New pharmacological trends and the role of blood-labyrinthine barrier in sudden sensorineural hearing loss

Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as a hearing loss of at least 30 dB over three contiguous test frequencies occurring within a 72-hour period. The incidence of ISSHL is reported to be 5-20 people per 100,000 per year. The majority of cases have no identifiable cause for hearing loss and are classified as “idiopathic.” The most common pathophysiological theories include viral diseases, immune mediated processes and vascular injury. The hypothesis that a disturbance of the cochlear microcirculation could be at the basis of the different triggering conditions stems from the observation that sudden hearing loss has an acute onset, is generally unilateral and can resolve within a few hours or days. Treatment of SSNHL remains one of the most problematic issues for contemporary otorhinolaryngology: although many meta-analyses and national guidelines have been issued, management is not standardized in terms of medical treatment, duration and route of administration.