Hodge Sarah E, Berliner Karen I, Grimes Rachel, Slattery William, Peng Kevin A
Division of Otology/Neurotology, Dept. of Otolaryngology - Head and Neck Surgery, Wellstar-Medical College of Georgia, Augusta, GA, USA.
Clinical Research Consultant, Marina del Rey, CA, USA.
Ann Otol Rhinol Laryngol. 2025 Oct;134(10):754-762. doi: 10.1177/00034894251344767. Epub 2025 Jun 5.
To analyze SSNHL patient data from a single large multi-physician institution to determine the nature of confounding factors that must be considered in designing adequate studies for improved diagnosis and treatment.
Retrospective review of a random sample of 330 patients (mean age = 61 yrs (19-96); 45% F) diagnosed with idiopathic SSNHL from 2013 to 2022 from a tertiary referral clinical practice. Data included demographics, treatment modality (oral prednisone only, intratympanic dexamethasone [IT Dex] only, or a combination of both) and regimen, time to treatment, and pure-tone averages (PTA) and word recognition scores (WRS). Different hearing outcomes were assessed, including recovery category (Complete, Partial, No Recovery) rates.
Only 56% of patients had a >30 dB loss compared to the contralateral ear, while PTA and WRS both ranged widely (6 dB-NR; 0%-100%). Oral steroids were the most common treatment (83%), used alone in 32.4%, with IT Dex injections used in 68.8%, but as only treatment in 17%. 50.6% received both treatments. Hearing outcomes were generally poor, with small improvements in PTA (mean improvement = -9.5 dB, SD = 18.7) and WRS (mean improvement = 9.1%, SD = 27.7) across all subjects, with no statistically significant differences between treatment groups and a high rate of no recovery (76.2%). Pretreatment PTA followed by treatment timing (≤14 days, >14 days) and treatment type contributed significantly to predicting amount of change in PTA but accounted for only a small portion of the variability in regression analysis (R = .232, ≤ .001).
Hearing outcomes with standard steroid treatments remain suboptimal. Patients presenting for treatment of SSNHL in clinical practice can vary greatly from the formal definition of SSNHL, and past studies may not be generalizable to the overall population of patients. This highlights the challenges in defining and treating SSNHL in a clinical environment and identifies confounding factors to be considered in future research designs.
分析来自一家大型多医生机构的突发性聋（SSNHL）患者数据，以确定在设计充分的研究以改善诊断和治疗时必须考虑的混杂因素的性质。
回顾性分析2013年至2022年从一家三级转诊临床实践中随机抽取的330例被诊断为特发性SSNHL的患者（平均年龄 = 61岁（19 - 96岁）；45%为女性）。数据包括人口统计学信息、治疗方式（仅口服泼尼松、仅鼓室内注射地塞米松[IT Dex]或两者联合）及方案、治疗时间、纯音平均听阈（PTA）和言语识别得分（WRS）。评估了不同的听力结果，包括恢复类别（完全恢复、部分恢复、未恢复）率。
与对侧耳相比，只有56%的患者听力损失>30dB，而PTA和WRS的范围都很广（6dB - 未恢复；0% - 100%）。口服类固醇是最常见的治疗方法（83%），单独使用的占32.4%，使用IT Dex注射的占68.8%，但仅作为唯一治疗方法的占17%。50.6%的患者接受了两种治疗。听力结果总体较差，所有受试者的PTA平均改善（平均改善 = -9.5dB，标准差 = 18.7）和WRS平均改善（平均改善 = 9.1%，标准差 = 27.7）较小，治疗组之间无统计学显著差异，未恢复率较高（76.2%）。治疗前PTA，其次是治疗时机（≤14天、>14天）和治疗类型对预测PTA的变化量有显著贡献，但在回归分析中仅占变异性的一小部分（R = 0.232，P≤0.001）。
标准类固醇治疗的听力结果仍然不理想。在临床实践中就诊接受SSNHL治疗的患者可能与SSNHL的正式定义有很大差异，过去的研究可能不适用于所有患者群体。这凸显了在临床环境中定义和治疗SSNHL的挑战，并确定了未来研究设计中要考虑的混杂因素。
