The neutrophil-to-lymphocyte ratio in children with sudden sensorineural hearing loss: a retrospective study

Clinical features and prognosis of pediatric idiopathic sudden sensorineural hearing loss: A bi-center retrospective study

Objective

Limited research has focused on the clinical features of sudden sensorineural hearing loss (SSNHL) in pediatric patients. This study is aimed to investigate the relationship between clinical features and the baseline hearing severity and outcomes of SSNHL in the pediatric population.

Method

We conducted a bi-center retrospective observational study in 145 SSNHL patients aged no more than 18 years who were recruited between November 2013 and October 2022. Data extracted from medical records, audiograms, complete blood count (CBC) and coagulation tests have been assessed for the relationship with the severity (the thresholds of the initial hearing) and outcomes (recovery rate, hearing gain and the thresholds of the final hearing).

Results

A lower lymphocyte count (P = 0.004) and a higher platelet-to-lymphocyte ratio (PLR) (P = 0.041) were found in the patient group with profound initial hearing than in the less severe group. Vertigo (β = 13.932, 95%CI: 4.082–23.782, P = 0.007) and lymphocyte count (β = −6.686, 95%CI: −10.919 to −2.454, P = 0.003) showed significant associations with the threshold of the initial hearing. In the multivariate logistic model, the probability of recovery was higher for patients with ascending and flat audiograms compared to those with descending audiograms (ascending: OR 8.168, 95% CI 1.450–70.143, P = 0.029; flat: OR 3.966, 95% CI 1.341–12.651, P = 0.015). Patients with tinnitus had a 3.2-fold increase in the probability of recovery (OR 3.222, 95% CI 1.241–8.907, P = 0.019), while the baseline hearing threshold (OR 0.968, 95% CI 0.936–0.998, P = 0.047) and duration to the onset of therapy (OR 0.942, 95% CI 0.890–0.977, P = 0.010) were negatively associated with the odds of recovery.

Conclusions

The present study showed that accompanying tinnitus, the severity of initial hearing loss, the time elapse and the audiogram configuration might be related to the prognosis of pediatric SSNHL. Meanwhile, the presence of vertigo, lower lymphocytes and higher PLR were associated with worse severity.

Inflammatory Indicators in Peripheral Blood in Sudden Sensorineural Hearing Loss Patients With Different Audiogram Shapes

Objective: A retrospective study was conducted to explore the immune-inflammatory responses in sudden sensorineural hearing Loss (SSNHL) patients with different audiogram shapes. Methods: One hundred and ten inpatients with SSNHL were assigned to 4 subgroups according to the audiogram shape and treated with systemic methylprednisolone. The numbers of white blood cells, neutrophils, lymphocytes, platelets, and monocytes were counted. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the monocyte-to-lymphocyte ratio (MLR) were calculated and statistically analyzed. Results: Neutrophil-to-lymphocyte ratio, MLR, and systemic immune index (SII) of SSNHL patients were significantly higher than the control group, while PLR was not statistically significant. There were no statistical differences in NLR, PLR, MLR, and SII among the 4 subgroups. Conclusion: Immune-inflammatory response may be a common pathogenesis in all SSNHL patients with different audiogram shapes. The predictive value of these hematologic markers needs further research in the future.

Correlation of Neutrophil-to-Lymphocyte Ratio and the Dilation of the Basilar Artery with the Potential Role of Vascular Compromise in the Pathophysiology of Idiopathic Sudden Sensorineural Hearing Loss

Idiopathic sudden sensorineural hearing loss (SSNHL) currently lacks a clear etiology, as well as an effective treatment. One of the most probable explanations for SSNHL is impairment of the cochlear blood flow. However, dissimilar to a fundoscopic examination, direct observation of cochlear blood vessels is not possible. To indirectly support an ischemic etiology of SSNHL, we investigated whether the degree of initial hearing loss is associated with two atherosclerotic risk factors: dilatation of the basilar artery (BA) and a chronic subclinical inflammatory status measured by the neutrophil-to-lymphocyte ratio (NLR). This retrospective study collected data from 105 consecutive patients diagnosed with idiopathic SSNHL. Then, the patients were divided into two groups according to their NLR as “abnormally high NLR (>3.53, n = 22)” and “NLR within the normal range (0.78−3.53, n = 83)”. The BA diameter and severity of initial hearing loss were significantly correlated with each other in the abnormally high NLR group (p < 0.001). However, there was no significant correlation between initial hearing loss and the BA diameter in the normal NLR group (p = 0.299). Therefore, the NLR may serve as a marker for SSNHL of vascular etiology and a rationale for magnetic resonance imaging examinations based on the pathophysiology.

Neutrophil-to-lymphocyte ratio as a prognostic inflammatory factor in sudden sensorineural hearing loss

Objectives: Sudden sensorineural hearing loss (SSNHL) has recently been investigated in terms of chronic inflammation. In this study, the associations of immunologic inflammatory factors (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) and hematologic inflammatory factors (white blood cell [WBC] count, neutrophil percentage, lymphocyte percentage, neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) with prognosis of SSNHL were evaluated. Methods: Fifteen patients with SSNHL were prospectively enrolled and followed. For the analysis of the prognostic factors for SSNHL, the patients were divided into two groups according to the final hearing threshold of the affected ear: ‘complete or partial recovery group’ and ‘slight improvement or no recovery group’. The CRP, ESR, WBC count, neutrophil percentage, lymphocyte percentage, NLR, and PLR obtained at the initial visit were compared. Results There were no significant differences in CRP, ESR, WBC count, and PLR between the two groups. In contrast, neutrophil percentage and NLR were significantly lower in the complete or partial recovery group than in the slight improvement or no recovery group ( p = 0.005 and 0.013, respectively). Lymphocyte percentage was significantly higher in the complete or partial recovery group than in the slight improvement or no recovery group ( p = 0.019). Conclusion NLR may be a useful prognostic inflammatory biomarker of SSNHL. Further evaluation of the association of immunologic and hematologic inflammatory factors with the prognosis of SSNHL is necessary with respect to inflammation to reveal additional significant biomarkers because inflammation is related to SSNHL.

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.

Association between routine hematological parameters and sudden sensorineural hearing loss: A meta-analysis

OBJECTIVE

Recent studies have shown that chronic inflammation contributes to the development of sudden sensorineural hearing loss (SSNHL). Some hematologic parameters have also been linked to the prognosis of SSNHL. However, the prognostic value of such hematological factors is not conclusive. This study explored the association of routine hematological parameters with SSNHL.

METHODS

A systematic literature search was conducted in PubMed, Cochrane Library, Web of Science and Embase to identify eligible studies. Standardized mean deviation (SMD) and the 95% confidence interval (CI) were retried from relevant studies for analysis. Heterogeneity, subgroup, and publication bias analyses were performed.

RESULTS

A total of 18 studies involving 1505 SSNHL patients and 1466 healthy persons were enrolled in the final analysis. The study population included 699 responders and 458 non-responders to treatment. Pooled results revealed that the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) value in the SSNHL patient group were higher than in the healthy group (SMD = 1.05, 95% CI: 0.86,1.24, p < 0.001, SMD = 0.52, 95% CI: 0.26,0.78, p < 0.001, respectively). However, there was no significant difference in the mean platelet volumes (MPV) between the groups (SMD = 0.03, 95% CI: 0.44, 0.49, p = 0.91). Notably, NLR and PLR values were evidently higher in the unrecovered group than in the recovered group (SMD = -0.63, 95% CI: 1.02, -0.23, p = 0.002, SMD = -0.4, 95% CI: 0.76, -0.03, p = 0.03, respectively). However, the MPV value was similar in both groups (SMD = -0.35, 95% CI: 1.14,0.44, p = 0.38).

CONCLUSIONS

Our results show that NLR and PLR values can predict the onset and prognosis of SSNHL.

Idiopathic Sudden Sensorineural Hearing Loss in Children: A Systematic Review and Meta-analysis

Objective

Idiopathic sudden sensorineural hearing loss (ISSNHL) is uncommon in children, and its treatment and outcome are debated. We aimed to critically review evidence in the literature about treatment options and functional outcomes of pediatric ISSNHL. Additionally, we performed a meta-analysis of the results of combined systemic-intratympanic steroid therapy versus solely systemic treatment.

Data Sources

A search was run in the PubMed, Scopus, and Google Scholar databases.

Review Methods

Included articles were original ISSNHL case series, written in English, with a population age ranging from 2 to 19 years. Other study types (single case reports, editorials, and reviews) and case series with known etiology of sudden hearing loss were excluded. Descriptive data of patients, treatments, outcomes, and possible prognostic factors were extracted and recorded for every included study.

Results

Twelve articles (7 cohort and 5 case-control studies) met all the selection criteria. Based on only the studies that provided sufficient data about clinical outcome, the pooled overall recovery rate was 67.91% (95% CI, 58.34%-77.48%). No studies showed a significant difference between systemic steroid and combined systemic-intratympanic steroid. The pooled odds ratio for combined systemic-intratympanic steroid versus systemic steroid alone was 0.90 (95% CI, 0.36-2.27) based on a random effects model, ruling out any significant difference between these treatment options.

Conclusions

The results of our meta-analysis did not support combination therapy more than systemic steroid alone. Further prospective clinical trials are necessary to establish evidence-based therapies.

Neutrophil-lymphocyte ratio as a valuable prognostic marker in idiopathic sudden sensorineural hearing loss

Background: Neutrophil-to-lymphocyte ratio (NLR) has emerged as a marker for degree of inflammation. Inflammation has been regarded as one of the causes of idiopathic sudden sensorineural hearing loss.Objectives: This study investigated the potential association between neutrophil-to-lymphocyte ratio (NLR) and prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).Material and methods: This retrospective, case-control clinical trial analyzed data from 186 subjects diagnosed with ISSNHL and admitted to Kyung-Hee Medical Center between March 2016 and February 2019. Hematologic and audiometric parameters were measured.Results: NLR showed a linear correlation with hearing recovery in patients with ISSNHL, with hearing gain (dB) = 56.698 - 3.718 × NLR (r² = 0.451, p = .001). Hearing recovery at all frequencies was numerically higher in patients with low (<6.661) than higher (≥6.661) NLR at all frequencies and was significantly higher at 500, 1000, 2000, 3000, and 4000 Hz. Hearing thresholds at 250, 500, 1000, 2000, 3000, and 4000 Hz in the low NLR group were significantly lower after treatment.Conclusions and significance: The ability to recover from ISSNHL decreases as NLR increases. NLR may be a valuable prognostic marker in patients with ISSNHL.

Predictive values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and other prognostic factors in pediatric idiopathic sudden sensorineural hearing loss

BACKGROUND AND OBJECTIVES

No consensus has been reached regarding the optimum treatment or factors affecting prognosis in pediatric idiopathic sudden sensorineural hearing loss (ISSNHL) due to its rarity. In the present study, treatment outcomes and prognostic factors of ISSNHL were investigated in pediatric patients who underwent steroid therapy.

SUBJECTS

and Methods: Forty-two patients diagnosed with ISSNHL were enrolled in this retrospective study and compared with 39 normal healthy controls with respect to demography and complete blood cell count test results. In addition, prognosis factors were sought by dividing the 42 ISSNHL patients to 3 groups according to their response to the treatment.

RESULTS

Neutrophil-to-lymphocyte ratio (NLR) value in the ISSNHL group were significantly higher than in the control group. NLR value in the three treatment response groups differed significantly. Early treatment with steroid and accompanying tinnitus were positive prognostic factor for hearing recovery. Other characteristics were not significant.

CONCLUSION

The results of this study suggest that good hearing recovery in children may be associated with early time of initial treatment and accompanying tinnitus. Also, NLR value might be useful readily accessible prognostic markers in pediatric ISSNHL patients. Further studies are required to confirm prognostic factors useful to predict prognosis and treat ISSNHL in pediatric patients.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Sudden Sensorineural Hearing Loss

OBJECTIVE

Sudden sensorineural hearing loss (SSNHL) is a common acute disease with an incidence of 0.5-2/10,000. This study aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be indicators for SSNHL.

METHODS

A total of 60 confirmed cases of SSNHL and 60 healthy volunteers were included in this study. Peripheral blood NLRs and PLRs were compared between these groups. The SSNHL patients were divided into two groups, according to therapeutic effect: an effective group and an ineffective group. Peripheral blood NLRs and PLRs before and after treatment were compared between these two groups.

RESULTS

The average NLRs and PLRs of these patients were both significantly higher than in controls. The average NLRs and PLRs of the ineffective group were both significantly higher than those of the effective group.

CONCLUSION

Peripheral blood NLR and PLR could be used as a convenient, reliable, and cost-effective indicator to predict the prognosis of SSNHL.

Relationship between platelet parameters and sudden sensorineural hearing loss: a systematic review and meta-analysis

Recent years, the discussion about whether platelets participant in the development of sudden sensorineural hearing loss (SSHL) continues and many studies on the relationship between them have come to our attention. Some studies believe that platelet parameters have significantly changed in patients with SSHL, while some not, controversially. Therefore, to investigate the association between platelet parameters, including mean platelet volume (MPV), platelet distribution width (PDW) and platelet count (PLT), and SSHL, expecting to resolve controversy and provide clinical evidence for diagnosis and monitoring of SSHL. Basic methods: Literature was retrieved searching electronic databases (PubMed, Embase, Cochrane, and Scopus) and searching references of related articles by hand. A total of 18 case-control studies involving 1837/1734 subjects (SSHL/control) were included. Meta-analysis showed there was no difference between the patients who suffered SSHL and healthy controls in MPV level [standard mean difference (SMD) (95% confidence interval (CI)) = 0.16 (-0.07, 0.40), I2 = 80%, P<0.00001] and PLT [SMD (95% CI) = -0.03(-0.18, 0.12), I2 = 73%, P<0.00001]. While PDW exhibited significant difference [SMD (95% CI) = 0.85 (0.20, 1.49), I2 = 93%, P<0.00001]. Subgroup analysis about geographical area suggested PLT have obvious evidence for SSHL in Eastern country [SMD (95% CI) = 0.23 (0.14, 0.33), I2 = 0%, P=0.81]. Our study did not support a correlation between MPV and SSHL, while PLT may have clinical significance for SSHL in Eastern country. With insufficient data to explore the resource of heterogeneity for PDW, there is no decisive conclusion reached.

Neutrophil-to-lymphocyte ratio predicts diagnosis and prognosis of idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis

BACKGROUND

Chronic inflammation has been regarded as one of the causes of idiopathic sudden sensorineural hearing loss (ISSHL). Several individual studies have reported the association between neutrophil-to-lymphocyte ratio (NLR) and ISSHL. However, the findings have been inconsistent, and these data have not been systematically evaluated. Thus, we conducted this meta-analysis to further explore the predictive value of NLR on formation and prognosis of ISSHL.

METHODS

A comprehensive literature search was performed to identify eligible studies based on PubMed, Embase, Web of Science, and China National Knowledge Infrastructure. The Standardized mean deviation (SMD) with its 95% confidence interval (CI) was applied to be the effect size estimate.

RESULTS

A total 10 papers with 15 retrospective case-control studies, which included 1029 ISSHL patients (the case group) and 1020 healthy people (the control group), were selected for the meta-analysis of the relationship between NLR and onset of ISSHL. The NLR levels in the case group were observed to be higher than the control group (SMD = 1.65, 95% CI = 1.20-2.09, P < .001). The pooled results did not significantly change by the subgroup analyses based on study region, baseline matching, and laterality. Moreover, 9 publications with 12 retrospective cohort studies, which included 590 recovered ISSHL patients and 438 unrecovered ISSHL patients, explored the association between NLR and ISSHL prognosis, and the combined data showed that the NLR value was much higher in unrecovered patients rather than recovered patients (SMD = 1.27, 95% CI: 0.62-1.92, P < .001). The subgroup analyses based on study region, laterality, type of steroid, medication administration, maintenance treatment, follow-up period, and definition of "recovered" further supported these results.

CONCLUSION

The results of this meta-analysis suggest that NLR might be a useful biomarker to determine the onset and prognosis of ISSHL.