Metachronous Sudden Sensorineural Hearing Loss: Patient Characteristics and Treatment Outcomes

A Prognostic Model to Predict Hearing Recovery in Patients With Idiopathic Sudden Onset Sensorineural Hearing Loss

Importance

The prognosis of idiopathic sudden onset sensorineural hearing loss (iSSNHL) is uncertain, which creates challenges in clinical decision-making for ear, nose, and throat (ENT) physicians and adds to the burden of the condition experienced by patients.

Objective

To develop and internally validate a prognostic model for hearing recovery among patients with iSSNHL to support ENT surgeons in making informed and individualized treatment decisions.

Design, Settings, and Participants

This prognostic study and model used cohort data from the Sudden Onset Sensorineural Hearing Loss study, which included 812 patients (age ≥16 years) diagnosed with iSSNHL at 76 National Health Service ENT departments in the UK from December 2019 to May 2022. Nine variables previously reported as independent prognostic factors for complete recovery of patients with iSSNHL were selected for inclusion. The final model was internally validated using bootstrapping with 500 repetitions, then coefficients were adjusted for the degree of optimism in the model. The model intercept was reassessed after adjustment of model coefficients. Impact of individual predictors was evaluated by estimating odds ratios with corresponding 95% CIs. Model performance was re-evaluated after internal validation and expressed by discrimination, calibration, and clinical utility. Data analyses were performed from March 2022 to April 2024.

Intervention

Routine treatment (per National Health Service standards), including oral steroids and intratympanic steroid injections.

Main Outcome and Measures

Complete hearing recovery defined as a return to within 10 dB of the patient's before iSSNHL hearing levels at all frequencies in the affected ear at 6 to 16 weeks after iSSNHL symptom onset.

Results

The study sample included 498 patients (mean [SD] age, 58.7 [16.0] years; 215 [46.9%] females and 243 [53.1%] males) who met the criteria for inclusion in the model. Of those, 210 (46%) were classified as having experienced complete hearing recovery. Five variables were found to be independent predictors for complete hearing recovery: steroid treatment within 7 days from symptom onset (OR, 5.23 vs no treatment ), lower severity of hearing loss at presentation (OR, 0.19 if loss is mild), absence of vertigo (OR, 0.56 vs no vertigo), younger patient age (OR, 0.64 per year), and a history of cardiovascular disease (OR, 1.84 vs no cardiovascular disease). The model showed good performance after internal validation with a c-index of 0.77 (95% CI, 0.7-0.81). Predictions for complete recovery aligned well with observed complete recovery rates, and greater clinical utility than treat all or treat none strategies was shown.

Conclusion and Relevance

This prognostic model evaluated in this study may be able to assist ENT surgeons in making informed treatment decisions for individual patients with iSSNHL. It is available online at no cost.

Comparison of Sudden Sensorineural Hearing Loss with Tinnitus and Short-Term Tinnitus

Objective

As one of the common symptoms of sudden sensorineural hearing loss (SSH), tinnitus seriously affects the life and work of SSH patients. The present study is aimed at exploring whether SSH can receive acoustic therapy and the factors that affect the efficacy of SSH acoustic therapy.

Methods

A total of 162 patients were outpatients and inpatients, 86 were SSH, and 76 were short-term tinnitus (STT). Both groups received pure tone audiometry, tinnitus matching, and residual inhibition test (RI). The Tinnitus Handicap Inventory (THI), visual analog scale with respect to tinnitus loudness (VAS), and RI in each group were evaluated. The effects of age, degree of hearing loss, and tinnitus course on the efficacy of SSH acoustic therapy were also evaluated.

Results

In the comparison of RI, THI, and VAS, there was no difference between SSH and STT (P > 0.05). SSH patients with mild hearing loss showed better acoustic therapy efficacy compared with SSH patients with severe hearing loss (P < 0.05), but there is no statistical difference in age and the course of tinnitus (P > 0.05).

Conclusion

The present study showed that SSH may improve tinnitus symptom through receiving acoustic therapy and SSH patients with mild hearing loss can get better acoustic therapy effects.