Analysis of clinical parameters as predictors of hearing recovery in patients with sudden sensorineural hearing loss

Poljak, Nikola Kolja; Klančnik, Marisa; Ivanišević, Petar; Mikulić, Petra; Vucemilovic, Marta Zrinka

doi:10.1016/j.bjorl.2022.08.002

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (Suppl 3) • Nov-Dec 2022 • https://doi.org/10.1016/j.bjorl.2022.08.002 copy

Analysis of clinical parameters as predictors of hearing recovery in patients with sudden sensorineural hearing loss

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Sudden sensorineural hearing loss is defined as a sensoneural hearing loss of at least 30 decibels, which affects at least three consecutive frequencies within 72 hours.

The etiology of SSNHL is fairly unknown, and so, it is often referred to as an idiopathic disease.

Sudden sensorineural hearing loss requires immediate treatment.

Tonal audiometry results, diabetes mellitus and onset of therapy were shown to be a statistically significant negative predictive factors for recovery.

Abstract

Objective:

To investigate the impact of certain clinical parameters on likelihood of hearing recovery after SSNHL and to detect potential variables that predict its outcome.

Methods:

A retrospective study was conducted in order to identify the clinical parameters which influence hearing recovery after SSNHL. Medical charts of 87 patients diagnosed with SSNHL and treated in the clinic from January 2015 to December 2019 were retrospectively reviewed. The effects of several parameters on the success of the treatment were statistically evaluated. Such parameters studied were age, gender, the severity of hearing loss, audiometric curve pattern, the time treatment was initiated, and metabolic factors.

Results:

Patient categorization according to tonal audiometric curve results statistically differed in terms of recovery (complete, partial, no recovery) (x² = 32.5; p< 0.001). There are 2× more diabetic patients in the group no recovery than in the group partial recovery (OR = 3.1; 95% CI 0.95–10; p = 0.061), and 5.3× more than in the group complete recovery (OR = 10.4; 95% CI 2.3–45; p = 0.002) (χ² = 11.2; p = 0.004). There is a statistically significant correlation between onset of therapy and recovery on a scale of significance of 93% (χ² = 5.3, p= 0.069).

Conclusion:

In our study tonal audiometry results, diabetes mellitus and onset of therapy were shown to be a statistically significant negative predictive factors for recovery. Results of pure tone audiometry suggest a flat profound curve is statistically associated with the no recovery rates, and a down sloping curve proved to be statistically associated with complete recovery rates.

Level of evidence: Level 1.

Keywords
Sudden sensorineural hearing loss; Predictors; Hearing recovery; Diabetes mellitus; Tone audiometry

Clinical and demographic data
Gender; n (%)
Males	50 (60)
Females	46 (40)
Age (years) median (Q1-Q3); min–max	56 (45–66; 8–87)
Dyslipidemia; n (%)	52 (62)
Hypertension; n (%)	44 (52)
Diabetes; n (%)	22 (26)
Onset of therapy (days) median (Q1–Q3; min–max)	3 (1–6;1–21)
Curve shape; n (%)
Flat profound	25 (29.8)
Down sloping	32 (38.1)
Up sloping	21 (25)
Flat moderate to severe	6 (7.1)
Hearing loss recovery; n (%)
Complete recovery	31 (37)
Partial recovery	34 (40)
No recovery	19 (23)

	Hearing loss recovery			p^a a χ2 test.
	Total	Complete (n = 31)	Incomplete (53)	p^a a χ2 test.	OR (95% CI)	p^b b Logistic regression.
Gender; n (%)				0.801
Males	50 (60)	19 (61)	31(58)
Females	46 (40)	12 (39)	22 (41)
Age (years)				0.175
≤ 56	42 (50)	19(61)	23 (43)
> 56	42 (50)	12 (39)	30 (57)
Dyslipidemia; n (%)	52 (62)	17 (55)	35 (66)	0.431
Hyperthension; n (%)	44 (52)	17 (55)	27 (51)	0.906
Diabetes; n (%)	22 (26)	3 (10)	19 (36)	0.018	5.2(1.4–19)	0.014
Onset of therapy (days)				0.045	3.1 (1.1–8.3)	0.028
1–3	52 (62)	24 (77)	28 (53)
> 3	32 (38)	7 (23)	25 (47)
Curve shape; n (%)				<0.001
Flat profound	25 (29.8)	3 (9.7)	22 (41.5)
Down sloping	32 (38.1)	14 (45.2)	18 (34)
Up sloping	21 (25)	14 (45.2)	7 (13.2)
Flat moderate to severe	6 (7.1)	0	6 (11.3)
Curve shape; n (%)				<0.001	10.4 (2.8–3.6)	<0.001
Down sloping and up sloping	53 (63)	28 (90)	25 (47)
Flat profound and flat moderate to severe	31 (37)	3 (10)	28 (53)

	OR	95%CI	p
Diabetes	4.2	0.995–17.5	0.051
Curve shape (down sloping and up sloping; flat profound and flat moderate to severe)	9.3	2.4–36	0.001
Onset of therapy (≤ ^a a Reference level. ; > 3)	3	0.978–9.2	0.055

	Recovery			p
	No recovery (n = 19)	Partial recovery (n = 25)	Complete recovery (n = 31)	p
Gender; n(%)				0.794
Males	10 (53)	21 (62)	19 (61)
Females	9 (47)	13 (38)	12 (39)
Age (years) median (Q1–Q3); min–max	61 (54–72; 30–87)	57 (43–67; 8–80)	52 (44–59; 27–81)	0.086
Dislipidemia	12 (63)	23 (68)	17 (55)	0.564
Hypertension	11 (58)	16 (47)	17 (55)	0.707
Diabetes	10 (53)	9 (26)	3 (10)	0.004
Curve shape				<0.001
Flat profound	13 (68.4)	9 (26.5)	3 (9.7)
Down sloping	1 (5.3)	17 (50)	14 (45.2)
Up sloping	3 (15.8)	4 (11.8)	14 (45.2)
Flat moderate to severe	2 (10.5)	4 (11.8)	0
Onset of therapy				0.069
≤ 3 (days)	11 (60)	17 (50)	24 (77)
> 3 (days)	8 (40)	17 (50)	7 (23)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail: pivanisevic@kbsplit.hr (P. Ivanisevic).