M. K. AGGARWAL ET AL. 205
ductive hearing loss in hypothyroidism is secondary to
Eustachian tube mucosal oedema [23].
Although it was not the endeavour of this study to
analyse the vestibular changes in goitrous hypothyroid-
ism, the authors would like to highlight that almost 39%
cases had a history of vertigo, out of which 26 patients
had an subjective improvement after levothyroxine ther-
apy at the end of 6 months. In this context it would be
important to note that the medical text mentions that al-
most 66% of patients of hypothyroidism suffer from ver-
tigo [2]. Tinnitus too was present in 17 cases. Nine of
these cases recorded a subjective improvement in form of
decrease in the duration and intensity of the tinnitus.
Thus a joint involvement of cochlear and vestibular sys-
tem is also seen in goitrous hypothyroidism as has been
reported for other metabolic disorders [24]. The authors
would also like to highlight that no case of Meniere’s
disease i.e. the classical triad of vertigo, deafness with
tinnitus was recorded in this case series, though the lit-
erature reports an intrinsic relationship between hypo-
thyroidism and Meniere’s disease (a recent study quotes
a prevalence of 32%) [5].
Interpretations of these results must take into consid-
eration the limitations of our analysis. As data from a
single tertiary health care centre was used, it reflects the
experience of our geographical area and may not be gen-
eralized. Information from observational studies can be
subject to potential biases (e.g. selection bias) and con-
founding. Critics may contend that 6 months follow-up
period is short. Furthermore, the results were not ascer-
tained blindly. Last but not the least; we were unable to
discern the reason for this decreased sensorineural hear-
ing loss in goitrous hypothyroidism. This could be due to
the demographic profile of our patients. But then the au-
thors would like to emphasise that the very cause of
hearing loss in hypothyroidism is debatable and contro-
versial. Nevertheless, the strength of this study lies in its
prospective character and independent statistical valida-
tion, which allowed for accurate assessment of data with-
out depending upon recalled information in accordance
with evidence based medicine. The authors would like to
highlight that this study represents the largest series of
patients on hypothyroidism. The true value of this study
in context of existing literature lies in the audiological
evaluation of patients belonging to the subgroup of goi-
trous hypothyroid, hitherto unreported in medical litera-
ture.
5. Conclusion
In conclusion, the patients of goitrous hypothyroidism
have a lower rate of sensorineural hearing loss as com-
pared with other patients of hypothyroidism. Further, this
study delineates a definitive role of L-thyroxine therapy
in improvement of hearing in patients suffering from
goitrous hypothyroidism. We believe that conclusions of
this study can serve as a guide for future research on the
cited subject.
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