[Causes of inner ear deafness; a critique of therapy (author's transl)].

In spite of recent criticisms, the diagnosis of inner ear hearing impairment is based on both pure tone thresholds and suprathreshold tests. The acoustico-facial reflex is useful only when used in conjunction with the suprathreshold tests.--Noise-induced deafness is generally confined to the higher frequencies of sound, and only exceptionally involve the middle frequencies as well. Low-tone hearing impairment may represent a partial symptom of Meniere's Disease as well as functional hearing loss. Zoster oticus produces a sensory hearing impairment but not a neural one, as might be expected from the neurotropy of the Herpes virus. Patients with socalled presbyacusis exhibit criteria of inner ear pathology which may represent a summation of different noxious agents damaging the inner ear throughout life rather than result from the physiologic process of aging. Traumatic hearing impairment seldom progresses, and usually involves central parts of the auditory pathways following blunt trauma.--We believe that uncritical therapy with vasodilating drugs is not useful in sensory hearing loss, especially if it is continued for months and if several drugs are employed at the same time. The danger of an unintended decrease in blood pressure is greater in these patients since many also suffer from hypotension which can then cause vascular insufficiency to the inner ear, similar to the "steal" effect. Therapy for inner ear hearing loss remains the responsibility of the otolaryngologist, and should still be based on proper diagnosis.