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Of course, if one knows what causes SHL, it isn't idiopathic by definition. Others include measles, herpes-1, and infectious mononucleosis. Many of these are in the herpes family. There are sporadic reports of other organisms as well e.
Immunization is not associated with SHL Baxter et al, One would expect that a viral "SHL" would progress over hours. Meniere'sperilymphatic fistulae or vascular occlusion Merchant et al, An additional study of 11 more temporal bones in Linthicum et alwas suggestive of a viral etiology.
In our view, these studies included too few temporal bone samples to be relied upon. More temporal bone donations are needed. Interestingly, the laboratory that reported the recent 11 bones, had been in ginkgo writing app for 50 years.
This tiny number of samples over 50 years points out that the infrastructure to gather temporal bones in the USA is suboptimal. We ourselves have had situations where a patient indicated a willingness to have their temporal bone "harvested" but a "harvester" -- an otologic surgeon -- was not available.
Once this happens, one loses one's enthusiasm in encouraging patients to be generous. Some authors maintain that vascular disease is the most likely cause Rambold et al, This is largely a conclusion based on exclusion of other causes, although Umesawa et al reported that cardiovascular risk factors including smoking and diabetes were significantly more common in men in SHL.
To us, this doesn't seem like very important as there are just too many qualifiers here. Also supporting the idea that vascular causes are important, is the observation that SHL following surgery outside the inner ear, is most commonly associated with cardiopulmonary bypass surgery Page and Peters, In general, when viruses or vascular etiologies are held out as the "cause" of a particular illness, it often means that the details are unclear.
Recently there has been some weak recent evidence that blood flow plays a role as some measures of hearing improve in animals after a "stellate ganglion block" that improves blood flow Firat et al, Use of some agents that affect blood flow -- largely increase it --such as sildenafil Viagra and Tidalafil Cialis but not vardenafil Levitra have been associated with hearing loss McGwin, ; Khan et al, ; Wester et al, Fortunately these are very rare occurences -- perhaps just due to chance.
Against this general idea is the observation that factor V Leiden a common cause of increased blood coagulation does not increase the chance of SHL Shu et al, Also, the previously mentioned study of Merchant et al in temporal bones is against the vascular hypothesis. In addition to ischemia the inner ear has one main arterythere is also the possibility of hemorrhage.
Just a few cases of this have been reported.
We are a little dubious about this, as we don't see why there should be bleeding in the inner ear, but not elsewhere. In addition, we are not entirely convinced that every abnormal MRI with bright signal necessarily means that there was a bleed.
On the other hand, there are reports of patients with coagulation disorders having inner ear bleeds. It is our thought that these patients should logically have both hearing and vestibular deficits, as the inner ear fluid is common to both systems.
Migraine is also associated with SHL, presumably through vascular mechanisms.Sudden hearing loss (SHL) is a significant hearing loss that occurs in 72 hours or less. It usually occurs in one ear only and resolves itself in more than 50 percent of cases; it may be treated with steroids.
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