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Sudden hearing loss (SHL) usually strikes like a bolt out of the blue. Patients typically report fullness, static Thirty percent of patients also experience a spinning sensation or dizziness. SHL is typically unilateral. |
About 300,000 SHL patients are treated each year in Germany alone. Doctors consider SHL a medical emergency because recovery of hearing crucially depends on early initiation of treatment. Failure to diagnose and treat SHL early enough increases the risk of residual problems such as persistent tinnitus. SHL is often caused by inner ear infarction, that causes sensitive hearing cells to be undersupplied with oxygen and nutrients. Apheresis, a blood cleansing procedure, is a new approach to significantly improve the flow properties of the blood by removal of fibrinogen and LDL cholesterol. A recent controlled randomised multicenter trial showed the rapid recovery of hearing after a single H.E.L.P. apheresis session. |
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Sudden hearing loss At least 20 per 100,000 persons in Western industrialized nations are estimated to suffer sudden hearing loss (SHL) each year. Not only is the frequency of SHL on the rise but people who experience this most frequent inner ear disorder are getting younger and younger. |
While the incidence of SHL still peaks among 50 to 60-year olds, the proportion of 30 to 40-year olds has been steadily increasing. Women are affected as often as men. SHL is characterized by a high rate of spontaneous recovery which may occur within hours, days or weeks of the event. SHL studies have reported spontaneous recovery of hearing in over 60 % of patients. Tinnitus is the most common late sequela of SHL. |
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Causes of Sudden Hearing Loss Medical research has not yet fully unraveled the causes of sudden hearing loss. Most medical scientists agree that SHL has a multifactorial etiology. Sudden onset, a high frequency of spontaneous recovery, and the typically unilateral nature of SHL support the theory that sudden hearing loss is most likely due However, viral infections and autoimmune disorders have also been suggested to trigger SHL in some people. |
Potential risk factors for sudden hearing loss are quite similar to those of myocardial infarction and include being overweight and having elevated blood lipids and lipid disorders. Other contributory causes include heart disease, excessive blood pressure fluctuations, increased clotting tendency of the blood, excessive smoking and alcohol consumption, and unusual physical exertion, strain or stress. Hearing cells can survive for a short time while being undersupplied with blood and oxygen. If blood flow is rapidly restored, the cells will usually recover. |
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Available Treatment Options for SHL Patients The various causes of sudden hearing loss have led to the development of a wide variety of treatments. All of these different approaches share the goal of restoring a patients hearing as soon as possible. This means that immediate initiation of therapy is essential. |
Treatment options are:
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Apheresis: A relatively new approach to the management of SHL is treatment by apheresis procedures. |
The patient’s blood is separated into the cellular components and the plasma. The latter is then treated for the elimination of those components suspected to be responsible for SHL, primarily fibrinogen and LDL. | These two steps can be carried out by filtration with subsequent precipitation (Heparin-induced Extracorporeal LDL Precipitation, H.E.L.P.) or by cascade filtration. | ||
How H.E.L.P. Apheresis Works H.E.L.P. removes LDL cholesterol, fibrinogen and lipoprotein(a), blood clotting proteins that impede blood circulation. A single such apheresis session removes more than 60 % of those particles from the blood. This procedure most rapidly improves the flow properties of the blood and also optimizes vessel diameter regulation. During a H.E.L.P. apheresis session, the patient has blood continuously removed via an arm vein. |
The blood cells are separated in a membrane plasma filter and immediately returned to the patient's bloodstream. Heparin is used to precipitate lipoprotein-heparin complexes from the resulting plasma and these complexes are pumped to a precipitate filter and separated there. A heparin adsorber is used to remove excess heparin from the cleansed plasma. Before returning it to the patient's bloodstream, the plasma is returned to its physiologic pH and volume by a consecutive dialysis step. |
All of these different steps are carried out using filters based on four different membranes produced by Membrana, each highly specialised for the individual purpose. Approximately 3,000 mL of blood is "cleansed" in one session, during which all plasma changes occur in an extracorporeal circuit and are 100 % reversible. The duration of treatment depends on the plasma volume and flow-rate and varies between 80 and 120 minutes. | ||
Benefit from H.E.L.P. in SHL Is Supported by Clinical Trial Outcomes The rapid and effective response of SHL patients to this particular kind of apheresis has recently been confirmed in a prospective, randomized multicenter trial (Suckfüll M (2002): Fibrinogen and LDL Apheresis in Treatment of Sudden Hearing Loss: A Randomised Multicenter Trial. Lancet 360; 1811–1817). |
A total of 201 SHL patients enrolled at four German university hospitals (Berlin, Bochum, Hamburg, and Munich) were randomized to either receive blood-thinning infusion therapy for 10 days in an inpatient setting ("standard") or undergo a single outpatient H.E.L.P. apheresis session ("HA"). HA proved better than standard therapy with regard to both acute and long-term recovery of hearing: Mean pure-tone thresholds turned out to be better in HA patients. | At six weeks, 84 % of HA patients (versus 78 % of standard therapy patients) had recovered hearing. Speech perception, essential for a patient's well-being, was rapidly and appreciably improved with HA. Patients with elevated LDL cholesterol or fibrinogen levels tend to derive particularly great benefit from HA. In these patients, the improvement in hearing ability showed a significant between-group difference in favor of HA. | ||
Recommended by the German Society of Otorhinolaryngology In its SHL Guideline revised in early 2004, the German Society of Otorhinolaryngology, Head and Neck Surgery recommends the use of H.E.L.P. apheresis for the treatment of sudden hearing loss, especially for severe cases of SHL (deafness or loss of hearing across all frequencies). |
Apheresis removing LDL cholesterol, fibrinogen and lipoprotein(a) is thus a viable method and has in fact been used for years in the management of familial hypercholesterolaemia. Recent research suggests that this method may also be a promising new approach to the management of other conditions where improvement of the flow properties of the blood is likely to improve patient outcomes including myocardial infarction, diabetic foot, stroke, and ischemic optic neuropathy. | Learn More About SHL and H.E.L.P. Educational materials about sudden hearing loss and H.E.L.P. apheresis can be obtained via email: |
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