Thromboelastography predicting the prognosis of sudden sensorineural hearing loss.

OBJECTIVES: To explore the association between thromboelastography and the clinical features as well as the prognosis of sudden sensorineural hearing loss (SSNHL). DESIGN: Single-centre, retrospective study. SETTING: A hospital in China. PARTICIPANTS: In total, 133 patients presented with SSNHL within 2 weeks before the study, who did not receive treatment. MAIN OUTCOME MEASURES: The patients' medical history was collected. Audiological, imaging and haematological examinations were performed before treatment. Patients with abnormal thromboelastography were re-examined 1 week after treatment, and efficacy was evaluated 1 month after treatment. The chi-squared test and binary logistic regression analysis were used to analyse the association between factors, such as vertigo, degree and type of hearing loss, vestibular function, inner ear MRI results, thromboelastography and efficacy of treatment. RESULTS: Thromboelastography was correlated with prognosis (p = 0.049) and degree (p = 0.030) and type of hearing loss (p = 0.013) in patients with SSNHL. The R (p =  0.002) and angle values (p =  0.010) correlated with prognosis. The MA (p =  0.022) and G values (p =  0.020) correlated with the degree of hearing loss. The R (p =  0.033) value correlated with inner ear MRI results, and the ΔG (p =  0.010) value correlated with fibrinogen levels. ΔThromboelastography (p =  0.032) was correlated with the prognosis of patients with abnormal thromboelastography results. Logistic regression analysis showed that thromboelastography correlated with prognosis (p =  0.013), and Δthromboelastography correlated with the prognosis of patients with abnormal thromboelastography results (p =  0.013) and vertigo (p =  0.016). CONCLUSION: Thromboelastography is an independent risk factor affecting the prognosis of SSNHL with the R and angle values playing a major role.

Clinical value of auditory nerve enhancement in idiopathic sudden sensorineural hearing loss: a retrospective study.

Background: The pathogenesis of idiopathic sudden sensorineural hearing loss remains unclear, and no substantial breakthroughs have been achieved in its treatment. Therefore, we conducted this study with the aim to investigate the clinical features and prognostic factors of patients with idiopathic sudden sensorineural hearing loss and auditory nerve enhancement by using three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) of the inner ear. Methods: We retrospectively analyzed the clinical data of adult patients, who experienced sudden unilateral deafness and were admitted to the Department of Otolaryngology, Shandong Provincial ENT Hospital, between December 2020 and July 2021. Patients were divided into an auditory nerve enhancement group and a normal inner ear group, according to 3D-FLAIR MRI findings. Differences in sex, age, side, disease course, underlying diseases, dizziness/vertigo, vestibular function, degree of deafness, hearing classification, and treatment efficacy were analyzed. Results: Of the 112 cases of sudden idiopathic deafness, 16.07% exhibited enhancement of the auditory nerve on inner-ear 3D-FLAIR MRI. Statistically significant differences in the degree and type of hearing loss were detected between the two groups (p < 0.05). The rates of abnormal results in the caloric, vestibular-evoked myogenic potential, and video head impulse tests were higher in the auditory nerve enhancement group. The cure rate (11.1%) in patients with auditory nerve enhancement was lower than that in patients with normal inner ear MRI findings (28.7%); however, the difference was not statistically significant. Conclusion: Findings from 3D-FLAIR MRI scans of the inner ear indicated that patients with sudden deafness and auditory nerve enhancement experienced severe hearing loss, aggravated vestibular function injury, and a significantly decreased cure rate. Prompt treatment, ideally within 2 weeks of disease onset, can facilitate hearing recovery.

Impact of environmental noise exposure as an inducing factor on the prognosis of sudden sensorineural hearing loss: a retrospective case-control study.

Objective: The study aimed to evaluate the clinical characteristics and prognostic factors associated with unilateral sudden sensorineural hearing loss (SSNHL) related to environmental noise exposure before its onset. Methods: A total of 50 unilateral SSNHL patients exposed to environmental noise before onset (case group) and 924 unilateral SSNHL patients without any exposure to obvious inducing factors before onset (control group) were enrolled between January 2018 and October 2022. We retrospectively analyzed differences between both groups using the chi-square test, Fisher's exact tests, independent t-tests, and Mann-Whitney U-tests as appropriate before and after propensity score matching (PSM) based on sex, age, and initial pure-tone average (PTA). Prognostic factors for the case group were analyzed using univariate and multivariate logistic analyses between the effective and ineffective groups. Results: Before PSM, significant differences were noted in age, sex, time to treatment, the proportion of combined diabetes mellitus, initial PTA, hearing gain, the incidence of vertigo or aural fulness, the rate of vestibular dysfunction or inner ear MRI abnormalities, the effective rate, the glucose and homocysteine levels, and the proportion of audiogram curve types (P < 0.05) between both groups. After PSM, compared to the control group, a longer time to treatment (Z= -3.02, P < 0.05), higher final PTA (Z= -2.39, P < 0.05), lower hearing gain (Z= -3.46, P < 0.05), lower rate of vestibular dysfunction (χ2 = 55.1, P < 0.001), and lower effective rate (χ2 = 4.87, P < 0.05) were observed in the case group. There was a significant difference between the audiogram curve types in both groups (χ2 = 14.9, P < 0.05). Time to treatment (95% confidence interval: 0.692-0.965, P < 0.05) and final PTA (95% confidence interval: 0.921-0.998, P < 0.05) were associated with the clinical outcomes for the case group. Conclusion: Unilateral SSNHL patients exposed to environmental noise triggers before onset showed a poorer effective rate and a lower rate of vestibular dysfunction than those who were not. The time to treatment and final PTA were associated with the prognosis of these patients.

Characteristics and prognostic analysis of simultaneous bilateral sudden sensorineural hearing loss.

Objective: To evaluate the clinical characteristics of simultaneous bilateral sudden sensorineural hearing loss (Si-BSSNHL) as well as its prognostic factors. Methods: Patients with Si-BSSNHL who were admitted to the Department of Otology Medicine between December 2018 and December 2021 were enrolled in the case group. Propensity score matching (PSM) for sex and age was used to select the control group, which included people who had unilateral sudden sensorineural hearing loss (USSNHL) during the same time period. Hearing recovery, audiological examinations, vestibular function assessments, laboratory tests, and demographic and clinical manifestations were analyzed for intergroup comparisons. Binary logistic regressions were used for both univariate and multivariate analyses of Si-BSSNHL prognostic factors. Results: Before PSM, the Si-BSSNHL and USSNHL groups differed significantly (p < 0.05) in terms of time from onset to treatment, initial pure-tone average (PTA), final PTA, hearing gain, audiogram curve type, proportion of tinnitus, high-density lipoprotein level, homocysteine level, and effective rate. After PSM, significant differences were also observed in time from onset to treatment, initial PTA, final PTA, hearing gain, total and indirect bilirubin levels, homocysteine level, and effective rate between the two groups (p < 0.05). There was a significant difference in the classification of therapeutic effects between the two groups (p < 0.001). For prognostic analysis, the audiogram curve type was significantly different between the effective group and the ineffective groups of Si-BSSNHL (p = 0.01), in which the sloping type was an independent risk factor for the prognosis of the right ear in Si-SSNHL (95% confidence interval, 0.006-0.549, p = 0.013). Conclusion: Patients with Si-BSSNHL had mild deafness, elevated total and indirect bilirubin and homocysteine levels, and poorer prognosis than those with USSNHL. Audiogram curve type was linked to the therapeutic effect of Si-BSSNHL, and the sloping type was an independent risk factor for a poor prognosis in the right ear of Si-SSNHL.

Idiopathic Sudden Sensorineural Hearing Loss in Different Ages: Prognosis of Patients With Initial Total Hearing Loss.

Objective: This study aimed to analyze the hearing improvement and prognosis factors of idiopathic sudden sensorineural hearing loss (ISSNHL) in different ages with initial total hearing loss. Methods: We reviewed the medical records of 5,711 hospitalized patients with ISSNHL from 2016 to 2021 in our center. All of the patients had been treated with uniform combination drug therapy. After excluding the patients with initial partial hearing loss and those diagnosed with clear etiology, 188 patients were enrolled in this study and divided into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, ≥ 71 years). In all groups, decreases in pure-tone average (PTA) 1 month posttreatment, effective rate, and clinical characteristics (vertigo, tinnitus, hospital stay, comorbidity, and inner ear magnetic resonance imaging) were analyzed. Results: Among the 188 enrolled patients, 86% had vertigo. Complete recovery was seen in 0.5% of patients, and marked recovery was seen in 43% of patients. The mean 1 month posttreatment PTAs were as follows: 18-30 years: 80 ± 7.5 dB; 31-40 years: 100 ± 9.0 dB; 41-50 years: 99 ± 8.3 dB; 51-60 years: 101 ± 8.6 dB; 61-70 years: 96 ± 9.6 dB; and ≥ 71 years: 88 ± 13.0 dB. Compared with the other groups, the 18-30- years group showed better recovery of hearing threshold in five frequencies (0.25, 0.5, 1, 2, and 4 kHz, respectively, at octave or semioctave frequencies under air conduction), and the recovery of hearing threshold at 0.25 and 0.5 Hz was better than the recovery at 1, 2, and 4 kHz. According to the results of the chi-square test statistical analysis, vertigo and comorbidities were associated with a poor prognosis of ISSNHL. Conclusion: In summary, the treatment outcomes of patients with ISSNHL with initial total hearing loss were poor. There was a significant age-related difference with respect to marked recovery 1 month posttreatment, and the 18-30- years group showed better recovery than the other age groups.