**Author details**

The most important criterion is the time between the emergence of the symptoms and the initiation of the treatment. The prognosis is much better in patients started treatment early. Another factor is the age of the patient. An age less than 15 or greater than 65 years indicates a bad prognosis. The prognosis worsens with the severity of the hearing loss. Although the prognosis is relatively better in the low-frequency hearing loss compared to the highfrequency hearing loss, an ascendant type audiometric curve promises a better prognosis than the descendant type audiometric curve. The presence of vertigo and nystagmus, which shows that vestibular system is also affected, is a sign of bad prognosis. In contrary, tinnitus indicates a good prognosis in SHL, because tinnitus is considered as a sign that the hair cells in the inner ear are not completely destroyed. Bilateral SHL has a relatively worse prognosis. Increased sedimentation rate and an increase in the high sensitive CRP levels are related to the severity of the inflammation and thus to the bad prognosis. In SHL, recovery can be observed within 6 months to 1 year, it is wise to arrange the pre-rehabilitation follow-up plan according to this duration. In SHL patients, who did not show any recovery after 1 year, hearing rehabilitation can be planned upon the patient's request and according to the severity of

As we have seen, SHL preserves its darkness as an enigma of ENT world. There are several already-published and a large number of ongoing studies on the etiology and treatment of SHL in the literature. Although certain diagnosis and treatment algorithms developed for SHL are already available, they cannot be implemented in all SHL cases. If corticosteroids cannot deliver sufficient results, there are not much treatment choices. Further studies for a

full elucidation of the physiopathology, etiology, and treatment of SHL are required.

the hearing loss.

84 An Excursus into Hearing Loss

**10. Conclusion**

**Abbreviations**

SHL Sudden hearing loss

CTL-2 Choline transporters like protein 2

AECA Anti-endothelial antibodies

SLE Systemic lupus erythematosus ITS Intratympanic steroid therapy

therapy

Hsp-70 Heat-shock protein 70

HBO Hyperbaric O2

ENT Ear-nose-throat CMV Cytomegalovirus Harun Acıpayam<sup>1</sup> \*, Hasan Emre Koçak2 and Mustafa Suphi Elbistanlı<sup>2</sup>

\*Address all correspondence to: harunacipayam@gmail.com

1 Department of Otolaryngology, Kanuni Sultan Süleyman Training and Research Hospital-Beylikdüzü Campus, İstanbul, Turkey

2 Department of Otolaryngology, Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
