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Abstract Objective Serum uric acid is proven to be associated with chronic hearing loss, but its effect on Sudden Sensorineural Hearing Loss (SSNHL) is unclear. This study aims to evaluate the prognostic values of serum uric acid levels in SSNHL patients. Methods The clinical records of SSNHL patients were retrospectively reviewed. Patients were divided into different groups based on hearing recovery and audiogram type, and uric acid levels were compared. Based on uric acid levels, patients were categorized into normouricemia and hyperuricemia groups, and clinical features and hearing recovery were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors. Results In total, 520 SSNHL patients were included in this study, including 226 females and 294 males. In female patients, 186 patients were included in the normouricemia group, and 40 patients were enrolled in the hyperuricemia group. Significant differences were observed in uric acid levels, Total Cholesterol (TC), rate of complete recovery, and slight recovery between the two groups. In male patients, 237 subjects were categorized into the normouricemia group, and 57 patients were included in the hyperuricemia group. The rate of complete recovery and slight recovery was lower in the hyperuricemia group compared to the normouricemia group. All patients were further divided into good recovery and poor recovery groups based on hearing outcomes. The uric acid levels, initial hearing threshold, rate of hyperuricemia, and TC were lower in the good recovery group than the poor recovery group both in female and male patients. Binary logistic regression results showed that uric acid levels, initial hearing threshold, and hyperuricemia were associated with hearing recovery. Conclusion Hyperuricemia might be an independent risk factor for hearing recovery in SSNHL patients. Serum uric acid and initial hearing threshold possibly affected the hearing outcome in males and females with SSNHL. Level of evidence Level 4.
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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.
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Abstract Introduction 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. Objective To assess whether the preexistence of MetS interferes on hearing recovery levels. Methods 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 (NCEPATP 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. Results 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 (p = 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; p = 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). Conclusion 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.
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Objective To study effects of the bacterial biofilm at different growth stages on dynamic behavior of the titanium partial ossicular replacement prosthesis (PORP), so as to provide theoretical references for clinical treatment of diseases such as secretory otitis media. Methods Based on the CT scan images of normal human right ear and combined with the self compiling program, a 3D finite element model of the ear was reconstructed for dynamic analysis on sound conduction, and compared with the experimental data. The model was computed by harmonic response analysis method, and the sound conduction effect of bacterial biofilm grown on PORP at different growth stages was analyzed. Results The simulated amplitude of umbo and stapes footplate was in accordance with experimental measurements, which confirmed the validity of this numerical model. The existence of biofilm would cause 0-1.6 dB hearing loss at low frequencies. The growth of biofilm in the radial direction of PORP would cause 0-12 dB hearing loss at intermediate and high frequencies, especially at 8 kHz, and the hearing loss could be as high as 11.2 dB. Conclusions The bacterial biofilm has an impact on hearing by reducing the hearing at low frequencies while raising a little at high frequencies. The biofilm grown in the radial direction of PORP will reduce hearing, and affect the working efficiency of PORP on hearing restoration.
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BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. SUBJECTS AND METHODS: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. RESULTS: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). CONCLUSIONS: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.