Rheopheresis for sudden sensorineural hearing loss.

Patients suffering from sudden sensorineural hearing loss (SSHL), especially those with hearing impairment refractory to infusion therapy, need new therapeutic options. Fibrinogen-LDL-apheresis, covering Rheopheresis and HELP-apheresis for the indication of SSHL, proved to be an effective treatment option within the therapeutic armamentarium for SSHL in two randomized controlled trials including each more than 200 patients, and has also been shown to be an effective treatment option for patients refractory to the first line standard treatment. Fibrinogen-LDL-apheresis effects an immediate pulsed reduction of plasma viscosity as well as whole blood viscosity, hypothesized to lead to a sustained microcirculatory recovery, thus improving the natural course of acute microcirculatory impairment significantly. The solid body of evidence provided by investigations on fibrinogen-LDL-apheresis in recent years has been recognized by German SSHL guidelines, proposing fibrinogen-lowering treatments like this as part of a multimodality approach. Superiority of fibrinogen-LDL-apheresis over established first line standard treatments could not been shown in general. In consequence, no regular reimbursement by health insurances is available, in particular facing the current policy of health insurances for initial therapeutic nihilism at the acute onset of SSHL. Patients can apply for individual reimbursement or must pay the cost for the treatment. Refractory patients hopefully will profit by growing experiences.