Department of Otorhinolaryngology and Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Otorhinolaryngology and Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Am J Otolaryngol. 2022 May-Jun;43(3):103455. doi: 10.1016/j.amjoto.2022.103455. Epub 2022 Apr 6.
Sudden sensorineural hearing loss (SSNHL) is an otologic emergency. Despite multiple efforts to clarify the factors affecting the prognosis of severe-to-profound SSNHL, various studies showed inconsistent results and lack of clinical significance. Therefore, we examined the clinical features and outcomes of severe-to-profound SSNHL.
We included patients who experienced SSNHL between 2018 and 2021 and were diagnosed according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; hearing loss over 70 dB on initial pure tone audiometry (PTA) was used to define severe-to-profound SSNHL. We retrospectively examine the demographic, laboratory, radiologic, and audiometric data of SSNHL patients. We also evaluated the final hearing gain of these patients by assessing their PTA findings and word-recognition scores.
Of the 178 patients, 94 (52.81%) and 84 (47.19%) showed profound (>90 dB) and severe (>70 to 90 dB) hearing loss, respectively. The presence of vertigo and hypertension differed significantly between the severe and profound groups (p < 0.001 and p = 0.012, respectively), as did the initial serum creatinine level (p = 0.043). Recovery in PTA showed a reliable correlation with the interval between onset and treatment in the severe group and periventricular white-matter findings in the profound group (p < 0.001 and p = 0.011, respectively). The presence of hypertension was related to recovery of low tone (p = 0.023 for 250 Hz; p = 0.034 for 500 Hz), while glycated hemoglobin level was related to recovery of high tone in the severe group (p = 0.049 for 4000 Hz; p = 0.047 for 8000 Hz).
Severe-to-profound SSNHL showed poor prognosis for hearing gain. The interval from onset to treatment was a significant prognostic factor for severe SSNHL, while the presence of vertigo, estimated glomerular filtration rate, and periventricular white-matter findings were significant prognostic factors for profound SSNHL.
突发性聋（SSNHL）是一种耳科急症。尽管人们为了阐明影响重度至极重度 SSNHL 预后的因素付出了诸多努力，但多项研究结果并不一致，且缺乏临床意义。因此，我们对重度至极重度 SSNHL 的临床特征和结局进行了研究。
我们纳入了 2018 年至 2021 年间发生 SSNHL 并符合美国耳鼻喉科学-头颈外科学会标准的患者；初始纯音测听（PTA）的听力损失超过 70dB 用于定义重度至极重度 SSNHL。我们回顾性地检查了 SSNHL 患者的人口统计学、实验室、影像学和听力数据。我们还通过评估这些患者的 PTA 发现和言语识别得分来评估他们的最终听力增益。
在 178 名患者中，94 名（52.81%）和 84 名（47.19%）分别表现为极重度（>90dB）和重度（>70 至 90dB）听力损失。在重度和极重度组之间，眩晕和高血压的存在差异具有统计学意义（p<0.001 和 p=0.012），初始血清肌酐水平也有差异（p=0.043）。在重度组中，PTA 的恢复与发病至治疗的时间间隔呈可靠相关性，在极重度组中与侧脑室周围白质表现呈可靠相关性（p<0.001 和 p=0.011）。高血压的存在与低频（250Hz，p=0.023；500Hz，p=0.034）的听力恢复有关，而糖化血红蛋白水平与重度组高频（4000Hz，p=0.049；8000Hz，p=0.047）的听力恢复有关。
重度至极重度 SSNHL 的听力增益预后较差。发病至治疗的时间间隔是重度 SSNHL 的重要预后因素，而眩晕、估计肾小球滤过率和侧脑室周围白质表现是极重度 SSNHL 的重要预后因素。
