Researchers determined the role of explorative tympanotomy in patients with Profound Sudden Sensorineural Hearing Loss (SSNHL) without clinical evidence of perilymphatic or labyrinthine fistula and to compare intraoperative findings with the postoperative hearing outcome. Sudden Sensorineural Hearing Loss (SSNHL) is defined as a unilateral decrease in pure tone audiogram of > 30 dB in at least 3 continuous frequencies over 3 days or less.

There are many different treatment regimens. Widely accepted are steroids as systemic or intratympanic application, local anesthetics, plasma expanders, vasodilators, or hyperbaric oxygen therapy, among many more infrequent agents. The role of explorative tympanotomy has been discussed as a possible surgical therapeutic option for decades.

This led to explorative tympanotomy, primarily after barotrauma, but no consensus exists as to whether tympanotomy and sealing of the round window should be routinely performed in cases of acute unilateral profound SSNHL. The objective of the study is to analyze the role of tympanotomy in patients with and without clinical evidence of perilymphatic fistula and to compare the outcome in terms of the hearing and intraoperative findings.

Sudden hearing loss is a common disease but there is no widely used standardized treatment regimen. In literature, there are placebo controlled studies that showed a significant improvement of recovery with hypervolemic hemodilution, steroids, hyperbaric oxygen therapy, and vitamins. PLF is mostly diagnosed by a combination of clinical findings such as sudden hearing loss, vertigo, and/or a possible elicitor in the anamnesis and intraoperative findings in explorative tympanotomy.

There are many ways to determine whether there is a rupture of one of the membranes. Inspection of the membranes under the surgery microscope and provocation with Valsalva maneuver and movement of the ossicular chain seemed to be the most exact and safest procedure and is standard practice in our clinic. In previous studies on tympanotomy in sudden hearing loss, a variation of percentage of actual rupture of a membrane is reported, varying from 61% to 40%.

In the investigation, 28% of all the patients examined showed a rupture in one of the membranes.  The hearing improvement in our series may suggest the necessity to obliterate the inner ear windows in cases of Profound SSNHL where explorative tympanotomy is indicated und despite the absence of vestibular symptoms. This can avoid missing micro-rupture of the oval or the round window, especially in cases of negative explorative tympanotomy.

Explorative tympanotomy seems to be useful in patients with profound SSNHL; patients with PLF benefit more from the surgical procedure and have better outcome than patients without PLF. Sealing of the oval and round windows in patients with SSNHL undergoing explorative tympanotomy could be effective even in the absence of visible intraoperative fistula.