maier@hno1.ukl.uni-freiburg.de
Schipper
J
J
D000086:Acetazolamide / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D004232:Diuretics / Q000627:therapeutic use; D004584:Electronystagmography; D018159:Endolymphatic Hydrops / Q000150:complications / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006401:Hematologic Agents / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008575:Meniere Disease / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D010431:Pentoxifylline / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D004232:Diuretics; D006401:Hematologic Agents; D008353:Mannitol; D000086:Acetazolamide; D010431:Pentoxifylline