Basilar artery tortuosity as a predictive factor for the efficacy of heparin adjuvant therapy in unilateral idiopathic sudden sensorineural hearing loss

Abstract Introduction Cochlear ischemia is hypothesized as one of the major etiologies of idiopathic sudden sensorineural hearing loss. Therefore, anticoagulant therapies are designed to be beneficial in certain patients with this condition. Objective This study aimed to determine which patients with idiopathic sudden sensorineural hearing loss would benefit from heparin treatment as adjuvant therapy. Methods In total, 134 patients who underwent magnetic resonance imaging for unilateral idiopathic sudden sensorineural hearing loss at a tertiary referral hospital between January 2014 and December 2018 were included in this retrospective study. All patients received Intratympanic steroid injections or heparin therapy plus oral corticosteroids. Radiological parameters of the vertebrobasilar system and clinical data from pre- and post-treatment assessments were analyzed. Results Most patients (71.6%) had a tortuous basilar artery The 65 patients with severe-to-profound idiopathic sudden sensorineural hearing loss showed a significant relationship between idiopathic sudden sensorineural hearing loss laterality and basilar artery displacement to the opposite side (p= 0.036), while the 69 patients with mild-to-moderate idiopathic sudden sensorineural hearing loss did not (p= 0.950). Additionally, the degree of basilar artery tortuosity was significantly associated with the degree of hearing impairment in the severe-to-profound idiopathic sudden sensorineural hearing loss group (p= 0.015). When idiopathic sudden sensorineural hearing loss occurred on the opposite side to basilar artery displacement, the improvement of hearing was significantly greater in patients treated with heparin than in those treated with intratympanic steroids (p= 0.041). Conclusion In a subset of patients with severe-to-profound idiopathic sudden sensorineural hearing loss, basilar artery tortuosity had a significant directional relationship with idiopathic sudden sensorineural hearing loss laterality. In these selected patients, a significant effect of heparin therapy on improving hearing was observed.

摘要 引言
有假说认为，耳蜗缺血（cochlear ischemia）是特发性突发性感音神经性听力损失（idiopathic sudden sensorineural hearing loss）的主要病因之一，因此抗凝治疗（anticoagulant therapies）被认为可使此类患者中的部分人群获益。

研究目的 本研究旨在明确哪些特发性突发性感音神经性听力损失患者可从作为辅助治疗（adjuvant therapy）的肝素治疗中获益。

研究方法 本回顾性研究（retrospective study）纳入了2014年1月至2018年12月期间，在某三级转诊医院（tertiary referral hospital）接受磁共振成像（magnetic resonance imaging）检查的单侧特发性突发性感音神经性听力损失患者共134例。所有患者均接受鼓室内类固醇注射（intratympanic steroid injections）或肝素联合口服糖皮质激素（oral corticosteroids）治疗。本研究对椎基底动脉系统（vertebrobasilar system）的影像学参数以及治疗前后评估的临床数据进行了分析。

研究结果 大多数患者（71.6%）存在基底动脉迂曲。在65例重度至极重度特发性突发性感音神经性听力损失患者中，特发性突发性感音神经性听力损失的侧别与基底动脉向对侧移位存在显著相关性（p=0.036）；而69例轻度至中度特发性突发性感音神经性听力损失患者未显示该相关性（p=0.950）。此外，在重度至极重度特发性突发性感音神经性听力损失组中，基底动脉迂曲程度与听力损害程度显著相关（p=0.015）。当特发性突发性感音神经性听力损失发生于基底动脉移位的对侧时，接受肝素治疗的患者的听力改善程度显著优于接受鼓室内类固醇注射的患者（p=0.041）。

研究结论 在部分重度至极重度特发性突发性感音神经性听力损失患者中，基底动脉迂曲与特发性突发性感音神经性听力损失的侧别存在显著的定向相关性。在这类经筛选的患者中，肝素治疗对听力改善具有显著效果。