Breda Miguel Sá, Menezes Ana Sousa, Oliveira Tiago Gil, Dias Luís
Otorhinolaryngology and Head & Neck Surgery Department, Hospital de Braga, Braga, Portugal.
Neuroradiology Department, Hospital de Braga, Braga, Portugal.
Int Arch Otorhinolaryngol. 2022 Jan 31;26(3):e296-e303. doi: 10.1055/s-0041-1741027. eCollection 2022 Jul.
Idiopathic sudden sensorineural hearing loss (ISSHL) is a disabling otologic urgency whose ethiopathogenesis is still controversial. Only in recent years metabolic syndrome (MetS) has been implicated as a possible aggravating factor in the prognosis of recovery from ISSHL. To assess whether the preexistence of MetS interferes on hearing recovery levels. Retrospective cohort study composed of adult (> 18 years old) ISSHL patients admitted for treatment between January 2015 and December 2019. To diagnose ISSHL, we used pure-tone audiometry, and identified MetS patients based on the criteria of the United States National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The treatment protocol comprised hospitalization for five days for the intravenous administration of dexamethasone, audiometric surveillance, imaging and blood analyses, and, based on recovery, the planning of rescue treatments (intratympanic administration of dexamethasone and/or hyperbaric oxygen). The Siegel criteria were used to evaluate the hearing outcomes. The final sample was composed of 81 patients, 48 without MetS (nMetS) and 33 with MetS. Regarding the Siegel recovery category, the nMetS group had significantly better results ( = 0.001), with 44% of complete recoveries against 6% in the MetS, and 58% of the MetS patients had the worst outcome, contrasting with 27% in the nMetS group. The nMetS group had an overall better evolution in terms of hearing recovery and had a significant improvement in the median hearing gain (20.6 dB versus 8.8 dB; = 0.008). Additionally, the multivariate analysis revealed that the presence of MetS is a significant risk factor for a worse outcome (odds ratio [OR] = 0.30; 95% confidence interval [95%CI] = 0.10-0.85). Regardless of age, gender, the initial audiometry threshold, and autoimmunity, MetS is a clear risk factor for a worse outcome regarding the recovery of hearing after ISSHL.
特发性突发性感音神经性听力损失（ISSHL）是一种致残性耳科急症，其发病机制仍存在争议。直到近年来，代谢综合征（MetS）才被认为可能是影响ISSHL恢复预后的一个加重因素。
为了评估MetS的预先存在是否会干扰听力恢复水平。
回顾性队列研究，研究对象为2015年1月至2019年12月期间收治的成年（>18岁）ISSHL患者。为诊断ISSHL，我们采用纯音听力测定法，并根据美国国家胆固醇教育计划成人治疗小组III（NCEP ATP III）的标准确定MetS患者。治疗方案包括住院五天，静脉注射地塞米松，听力监测、影像学和血液分析，并根据恢复情况规划挽救治疗（鼓室内注射地塞米松和/或高压氧）。采用西格尔标准评估听力结果。
最终样本由81名患者组成，48名无MetS（nMetS）患者和33名有MetS患者。关于西格尔恢复类别，nMetS组的结果明显更好（P = 0.001），完全恢复率为44%，而MetS组为6%，58%的MetS患者预后最差，而nMetS组为27%。nMetS组在听力恢复方面总体进展更好，中位听力增益有显著改善（20.6dB对8.8dB；P = 0.008）。此外，多变量分析显示，MetS的存在是预后较差的一个显著危险因素（比值比[OR]=0.30；95%置信区间[95%CI]=0.10 - 0.85）。
无论年龄、性别、初始听力测定阈值和自身免疫情况如何，MetS都是ISSHL后听力恢复预后较差的一个明确危险因素。
