Ani İşitme Kaybı
Özet
Ani işitme kaybı (AİK), 72 saat veya daha kısa sürede gelişen, saf ses odyogramında ardışık en az üç frekansta ortalama en az 30 dBHL sensörinöral işitme kaybı olarak tanımlanan acil bir durumdur. Genellikle tek taraflı görülmekle birlikte, menenjit, otoimmün hastalıklar veya tümörler gibi nedenlerle nadiren bilateral de olabilir. Etiyolojisinde enfeksiyon (özellikle viral), vasküler oklüzyon, membran rüptürü ve otoimmün teoriler ileri sürülmektedir. Tanı aşamasında detaylı öykü ve fizik muayenenin yanı sıra saf ses odyometrisi, ABR ve özellikle retrokoklear patolojileri dışlamak için altın standart olan manyetik rezonans görüntüleme (MRG) kullanılır. Tedavide en yaygın ve etkili seçenek ilk iki hafta içinde başlanan oral kortikosteroidlerdir. Sistemik yan etkileri azaltmak amacıyla intratimpanik steroid enjeksiyonları da tercih edilebilir. Bunların dışında hiperbarik oksijen, antiviraller ve vazoaktif ajanlar da tedavi protokollerinde yer almaktadır. Hastalığın seyrini etkileyen prognoz faktörleri arasında; ileri yaş, tedaviye geç başlanması, vertigonun eşlik etmesi ve ileri derece işitme kaybı kötü prognoz göstergesi iken, orta frekanslardaki kayıplar iyi prognoza işaret eder.
Sudden sensorineural hearing loss (SSNHL) is a medical emergency defined as a hearing loss of at least 30 dBHL affecting at least three consecutive frequencies on a pure-tone audiogram, occurring within 72 hours or less. Although typically unilateral, bilateral involvement can rarely occur due to reasons such as meningitis, autoimmune inner ear diseases, or tumors. The primary etiological frameworks include infectious (mainly viral), vascular occlusion, membrane rupture, and autoimmune theories. Diagnosis requires a detailed history and physical examination, supplemented by pure-tone audiometry, ABR, and magnetic resonance imaging (MRI), which is the most sensitive imaging modality to exclude retrocochlear pathologies. Corticosteroids administered orally within the first two weeks represent the most widely used and effective treatment modality. Intratympanic steroid injections serve as a valuable alternative or rescue therapy to mitigate systemic side effects. Additional therapeutic strategies encompass hyperbaric oxygen therapy, antivirals, and vasoactive agents. Prognostic outcomes are heavily influenced by several factors; advanced age, delayed initiation of treatment, accompanying vertigo, and severe baseline hearing loss indicate a poor prognosis, whereas hearing loss restricted to middle frequencies demonstrates a favorable outcome.
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