Pengaruh Intra-Arterial Heparin Flushing terhadap Hasil Audiometri Nada Murni, Distortion Product Otoacoustic Emission, Kadar Prestin, dan Kadar Vascular Endothelial Growth Factor pada Pasien dengan Gangguan Pendengaran di RSPAD Gatot Subroto

Abstract

Background: Several causes of sensorineural hearing loss are known to cause cochlear vascular changes such as changes in blood flow, increased vascular permeability, and vasoconstriction. The sensorineural type hearing loss caused by abnormalities in the cochlea requires special attention because the therapy is still inadequate due to the limited use of hearing aids. The intra-arterial heparin flushing (IAHF) is a procedure that can recover circulation and its agent, heparin, also has antioxidant activity. Therefore, the IAHF procedure has the potential to improve hearing function and can be considered a therapy for SNHL. Aims: The study aims to evaluate the effect of the IAHF procedure on hearing improvement based on the difference in hearing threshold values, SNR values, VEGF level, and prestin level before and after the IAHF procedure. Methods: The study was experimental study with a Pretest-Posttest One-Group Only design. A total of 22 patients with sensorineural and mixed hearing loss who met inclusion and exclusion criteria were underwent pure tone audiometry test for measuring the hearing threshold and DPOAE test for measuring SNR before and 4 hours and 1 month after the IAHF procedure. The VEGF and prestin levels were also measured before and 4 hours and 1 month after the IAHF procedure using ELISA method. The mean difference in hearing threshold was analyzed using paired Students t-test for normally distributed data and Wilcoxon for non-normally distributed data. Results: There was an improvement in the average hearing threshold value of the right and left ear 4 hours after the IAHF procedure, while statistically there was no significant difference (p>0.05) and there was an improvement in the average SNR value of the right ear 4 hours after the IAHF procedure at high frequency and there was a significant difference in the SNR value only in the left ear at a frequency of 1,500 Hz before and 1 month after the IAHF procedure (p<0.05). The average prestin level was found to decrease while the average VEGF level was found to increase 4 hours and 1 month after the IAHF procedure. No statistically significant differences were found for prestin and VEGF levels before the IAHF procedure and 4 hours and 1 month after the IAHF procedure. Conclusion: It was found that there were changes in hearing threshold values, SNR, prestin, and VEGF levels 4 hours after the IAHF procedure. The study showed that the IAHF procedure may have a therapeutic effect on sensorineural or mixed type hearing loss patients.