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Objectives: We tested the hypothesis that comorbid diseases significantly affect the prognosis of sudden sensorineural hearing loss (ISSNHL)., Study Design: A retrospective cohort study., Methods: The records of patients newly diagnosed with ISSNHL and treated with steroid prednisolone in a tertiary referral center between January 2003 and December 2013 were retrospectively reviewed. Pretreatment and posttreatment hearing levels were evaluated using pure-tone average (PTA) and word recognition score (WRS). The comorbidities of diabetes, hypertension, coronary artery disease, hypercholesterolemia, cerebrovascular disease, chronic kidney disease, and anemia were identified. We examined the effects of these comorbid diseases on the prognosis of ISSNHL 2 months posttreatment., Results: Regression analyses adjusted for gender, age, pretreatment hearing, treatment delay time, and all the comorbidities showed that the probability of major improvement in the PTA was significantly higher in patients without diabetes compared to those with diabetes (univariate odds ratio [OR], 1.90; 95% confidence interval (CI), 1.25-2.90; multivariate OR, 1.69; 95% CI, 1.03-2.77). Major (≥ 90%) and moderate (50%-89% improvement of the PTA, but with a remaining hearing loss of > 10 dB) improvement in the PTA was significantly higher in patients without hypercholesterolemia compared to those with hypercholesterolemia (univariate OR, 1.78; 95% CI, 1.13-2.80; multivariate OR, 1.70; 95% CI, 1.02-2.84). There was, however, no significant difference in the distribution of major (≥ 90%), moderate (50%-89%), and minor (< 50%) improvement in the posttreatment WRS for these comorbid diseases., Conclusions: Comorbid diabetes or hypercholesterolemia may indicate a smaller probability of major or moderate PTA improvement for patients with ISSNHL., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Few studies have investigated the effect of steroids on idiopathic sudden hearing loss (ISHL). Recently, Wilson, et al., reported a double blind study demonstrating a statistically significant improvement of hearing using steroids is ISHL. This report, fashioned after the Wilson study, confirms his findings and analyzes the relationship of several factors to the probability of hearing recovery.

A simple and safe technique for the sublabial transseptal transsphenoidal approach to the hypophysis and parasellar region is described. A review of the literature reveals that this technique and other transsphenoidal routes to the hypophysis were performed more than half a century ago.These procedures fell into disfavor because fo low magnification and insufficient illumination of the operative field, infection and inadequate postoperative endocrine replacement therapy. With today's antibiotic therapy and hormonal replacement, plus the use of the operating microscope, the transsphenoidal route to the hypophysis has gained renewed interest among neurosurgeons and otolaryngologists. Each of the transsphenoidal routes and the advantages of the "from below" approach are described. The applications of transsphenoidal approach and the nonsurgical modalities for hypophysectomy are reviewed. The simplicity and safety of the sublabial transseptal transsphenoidal approach depend on a thorough familiarity with the surgical anatomy, proper positioning of the patient, and the availability of appropriate instrumentation. Photographs of specially prepared whole head anatomical specimens plus skull dissections with radiographic correlation illustrate the pertinent anatomy. Some of the vital structures to be identified and avoided are the optic canals, carotid arteries, circular sinuses, cavernous sinuses, III, IV, V, VI cranial nerves, foramen rotundum, medial walls of the orbits, medial walls of maxillary sinuses, medial pterygoid plates and pterygoid canals. A method for preoperative determination of key distances within the patient's skull is described along with other preoperative tests. This paper discusses the self-retaining speculum and other new instruments for this procedure. A gauge mounted on the front end of the speculum is calibrated to measure the size of the opening at the tip of the speculum. Thirty cases are included in this report, six of which are presented in detail. No operative mortality, CSF rhinorrhea, visual damage carotid or cavernous sinus hemorrhage fracture of the medial pterygoid plates or maxilla were encountered in this series. Three patients developed diabetes insipidus and two patients had meningitis which responded to antibiotic therapy.