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Sudden hearing loss: aao-hnsf clinical practice guideline by wgre ethbtn
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Sudden hearing loss: aao-hnsf clinical practice guideline |
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On March 1, 2012, the American Academy of Otolaryngology-Head andNeck Surgery Foundation published a new Clinical Practice Guidelineon Sudden Hearing Loss (SHL). This guideline is published as asupplement to Otolaryngology-Head and Neck Surgery. A sudden loss of hearing is a frightening symptom that most oftenprompts urgent medical care. Current diagnosis and treatment plansvary greatly. This guideline provides evidence-basedrecommendations for the diagnosis, management, and follow-up ofadults who present with SHL.
Prompt, accurate recognition andmanagement of sudden sensorineural hearing loss (SSNHL), a subsetof SHL, may improve hearing recovery and patient quality of life.SSNHL affects 5 to 20 per 100,000 population, with about 4,000 newcases per year in the United States. The purpose of this guideline is to provide all clinicians who mayencounter patients with SHL with evidence-based recommendations fordiagnosis, counseling, treatment, and follow-up. By focusing onopportunities for quality improvement, the guideline should improvediagnostic accuracy, facilitate prompt intervention, decreasevariations in management, reduce unnecessary tests and imagingprocedures, and improve hearing and rehabilitative outcomes foraffected patients. "We are pleased that this guideline provides doctors with a set ofevidence-based recommendations for patients who present with suddenhearing loss.
This guideline will help advance the care ofafflicted patients and result in improved outcomes," said Robert J.Stachler, MD, Guideline Chair. Key Points for the AAO-HNSF Clinical Practice Guideline: SuddenHearing Loss What is sudden hearing loss and why is it important? Sudden hearingloss (SHL) is a frightening symptom that often prompts an urgent oremergent visit to a physician. The guideline primarily focuses onsudden sensorineural hearing loss (SSNHL) in adult patients (aged18 and over). The panel recognized that patients enter the health care systemwith SHL as a nonspecific, primary complaint.
Therefore, theinitial recommendations of the guideline deal with efficientlydistinguishing SSNHL from other causes of SHL at the time ofpresentation. Prompt recognition and management of SSNHL mayimprove hearing recovery and patient quality of life (QOL). SSNHLaffects 5 to 20 per 100,000 population, with about 4,000 new casesper year in the United States. Why is the sudden hearing loss guideline newsworthy? This is thefirst evidence-based guideline on sudden hearing loss in the UnitedStates.
The guideline's recommendations should improve diagnosticaccuracy, facilitate prompt intervention, decrease inappropriatevariations in management, reduce unnecessary tests and imagingprocedures, and improve hearing and rehabilitative outcomes foraffected patients. What is the purpose of the sudden hearing loss guideline? Toprovide clinicians with evidence-based recommendations for thediagnosis, management, and follow-up of patients who present withSHL. The guideline is intended for all clinicians who diagnose ormanage adult patients (18 and over) who present with SHL. Theguideline was developed by a multidisciplinary panel representingthe fields of otolaryngology, otology, neurotology, neurology,family medicine, emergency medicine, audiology, nursepractitioners, and consumer advocacy groups. What are the newsworthy points made in the guideline? Prompt and accurate diagnosis is important: a.
Sensorineural ('nerve') hearing loss should be distinguishedclinically from conductive ('mechanical') hearing loss. b. Unusual presentations such as bilateral SSNHL, recurrent SSNHL,or focal neurological findings (problem with nerve, spinal cord, orbrain function) may represent definable underlying disease andshould be managed accordingly. c.
The diagnosis of idiopathic sudden sensorineural hearing loss(ISSNHL), is made when audiometry confirms a 30 decibel hearingloss at three consecutive frequencies and an underlying conditioncannot be identified by history and physical exam. Unnecessary tests and treatments should be avoided: a. Routine head/brain CT scans, often ordered in the ER setting,are not helpful and expose the patient to ionizing radiation. b. Routine, non-targeted, laboratory testing is not recommended.
c. The following should not be routinely prescribed: antivirals,thrombolytics, vasodilators, vasoactive substances, or antioxidantsto patients with ISSNHL. Retrocochlear workup should be performed in all patients withISSNHL, regardless of hearing recovery. Initial therapy for ISSNHL may include corticosteroids. a.
Corticosteroids may be delivered systemically or viaintratympanic application. b. Hyperbaric oxygen, currently not FDA-approved for thisindication, may be offered. Doctors should offer intratympanic steroid perfusion when patientshave incomplete recovery from ISSNHL after failure of initialmanagement. Follow-up and counseling is important: a.
Doctors should educate patients with ISSNHL about the naturalhistory of the condition, the benefits and risks of medicalinterventions, and the limitations of existing evidence regardingefficacy. b. Doctors should obtain follow-up audiometry within six months ofdiagnosis for patients with ISSNHL. c.
Doctors should counsel patients with incomplete hearing recoveryabout the possible benefits of amplification and hearing assistivetechnology and other supportive measures. Additional References Citations. I am Polo Shirts/T-Shirts writer, reports some information about electroplated diamond blades , agm battery 12v.
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