Vascular events, immunological processes, and
viral infections have to be considered as pathomechanisms for most cases of
sudden hearing loss (SHL). In order to clarify predisposing conditions for vascular events. hemorheological parameters have been studied in 53 patients suffering from SHL within 5 days of onset, along with a control group. The striking result was a significantly elevated level of plasma
fibrinogen leading to a significantly increased erythrocyte aggregation and plasma viscosity. No significant difference could be found in all other parameters of clinical chemistry, hematology, and hemostasis. These results encouraged us to use
heparin-induced extracorporeal
low-density lipoprotein (
LDL) precipitation (HELP)
apheresis, which acutely and drastically reduces
LDL.
fibrinogen, and
lipoprotein (a) in the treatment of patients suffering from
sudden hearing loss and hyperfibrinogenemia or
hypercholesterolemia. In a pilot study including 30 patients, we found a better recovery of hearing in the patients treated with a single HELP
apheresis when compared to conventional treatment for 10 days with
prednisolone and dextranes. Currently, we verify these results in a larger multicenter trial in patients regardless of their
fibrinogen or
LDL levels. In the future, there will be different specific treatments of
sudden hearing loss based on the different pathomechanisms. The clinical impression and first controlled data make it likely that HELP
apheresis is useful in the
therapy of
sudden hearing loss with suspected vascular origin.