The use of recombinant tissue-type plasminogen activator for the treatment of sudden and chronic hearing loss.

We treated 80 patients with sudden hearing loss and 70 patients with chronic decreasing cochlear function to date with intravenous infusion of a glycoprotein analogous to recombinant tissue-type plasminogen activator (rt-PA): 3 mg dissolved in 250 mg of physiological saline given every 12 hours intravenously. Specifically excluded were patients with known abnormal coagulation. We treated no patient for longer than 20 days. Before therapy, 6 months therapy began, and at the end of treatment, all patients underwent the following instrumental examinations: prothrombin and fibrinogen level measurements, liminal tonal audiometry, tympanometry, and assessment of otoacoustic emissions and otoacoustic products of distortion. Daily during the treatment, we monitored the patients by liminal tonal audiometry and assessment of otoacoustic emissions with linear click emission and otoacoustic products of distortion. We discharged patients when their audibility threshold stabilized. No patient experienced side effects due to the treatment, and functional results were excellent in all (even more so if compared with the protocols of therapy previously used for these kinds of diseases). The tissue plasminogen activator was used with remarkable success for the treatment of sudden hearing loss; this study shows remarkable success with a very low dose of rt-PA as compared to the standard dosage used for treatment of myocardial infarction.