Early hearing improvement predicts the prognosis of idiopathic sudden sensorineural hearing loss

Predicting Sudden Sensorineural Hearing Loss Recovery with Patient-Personalized Seigel's Criteria Using Machine Learning

BACKGROUND

Accurate prognostic prediction is crucial for managing Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). Previous studies developing ISSHL prognosis models often overlooked individual variability in hearing damage by relying on fixed frequency domains. This study aims to develop models predicting ISSHL prognosis one month after treatment, focusing on patient-specific hearing impairments.

METHODS

Patient-Personalized Seigel's Criteria (PPSC) were developed considering patient-specific hearing impairment related to ISSHL criteria. We performed a statistical test to assess the shift in the recovery assessment when applying PPSC. The utilized dataset of 581 patients comprised demographic information, health records, laboratory testing, onset and treatment, and hearing levels. To reduce the model's reliance on hearing level features, we used only the averages of hearing levels of the impaired frequencies. Then, model development, evaluation, and interpretation proceeded.

RESULTS

The chi-square test (p-value: 0.106) indicated that the shift in recovery assessment is not statistically significant. The soft-voting ensemble model was most effective, achieving an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.864 (95% CI: 0.801-0.927), with model interpretation based on the SHapley Additive exPlanations value.

CONCLUSIONS

With PPSC, providing a hearing assessment comparable to traditional Seigel's criteria, the developed models successfully predicted ISSHL recovery one month post-treatment by considering patient-specific impairments.

Development of clinical predictive nomograms for prognosis of idiopathic sudden sensorineural hearing loss

BACKGROUND

The outcome of clinical treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) is frequently the primary concern.

AIM

For the convenient prediction of reference prognosis outcomes in patients with ISSNHL.

MATERIALS AND METHODS

Patients diagnosed with ISSNHL who were admitted to the otorhinolaryngology ward of Zhejiang Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2023 were included. Univariate and multivariate logistic regression analyses were employed to identify independent prognostic factors for the treatment outcome of ISSNHL, which were subsequently used to develop nomograms. Discrimination, calibration, and clinical utility were assessed to evaluate the performance of the ISSNHL nomograms.

RESULTS

371 ISSNHL patients were enrolled in this study. Multivariable logistic regression analysis showed that history of deafness, aural fullness, time of onset, and age were independent prognostic factors for ISSNHL patients, with statistically significant regression coefficients. Predictive nomograms were developed with excellent discrimination, calibration, and clinical value.

CONCLUSIONS

Leveraging data from ISSNHL patients, we developed a predictive nomogram to assess prognostic factors upon admission. This nomogram facilitates clinicians in approximating the likelihood of favorable prognosis.

SIGNIFICANCE

By accumulating clinical data from ISSNHL patients, it's anticipated that the possibility of recovery following treatment can be determined.

A Comprehensive Study on Sudden Deafness for Analyzing Their Clinical Characteristics and Prognostic Factors

Background: To study the factors associated with the prognosis of patients with sudden deafness to facilitate clinical treatment and improve efficacy. Methods: A total of 414 patients with sudden deafness treated in Zhenjiang First People's Hospital from January 2020 to December 2022 were chosen. Relevant data were gathered and the effectiveness of treatment was assessed by comparing hearing test results before and after hospital admission and divided into effective and ineffective groups, and the effectiveness of each factor was analyzed using univariate analysis, Spearman's correlation analysis, and multifactor logistic regression. Results: The 2 groups had significant differences in age, presence of tinnitus, degree of hearing loss, and triglyceride levels. Spearman's rank correlation analysis showed a negative correlation between hearing threshold of at least 81 dB at 250 to 8000 Hz, the low-density lipoprotein (LDL), triglyceride levels, and the prognosis (r < 0, P < .001). A positive correlation exists between high-density lipoprotein levels and prognosis (r > 0, P < .001). Receiver operating characteristic curve showed LDL level, age, and time since disease onset appears to be highly predictive. Multivariable logistic regression analysis showed that age >47 years, LDL >2.93 mmol/L, and time to presentation >10 days after disease onset are at higher risk for poor prognosis. Conclusion: Factors that influence the prognosis of patients with sudden deafness include age, tinnitus symptoms, high LDL levels, and the type of hearing curve. Early intervention and targeted treatment should be given to high-risk patients to improve the outcome of sudden deafness in clinical practice.

Increased risk of sudden sensorineural hearing loss in patients with cervical spondylosis

Whether cervical spondylosis (CS) is a risk factor for sudden sensorineural hearing loss (SSNHL) remains unclear. This study used national population-based data to investigate the risk of SSNHL in patients with CS in Taiwan of different ages and sexes. This study used data covering 2 million people in Taiwan, which were obtained from the National Health Insurance Research Database. The data that support the findings of this study are available from National Health Insurance Research Database but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding authors upon reasonable request and with permission of National Health Insurance Research Database. This retrospective cohort study enrolled 91,587 patients with a newly diagnosed CS between January 2000 and December 2018. Case and control cohorts were matched 1:1 according to age, sex, and comorbidities. SSNHL incidence rate and risk were compared between the groups. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The mean follow-up period was 8.80 (SD = 4.12) and 8.24 (SD = 4.09) years in the CS and control cohorts, respectively. The incidence rate of SSNHL in the CS cohort (85.28 per 100 000 person-years) was 1.49-fold significantly higher than that in the non-CS cohort (57.13 per 100,000 person-years) (95% CI 1.32-1.68, P < .001). After age, sex, and selected comorbidities were adjusted for, CS exhibited an independent risk factor for SSNHL (adjusted HR = 1.52; 95% CI   1.34-1.71, P < .001). An age-stratified analysis in this study demonstrated a strong and highly significant association between CS and SSNHL in patients aged < 35 years (IRR = 2.28, 95% CI   1.18-4.39, P = .013). This large-scale Taiwanese-population-based retrospective study found that CS was associated with an increased risk of SSNHL. Acute hearing loss in patients with CS, particularly at a young age, should be carefully evaluated, and prompt treatment for SSNHL should be initiated.

Vestibular mapping in Ramsay-Hunt syndrome and idiopathic sudden sensorineural hearing loss

PURPOSE

To observe vestibular impairment patterns in patients with Ramsay Hunt syndrome with dizziness (RHS_D) and sudden sensorineural hearing loss with dizziness (SSNHL_D) using hierarchical cluster analysis (HCA) to interpret results with possible mechanisms.

METHODS

The data of 30 RHS_D and 81 SSNHL_D patients from January 2017 to August 2022 in a single tertiary referral center were retrospectively analyzed. Video head impulse test (vHIT) and vestibular evoked myogenic potential (VEMP) were used for vestibular analysis of peripheral vestibular organs, and the results of vHIT and VEMP were analyzed. HCA was used to analyze vestibular impairment patterns.

RESULTS

In RHS_D patients, the lateral semicircular canal (LSCC) was the most impaired semicircular canal (SCC), followed by the anterior semicircular canal (ASCC) and the posterior semicircular canal (PSCC), and the utricle was more impaired than the saccule. In SSNHL_D patients, the PSCC was the most impaired SCC, followed by the LSCC and the ASCC, and the utricle was more impaired than the saccule. In HCA of RHS_D patients, the ASCC and utricle were initially clustered, followed by the LSCC, PSCC and saccule in order. In the HCA of SSNHL_D patients, the PSCC was solely merged and independently clustered.

CONCLUSION

There were different patterns of vestibular impairments between RHS_D and SSNHL_D patients. The vestibular analysis and HCA results of SSNHL_D showed tendency of skip lesion, which could be explained by vascular pathophysiology.

Noninvasive prognostic factors and web predictive tools for idiopathic sudden sensorineural hearing loss

PURPOSE

To friendly predict a reference prognostic outcome for idiopathic sudden sensorineural hearing loss (ISSNHL) patients with or without anxiety, we identified independent prognostic factors and developed practical predictive tools without invasive tests.

METHODS

Patients with ISSNHL in our center were enrolled from June 2013 to December 2018. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors of the complete recovery and the overall recovery for ISSNHL, which were subsequently utilized to develop the web nomograms. The discrimination, calibration, and clinical benefit were used to evaluate the performance of nomograms for ISSNHL.

RESULTS

704 ISSNHL patients were finally enrolled in this study. Multivariate logistic regression analysis showed that age, time of onset, gender, affected ear, degree, and type of hearing loss were independent prognostic factors of complete recovery. Age, time of onset, affected ear, and type of hearing loss were independent prognostic factors of overall recovery. Web predictive nomograms were developed with excellent discrimination, calibration, and clinical value.

CONCLUSION

Based on the patients' data with a considerable size, independent noninvasive prognostic factors of complete recovery and overall recovery of ISSNHL were identified. Integrating these prognostic factors without invasive tests, practical web predictive nomograms were developed. Using web nomograms, clinical doctors could provide reference data (the predicted recovery rate) for supporting prognostic consultation of ISSNHL patients, especially those with anxiety.

Hearing recovery prediction and prognostic factors of idiopathic sudden sensorineural hearing loss: a retrospective analysis with a deep neural network model

OBJECTIVE

Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is an otologic emergency, and an early prediction of prognosis may facilitate proper treatment. Therefore, we investigated the prognostic factors for predicting the recovery in patients with ISSHL treated with combined treatment method using machine learning models.

METHODS

We retrospectively reviewed the medical records of 298 patients with ISSHL at a tertiary medical institution between January 2015 and September 2020. Fifty-two variables were analyzed to predict hearing recovery. Recovery was defined using Siegel's criteria, and the patients were categorized into recovery and non-recovery groups. Recovery was predicted by various machine learning models. In addition, the prognostic factors were analyzed using the difference in the loss function.

RESULTS

There were significant differences in variables including age, hypertension, previous hearing loss, ear fullness, duration of hospital admission, initial hearing level of the affected and unaffected ears, and post-treatment hearing level between recovery and non-recovery groups. The deep neural network model showed the highest predictive performance (accuracy, 88.81%; area under the receiver operating characteristic curve, 0.9448). In addition, initial hearing level of affected and non-affected ear, post-treatment (2-weeks) hearing level of affected ear were significant factors for predicting the prognosis.

CONCLUSION

The deep neural network model showed the highest predictive performance for recovery in patients with ISSHL. Some factors with prognostic value were identified. Further studies using a larger patient population are warranted.

LEVEL OF EVIDENCE

Level 4.

Clinical Profiles and Prognoses of Adult Patients with Full-Frequency Sudden Sensorineural Hearing Loss in Combination Therapy

We aimed to characterize the clinical profiles and short-term outcomes of adult patients with full-frequency idiopathic sudden sensorineural hearing loss (ISSNHL) treated uniformly with combination therapy, and to determine the prognostic predictors for the combination therapy. A total of 131 eligible cases hospitalized in our department from January 2018 to June 2021 were retrospectively reviewed. All enrolled cases received a standardized combination therapy employing intravenous methylprednisolone, batroxobin, and Ginkgo biloba extract during the 12 days of hospitalization. The clinical and audiometric profiles were compared between recovered patients and their unrecovered counterparts. The overall recovery rate was 57.3% in the study. Accompanying vertigo (odds ratio = 0.360, p = 0.006) and body mass index (BMI, odds ratio = 1.158, p = 0.016) were two independent predictors of hearing outcomes of the therapy. The male gender and cigarette-smoking history were marginally associated with good hearing prognosis (p = 0.051 and 0.070, respectively). Patients with BMI ≥ 22.4 kg/m² had a better chance of hearing recovery (p = 0.02). Conclusions: Accompanying vertigo and low BMI (<22.4 kg/m²) were independently associated with poor prognosis for full-frequency ISSNHL in combination therapy. Male gender and cigarette-smoking history might be considered positive effects on hearing prognosis.

Abnormal posterior semicircular canal function may predict poor prognosis in patients with severe and profound ISSNHL

Background

Severe and profound idiopathic sudden sensorineural hearing loss (ISSNHL) generally leads to unfavorable prognosis, and has a considerable impact on patient quality of life. However, related prognostic factors remain controversial.

Objective

To elaborate the relationship between vestibular function impairment and the prognosis of patients with severe and profound ISSNHL, and investigated the relevant factors affecting prognosis.

Methods

Forty-nine patients with severe and profound ISSNHL were divided into good outcome group [GO group, pure tone average (PTA) improvement > 30 dB] and poor outcome group (PO group, PTA improvement ≤ 30 dB) according to hearing outcomes. The clinical characteristics and the proportion of abnormal vestibular function tests in these two groups were analyzed by univariate analysis, and multivariable logistic regression analysis was performed for parameters with significant differences.

Results

Forty-six patients had abnormal vestibular function test results (46/49, 93.88%). The number of vestibular organ injuries was 1.82 ± 1.29 in all patients, with higher mean numbers in PO group (2.22 ± 1.37) than in GO group (1.32 ± 0.99). Univariate analysis revealed no statistical differences between the GO and PO groups in terms of gender, age, side of the affected ear, vestibular symptoms, delayed treatment, instantaneous gain value of horizontal semicircular canal, regression gain value of vertical semicircular canal, abnormal rates of oVEMP, cVEMP, caloric test and vHIT in anterior and horizontal semicircular canal, however, significant differences were found in the initial hearing loss and abnormal vHIT of posterior semicircular canal (PSC). Multivariable analysis revealed that only PSC injury was an independent risk factor for predicting the prognosis of patients with severe and profound ISSNHL. Patients with abnormal PSC function had worse initial hearing impairment and prognosis than patients with normal PSC function. The sensitivity of abnormal PSC function in predicting poor prognosis in patients with severe and profound ISSNHL was 66.67%, specificity was 95.45%, and positive and negative likelihood ratios were 14.65 and 0.35, respectively.

Conclusion

Abnormal PSC function is an independent risk factor for poor prognosis in patients with severe and profound ISSNHL. Ischemia in the branches of the internal auditory artery supplying the cochlea and PSC may be the underlying mechanism.

Is repetitive systemic corticosteroid therapy effective for idiopathic sudden sensorineural hearing loss? a retrospective study

Introduction

Some idiopathic sudden sensorineural hearing loss (ISSHL) cases experience repetitive systemic corticosteroid treatment, but studies focusing on repetitive systemic corticosteroid administration have not been reported. Thus, we investigated the clinical characteristics and usefulness of repetitive systemic corticosteroid treatment in ISSHL cases.

Methods

We reviewed the medical records of 103 patients who received corticosteroids only in our hospital (single-treatment group), and 46 patients who presented at our hospital after receiving corticosteroids in a nearby clinic and were subsequently treated with corticosteroids again in our hospital (repetitive-treatment group). Clinical backgrounds, hearing thresholds, and hearing prognosis were assessed.

Results

The final hearing outcomes were not different between the two groups. Further, in the repetitive-treatment group, statistical differences were found between the good and poor prognosis groups in the number of days to start corticosteroid administration (p = 0.03), the dose of corticosteroid (p = 0.02), and the duration of corticosteroid administration (p = 0.02) at the previous facility. Multivariate analysis revealed a significant difference in the dose of corticosteroids administered by the previous clinic (p = 0.004).

Conclusion

The repetitive systemic corticosteroid administration might play a supplementary role in hearing improvement, and initial sufficient corticosteroid administration would lead to good hearing outcomes in an early phase of ISSHL.

Predictive factors for recovery in idiopathic sudden sensory neural hearing loss

Background

Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered a clinical symptom of various conditions. Circulatory disorders, viral infection, labyrinthine membrane rupture, and autoimmune reactions are considered as the common causes, but the exact cause remains unestablished. Various drugs and methods have been used empirically for the treatment of ISSHL. The current study aimed at evaluation factors contributing to the success of standardized medical therapy in cases of ISSNHL.

Methods

In period between 2019 and 2021, a total 40 patients with ISSNHL were enrolled. All patients were subjected to history taking, physical and ENT evaluation. Patients were managed according to the recent guidelines for managing ISSNHL included systemic steroid and salvage therapy.

Results

Mean age of studied patients was 42.55 ± 13.14 years with range between 19 and 70 years. Out of the studied patients; 26 (65%) patients were males and 14 (35%) patients were females. Majority (80%) of patients had no comorbidities. Based on the current study, we found that only 12 (30%) patients were improved while 28 (70%) patients were not improved. It was found that majority (58.3%) of improved patients was females. Frequency of vertigo was significantly higher among patients who were not improved. Three (10.7%) patients of not-improved group and 5 (41.7%) patients of improved group had low lymphocyte:monocytes ratio.

Conclusion

Patients with ISSNHL, the presence of vertigo and late onset of presentation may carry a risk for poor prognosis. Multiple centers studies with large number of patients are warranted to confirm such findings.

Efficacy of Mesotympanum Injection and Posterior Auricular Injection in Sudden Hearing Loss of Diabetes Patients

The efficacy of tympanum injection and posterior auricular injection in diabetes with sudden hearing loss (SHL) was analyzed. A mobile terminal-based portable pure tone audiometry system and its processing method were established. Based on mobile terminals, a portable pure tone audiometry system including an Android system, pure sound signal generation, pure tone hearing threshold, and client module was established. A masking model and self-adaptive algorithm were used to detect and reduce noise. Besides, the performance of the portable pure tone audiometry system was detected. A total of 46 diabetes patients with SHL diagnosed at the otolaryngology department in BeiChen Hospital between August 2019 and November 2021 were selected as the research objects and randomly divided into the retroauricular group (posterior auricular injection) and the tympanic group (tympanum injection). Each group included 23 cases. All patients received pure tone audiometry (PTA) before and after the treatment. The changes in fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA1c) of the patients were monitored before and after the treatment. Besides, tinnitus loudness visual analog scale (VAS), pain VAS, efficacy, and the incidence of adverse reactions of the patients in two groups were compared. The results indicated that the hear threshold error detected by the medical audiometer and a portable pure tone audiometry system was within 2dB. Before the optimization, there was an error of about 10dB between the hear thresholds detected by the self-adaptive algorithm and a medical audiometer. After the treatment, the hear threshold and average PTA of the patients in the retroauricular and the tympanic groups under different frequencies were both reduced compared with those before the treatment (P < 0.05). The tinnitus VAS score in the retroauricular group was decreased more notably than that in tympanic group (P < 0.01), and the pain VAS score was much lower than that in the tympanic group (P < 0.001). The comparison of FPG, 2hPG, HbA1c, the proportions of cured, significantly effective, effective, ineffective patients, and the total effective rate in the patients in the retroauricular and the tympanic groups before and after the treatment all showed no statistical differences (P > 0.05). The incidence of adverse reactions in tympanic group after the treatment was dramatically higher than that in retroauricular group (P < 0.001). The above results demonstrated that posterior auricular injection showed potential application values in the treatment of SHL with diabetes and established a portable pure tone audiometry system as well as its noise processing method.

Prediction of hearing recovery in unilateral sudden sensorineural hearing loss using artificial intelligence

Despite the significance of predicting the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL), no predictive models have been established. This study used artificial intelligence to develop prognosis models to predict recovery from ISSNHL. We retrospectively reviewed the medical data of 453 patients with ISSNHL (men, 220; women, 233; mean age, 50.3 years) who underwent treatment at a tertiary hospital between January 2021 and December 2019 and were followed up after 1 month. According to Siegel's criteria, 203 patients recovered in 1 month. Demographic characteristics, clinical and laboratory data, and pure-tone audiometry were analyzed. Logistic regression (baseline), a support vector machine, extreme gradient boosting, a light gradient boosting machine, and multilayer perceptron were used. The outcomes were the area under the receiver operating characteristic curve (AUROC) primarily, area under the precision-recall curve, Brier score, balanced accuracy, and F1 score. The light gradient boosting machine model had the best AUROC and balanced accuracy. Together with multilayer perceptron, it was also significantly superior to logistic regression in terms of AUROC. Using the SHapley Additive exPlanation method, we found that the initial audiogram shape is the most important prognostic factor. Machine/deep learning methods were successfully established to predict the prognosis of ISSNHL.