Side-related differences in sudden sensorineural hearing loss in children

Analysis of hearing prognosis risk factors in pediatric unilateral sudden sensorineural hearing loss

OBJECTIVES

Pediatric idiopathic sudden hearing loss (PISSNHL) is a rare disease with no established factor affecting its prognosis. In this study, we investigate the risk factors affecting the prognosis of PISSNHL.

MATERIAL AND METHODS

Among the patients who visited our hospital from January 2010 to December 2021, the characteristics associated prognosis of 54 patients with unilateral PISSNHL were retrospectively confirmed.

RESULTS

Patients' recovery was determined by applying Siegel's criteria (SC) and AAO-HNS criteria (AC). Twenty-seven (50 %) and 29 patients (54.3 %) recovered for SC and AC, respectively. Age, sex, side, duration between onset and treatment, administration of intra-tympanic steroid injection, accompanying symptoms (tinnitus and dizziness), BMI, serum creatinine level, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte count (PLR), lymphocyte count, and platelet count were not significantly different between the recovery group and the poor recovery group (P > 0.05). The patients were divided into five groups according to the initial hearing of the affected ear and again according to their audiogram type. The initial hearing levels, hearing level severity, and the audiogram type were significantly different between the deaf group (>100 dB HL) and the non-deaf group (P < 0.05).

CONCLUSION

The prognosis of PISSNHL is closely related to the initial hearing at the onset. If the initial hearing level is <100 dB, the recovery rate is approximately 50 %, therefore requiring active treatment and emotional support. It may also be related to the type of audiometric curve.

A review of bilateral sudden sensorineural hearing loss in pediatric patients

OBJECTIVE

Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition.

METHODS

PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected.

RESULTS

Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n = 3), meningitis (n = 13), mumps (n = 5), ototoxin exposure (n = 13), and enlarged vestibular aqueduct (n = 9). Tinnitus (n = 30) was the most reported concurrent symptom, followed by vertigo (n = 21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing.

CONCLUSIONS

This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.

Analysis of clinical features and prognostic correlation factors of sudden sensorineural hearing loss in children

OBJECTIVE

This study aimed to investigate the clinical features and prognostic correlation factors of sudden sensorineural hearing loss in children (CSSNHL).

METHODS

From January 2016 to December 2021, the clinical data of hospitalized children presenting with sudden sensorineural hearing loss, including age, gender, the ear of onset, onset of treatment, concomitant symptoms, the degree of hearing loss, and audiogram curve type, were retrospectively collected and the effective rate of treatment and the factors affecting prognosis were statistically analyzed.

RESULTS

The effective rate of CSSNHL was 29.97%. Univariate analyses showed that the onset of treatment, the degree of hearing loss, audiogram curve type, and tinnitus were associated with prognosis (P < 0.05). Multivariate analyses showed that onset of treatment was correlated with prognosis (OR = 0.939, 95% CI = 0.911-0.969, P < 0.001). Compared with patients in the profound group, the therapeutic performance of the severe, moderate, and mild groups were significantly different (OR = 9.951, 11.264, 13.373, 95% CI = 2.311-42.856, 2.818-45.028, and 5.310-33.677, P < 0.05). Compared with patients with profound audiogram, ascending audiogram and flat audiogram were related to therapeutic performance (OR = 13.373 and 14.481, 95% CI = 5.310-33.677, 6.509-32.217, P < 0.001).

CONCLUSIONS

The prognosis of CSSNHL patients was related to the onset of treatment, the degree of hearing loss, and the audiogram curve type. Patients who received earlier treatment, had lighter hearing loss and the ascending and flat audiograms exhibited improved prognosis.

Çocuklarda ani sensörinöral işitme kaybı: etiyoloji, prognostik faktörler ve tedavi sonuçları

Aim: Sudden sensorineural hearing loss (SSNHL) may have a negative impact on the language and psychological development of children, especially if it is not diagnosed early and treated promptly. This study were aimed to determine and compare the etiological factors, treatment outcomes and prognostic factors in the pediatric patients who were followed up with the diagnosis of SSNHL. Materials and Methods: The files of 28 children were analyzed retrospectively. In pure tone audiometry, the average of pure tone thresholds of 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz were accepted as pure tone averages (PTAV). Patients' recovery status was determined according to Siegel criteria. Audiometric curve types were evaluated as ascending, descending, and flat. Results: The ages of patients with SSNHL was mean ± SD 14.89 ± 3.24 (min-max: 7 and 18). The pre-treatment PTAV was mean ± SD 55.27 ± 12.39 dB HL (min-max: 38.5 and 85.25 dB HL) and the PTAV after treatment was mean ± SD 23.13 ± 18.22 dB HL (min-max: 5 and 72.5 dB HL). Audiometric curve types were detected as descending curve (n: 11, 39.2%), ascending curve (n: 5, 17.9%), flat curve (n: 12, 44.9%). Eighteen (64.3%) patients had complete recovery, 8 (28.6%) patients had partial recovery, and 2 (7.1%) patients had no recovery after the treatment. Conclusion: The response to treatment was found to be high. Descending audiometric curve type was found as a positive prognostic factor. Although the presence of tinnitus was a better prognostic factor than the presence of vertigo.

Clinical features and prognostic factors of children with profound sudden sensorineural hearing loss

OBJECTIVE

To investigate the clinical features and factors affecting the prognosis of children with profound sudden sensorineural hearing loss (SSNHL).

METHODS

We retrospectively analyzed the clinical data of 147 children with profound SSNHL who received inpatient treatment at our department from January 2016 to January 2021. All children were administered with systemic steroid therapy and/or intratympanic steroid (ITS) treatment for 2 weeks. Statistical analyses were performed for the clinical features, treatment effectiveness, and factors affecting the prognosis using SPSS 23.0.

RESULTS

The median age of the study population was 8 (6-10) years. The median treatment onset time was 8 (4-20) days. The most common concomitant symptom was tinnitus (45.58%). Laboratory findings showed that the percentages of children with abnormal leukocytes was 25.85%, abnormal platelet counts was 17.01%, abnormal cytomegalovirus IgG antibodies was 36.73% and abnormal Epstein-Barr (EB) virus IgG antibodies was 41.50%. The overall recovery rate of the treatment was 20.04%. The univariate analysis showed that age, treatment onset time, tinnitus, and ITS treatment were associated with the prognosis (p < 0.05). Regarding laboratory findings, the neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio differed significantly between the effective and invalid treatment effect groups (p < 0.05). The multivariable logistic regression analysis showed that treatment onset time [odds ratio (OR) = 0.936, 95% confidence interval (CI): 0.881-0.994] and ITS treatment (OR = 0.174, 95% CI: 0.044-0.0687) correlated with hearing recovery (p < 0.05).

CONCLUSION

In this study, the earlier the treatment start time of children with profound SSNHL, the better was the prognosis. Further, ITS could be an effective treatment option.

Vestibular function of pediatric patients with sudden sensorineural hearing loss: based on vertigo symptom and vestibular function testing

BACKGROUND

This study aimed to evaluate the relationship between vestibular and auditory functions in pediatric patients with sudden sensorineural hearing loss (SSHL).

METHODS

A total of 30 pediatric patients experiencing unilateral SSHL between 5.9 and 13.0 years of age were enrolled in this study. Pure tone audiometry was evaluated prior to treatment initiation and again after one month of treatment. Prior to treatment initiation, vertigo symptoms were noted; then several vestibular function tests were conducted including caloric testing, ocular vestibular evoked myogenic potentials (o-VEMPs) and cervical vestibular evoked myogenic potentials (c-VEMPs). Associations between pre and post-treatment vestibular function and hearing threshold levels were analyzed.

RESULTS

Initial hearing thresholds of children with vertigo were higher than thresholds of children without vertigo (92 dB vs 79 dB, P = 0.033), while initial hearing thresholds of children with abnormal caloric test findings were higher than thresholds of children with normal caloric test findings (93 dB vs 67 dB, P = 0.014). Cutoff values of hearing thresholds for those with vertigo symptoms and abnormal vestibular test results were 86.000- and 89.583-dB HL, respectively. Regarding prognosis, children with vertigo exhibited lower recovery rates than children without vertigo (33% vs 75%, P = 0.025); recovery rates of children with abnormal caloric test results were lower than the overall recovery rate (25% vs 73%, respectively, P = 0.039).

CONCLUSION

Assessments of vertigo symptoms and vestibular function are useful tools in predicting pediatric SSHL patient disease severity and prognosis.

Radiologic Findings in Pediatric Sudden Sensorineural Hearing Loss

OBJECTIVE

Pediatric sudden sensorineural hearing loss (pSSNHL) is a rare phenomenon. There is currently no consensus on the role of imaging in the work-up for this patient population. We aim to evaluate the efficacy of magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) studies in determining the etiology of pSSNHL.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary Hospital and Ambulatory Otolaryngology Clinic.

PATIENTS

Patients ≤18 years of age with sudden sensorineural hearing loss (SSNHL) and who had either MRI or CT imaging between January 2010 and May 2019 were included.

INTERVENTION

Diagnostic imaging.

MAIN OUTCOME MEASURES

Clinical characteristics and radiology impressions.

RESULTS

A total of 11 patients were identified, and 10 had unilateral SSNHL. MRI was performed on all patients, five patients had additional CT imaging. Abnormal imaging findings relevant to SSNHL were observed in five patients (45.5%), which included enlarged endolymphatic duct and sac, labyrinthine ossification, apical petrositis, hypoplastic cochlear nerve, and arachnoid cyst in the internal auditory canal; one patient had unrelated findings (enlarged pituitary gland), all remaining imaging studies were normal.

CONCLUSION

In our cohort, we found a higher imaging yield on pSSNHL than what has been reported for adult populations, indicating that the use of imaging in the diagnostic work-up is especially important in children.

The Correlation of Clinical Features and Endolymphatic Hydrops Visualized by 3D-Real IR MRI in Children With Sudden Sensorineural Hearing Loss

OBJECTIVES

To investigate the correlation between clinical features and endolymphatic hydrops (EH) in children with sudden sensorineural hearing loss (SSNHL).

METHODS

We collected 30 SSNHL children aged ≤17 years old, all of whom underwent intravenous gadolinium injection. After 4 hours, inner ear 3-dimensional inversion recovery sequence with real reconstruction (3D-real IR) magnetic resonance imaging was performed. Combined with their medical history such as gender, age, disease course, hearing loss, and so on, the results were analyzed.

RESULTS

Different degrees of EH were shown in the vestibule or different turns of cochlea in the affected ears of SSNHL children, and 12 (40%) of 30 children showed positive EH. Age, low and middle frequency hearing loss, and other clinical symptoms such as dizziness and ear fullness have been shown to be related to a certain degree of EH in vestibule or cochlea, whereas no relationship was found between EH and other clinical features such as high-frequency hearing loss, gender, affected side, and tinnitus.

CONCLUSIONS

Endolymphatic hydrops may not reflect the trend of disease progression over time in children with SSNHL, but the age of onset may be an important factor in the presence or absence of EH. Endolymphatic hydrops may be one of the causes of dizziness and ear fullness but has no obvious connection with the occurrence of tinnitus. Older SSNHL children with dizziness and ear fullness should maintain long-term follow-up to dynamically monitor the changes in EH.

Paediatric Sudden Sensorineural Hearing Loss: Pooled Analysis and Systematic Review

Sudden sensorineural hearing loss (SSNHL) is defined as hearing loss of ≥30 dB in one or both ears, developing within 3 days, affecting ≥3 contiguous frequencies. It is rare in children, but if untreated can cause significant morbidity. During the critical developmental period, it may cause lifelong social, behavioral, and mental sequelae. Currently, little guidance exists on prognosis and management within a pediatric population. A systematic literature review of pediatric SSNHL on PubMed, EMBASE, and the Cochrane CENTRAL database was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A total of 620 papers met the Medical Subject Headings criteria, of which 14 met analysis criteria-13 were level 4 and 1 was level 2b evidence. A population of 732 individuals was analyzed. Most reported cases of pediatric SSNHL were idiopathic. Other etiologies included viral infection, trauma, ototoxic drugs, and structural abnormalities. Recovery was defined as any improvement in hearing after the initial loss, from "slight" to "complete." Recovery ranged from 20% to 100%, with a pooled rate of 56%. Systemic steroids were the mainstay of treatment, although salvage intratympanic steroid therapy had a role after the failure of systemic steroids. Children with bilateral SSNHL had poorer outcomes than those with unilateral loss, with 29% showing improvement. Two studies reported outcomes with no treatment, for which recovery rate was 7%. This analysis of SSNHL shows that 61% of children with unilateral and 29% of children with bilateral SSNHL demonstrate some recovery, a worse prognosis than adults. Multiple treatment regimens exist, although comparison is challenging owing to inconsistently reported improvement parameters.

Pediatric sudden sensorineural hearing loss: Experience in a pediatric ENT emergency care center

OBJECTIVES

Sudden sensorineural hearing loss (SSNHL) is relatively rare and its physiopathology remains unclear, particularly in children. Our goal was to evaluate clinical characteristics, etiologies, management, treatment outcomes and prognostic factors in the pediatric population.

METHODS

We performed a retrospective chart review of all children registered for SSNHL between August 2004 and September 2017 in a tertiary care pediatric hospital. We analysed data regarding clinical symptoms, audiological characteristics, diagnostic investigations and treatment outcomes.

RESULTS

Thirty-five patients were included. Mean age was 12 years (range 4-18 years). Male:female ratio was 15:20. Hearing loss was left-sided for 18 patients, right-sided for 12 patients and bilateral for 5 patients. Degree of hearing loss varied from mild to profound across frequencies in the 40 ears studied. Thirty-four patients had associated otologic symptoms: the most frequent was tinnitus (28 ears), followed by vertigo (23 ears), otalgia (5 ears) and sensation of blocked ear (5 ears). Twenty-nine patients received systemic steroids and 3 intra-tympanic steroids. In the treated group, 69% had improvement on the audiograms (14% total, 55% partial). Vestibular tests were performed in 16 patients and were abnormal in 10 patients. Radiological examination included computed tomography scan (n = 16) and/or magnetic resonance imaging (n = 33). They revealed 2 bilateral enlarged vestibular aqueducts, 1 labyrinthitis, 1 intra-cochlear haemorrhage.

CONCLUSION

SSNHL can affect speech and language development in children. There are differences among the pediatric population, including inner ear malformation and immune disease. Specific work up is proposed. Appropriate diagnosis and therapeutic management are discussed.

Sudden Sensorineural Hearing Loss in Children-Management and Outcomes: A Meta-analysis

OBJECTIVE

To identify which patient characteristics and treatments are associated with hearing improvement in patients with pediatric sudden sensorineural hearing loss (SSNHL).

METHODS

PubMed, Web of Science, Cochrane Library, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for articles published before February 5, 2019, and references of relevant articles were screened. Original English-language case series and cohort studies were included if they addressed SSNHL in patients <20 years of age. Study characteristics, patient demographics, symptoms, treatments, and hearing outcomes were extracted. The primary outcome was hearing improvement.

RESULTS

Thirteen studies were included, totaling 605 patients (670 ears). Hearing did not improve in 46.7% of ears (95% confidence interval [CI]: 34.4% to 59.0%). Imaging (computed tomography and/or magnetic resonance imaging) results were described in three studies, and 24.2% of ears (95% CI: 7.7% to 40.6%) had abnormal findings. The most common serological finding was cytomegalovirus immunoglobulin (Ig)G or IgM (34.3% of ears tested, 95% CI: -2.9% to 71.6%). Unilateral hearing loss (odds ratio [OR]:3.85, P < .001), tinnitus (OR: 2.20, P = .003), age >12 years (OR: 2.11, P = .002), and ascending audiogram (OR: 3.66, P = .005), but not systemic or intratympanic steroids, were associated with increased odds of partial or complete improvement. In contrast, profound hearing loss (OR: 0.29, P < .001) and treatment delay of >6 days (OR: 0.27, P < .001) were associated with decreased odds of improvement.

CONCLUSIONS

Despite treatment, half of patients had no improvement in hearing. Prognostic factors associated with hearing improvement were generally consistent with those established in the adult population. Further research with consistent definitions for hearing improvement is needed to improve the understanding and treatment of pediatric SSNHL.

LEVEL OF EVIDENCE

Laryngoscope, 131:425-434, 2021.