Hearing recovery prediction and prognostic factors of idiopathic sudden sensorineural hearing loss: a retrospective analysis with a deep neural network model.

OBJECTIVE: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is an otologic emergency, and an early prediction of prognosis may facilitate proper treatment. Therefore, we investigated the prognostic factors for predicting the recovery in patients with ISSHL treated with combined treatment method using machine learning models. METHODS: We retrospectively reviewed the medical records of 298 patients with ISSHL at a tertiary medical institution between January 2015 and September 2020. Fifty-two variables were analyzed to predict hearing recovery. Recovery was defined using Siegel's criteria, and the patients were categorized into recovery and non-recovery groups. Recovery was predicted by various machine learning models. In addition, the prognostic factors were analyzed using the difference in the loss function. RESULTS: There were significant differences in variables including age, hypertension, previous hearing loss, ear fullness, duration of hospital admission, initial hearing level of the affected and unaffected ears, and post-treatment hearing level between recovery and non-recovery groups. The deep neural network model showed the highest predictive performance (accuracy, 88.81%; area under the receiver operating characteristic curve, 0.9448). In addition, initial hearing level of affected and non-affected ear, post-treatment (2-weeks) hearing level of affected ear were significant factors for predicting the prognosis. CONCLUSION: The deep neural network model showed the highest predictive performance for recovery in patients with ISSHL. Some factors with prognostic value were identified. Further studies using a larger patient population are warranted. LEVEL OF EVIDENCE: Level 4.

Hearing recovery prediction and prognostic factors of idiopathic sudden sensorineural hearing loss: a retrospective analysis with a deep neural network model

Abstract Objective Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is an otologic emergency, and an early prediction of prognosis may facilitate proper treatment. Therefore, we investigated the prognostic factors for predicting the recovery in patients with ISSHL treated with combined treatment method using machine learning models. Methods We retrospectively reviewed the medical records of 298 patients with ISSHL at a tertiary medical institution between January 2015 and September 2020. Fifty-two variables were analyzed to predict hearing recovery. Recovery was defined using Siegel's criteria, and the patients were categorized into recovery and non-recovery groups. Recovery was predicted by various machine learning models. In addition, the prognostic factors were analyzed using the difference in the loss function. Results There were significant differences in variables including age, hypertension, previous hearing loss, ear fullness, duration of hospital admission, initial hearing level of the affected and unaffected ears, and post-treatment hearing level between recovery and non-recovery groups. The deep neural network model showed the highest predictive performance (accuracy, 88.81%; area under the receiver operating characteristic curve, 0.9448). In addition, initial hearing level of affected and non-affected ear, post-treatment (2-weeks) hearing level of affected ear were significant factors for predicting the prognosis. Conclusion The deep neural network model showed the highest predictive performance for recovery in patients with ISSHL. Some factors with prognostic value were identified. Further studies using a larger patient population are warranted. Level of evidence: Level 4.

Comunicação no atendimento/assistência em saúde de pessoas surdas: revisão integrativa da literatura / Communication in health care/delivery of health care for deaf people: an integrative literature review

As barreiras de comunicação têm impactos diretos nos resultados de saúde das pessoas surdas, que muitas vezes ficam expostas a riscos de tratamentos inadequados sem consentimento. Neste contexto, a comunicação tem papel fundamental na avaliação e implementação dos cuidados específicos para essa clientela. Trata-se de uma revisão integrativa da literatura cujo objetivo foi identificar, avaliar e sintetizar evidências acerca de como é feito o atendimento a pessoa surda nos diversos serviços presentes na área da saúde. As bases de dados Pubmed/Medline, CINHAL e LILACS foram utilizadas para a busca dos estudos primários indexados nos últimos 10 anos. Os descritores controlados foram delimitados de acordo com o vocabulário padronizado para cada uma das bases de dados. Dos 3.273 estudos localizados e considerando os critérios de seleção adotados, 86 estudos foram lidos na íntegra e 11 estudos primários foram incluídos na revisão integrativa. Foi utilizado um instrumento validado para a extração dos dados. A análise dos dados foi descritiva. Os estudos primários incluídos foram divididos em três categorias temáticas: Uso das línguas de sinais ou escritas, Atendimento por intermédio de terceiros (intérpretes e familiares) ou leitura labial e; Uso de tecnologias de informação e comunicação e outros dispositivos de mídia. Por meio dos estudos primários avaliados pode-se observar que ainda há uma ausência de adequação dos serviços de saúde com relação ao atendimento da pessoa surda. Entre elas foram identificadas a ausência de treinamento dos profissionais de saúde em linguagem de sinais, dificuldades na compreensão da linguagem escrita, dificuldade de acesso a intérpretes de línguas de sinais, dependência de familiares e amigos para acessar os serviços de saúde e, dificuldades com a leitura labial. Os dados desta pesquisa possibilitam aos profissionais de saúde e de enfermagem conhecer melhor quais lacunas na comunicação com os surdos devem ser preenchidas nos serviços de saúde e dessa forma orientar a prática assistencial e políticas para a inclusão destes.

Communication barriers have a direct impact on the health outcomes of deaf people, who are often exposed to the risks of inappropriate treatment without consent. In this context, communication has a fundamental role in the evaluation and implementation of specific care for this clientele. It is an integrative review of the literature whose objective was to identify, evaluate and synthesize evidence about how care is provided for the deaf in the various services present in the health area. The Pubmed / Medline, CINHAL and LILACS databases were used to search for indexed primary studies in the last 10 years. The controlled descriptors were delimited according to the standardized vocabulary for each of the databases. Of the 3,273 studies located and considering the selection criteria adopted, 86 studies were selected for reading in full and 11 primary studies were included in the integrative review. A validated instrument was used for data extraction. Data analysis was descriptive. The included primary studies were divided into three thematic categories: Use of sign or written languages, Assistance through third parties (interpreters and family members) or lip reading and; Use of information and communication technologies and other media devices. Through the primary studies evaluated, it can be observed that there is still a lack of adequacy of health services in relation to the care of the deaf person. Among them were identified the lack of training of health professionals in sign language, difficulties in understanding written language, difficulty in accessing sign language interpreters, dependence on family and friends to access health services, and difficulties with lip reading. The data of this research enable health and nursing professionals to better understand which gaps in communication with the deaf should be filled in the health services and in this way guide the care practice and policies for their inclusion.

Investigation of neutrophil-to-lymphocyte ratio and mean platelet volume in sudden hearing loss, / Investigação da relação neutrófilos/linfócitos e volume médio de plaquetas na surdez súbita

ABSTRACT INTRODUCTION: Several theories attempt to explain the pathophysiology of sudden hearing loss. OBJECTIVE: The objective of this study was to investigate the possible role of inflammation and atherothrombosis in sudden hearing loss patients through the neutrophil-to-lymphocyte ratio and mean platelet volume. METHODS: Study design - retrospective cross-sectional historical cohort. This study was conducted on two groups: one with 59 individuals diagnosed with sudden hearing loss, and other with 59 healthy individuals with the same characteristics of gender and age distribution, neutrophil-to-lymphocyte ratio and mean platelet volume levels were measured in patients diagnosed with sudden hearing loss as well as in the control group, and it was verified whether these results interfered for a better or worse prognosis with treatment of sudden deafness. RESULTS: Neutrophil-to-lymphocyte ratio levels are much higher in patients diagnosed with sudden hearing loss compared to the control group. Similarly, mean levels of neutrophil-to-lymphocyte ratio are higher in non-recovered versus recovered patients (p = 0.001). However, we could not find a correlation with mean platelet volume levels (p > 0.05). CONCLUSION: Neutrophil-to-lymphocyte ratio is a quick and reliable indicator regarding diagnosis and prognosis of sudden hearing loss; on the other hand, mean platelet volume may be considered a less important indicator in this aspect.

RESUMO INTRODUÇÃO: Várias teorias tentam explicar a fisiopatologia da surdez súbita (SS). OBJETIVO: O objetivo deste estudo foi investigar o possível papel da inflamação e da aterotrombose nos pacientes de SS através da relação neutrófilos/linfócitos (RNL) e volume plaquetário médio (VPM). MÉTODO: Forma de estudo - coorte histórica com corte transversal (retrospectivo). Este estudo foi realizado com 59 indivíduos portadores de SS e 59 saudáveis, com as mesmas características em distribuição de gênero e idade. Os níveis de VPM e RNL foram medidos nos pacientes diagnosticados com SS e no grupo controle, verificando-se se tais resultados implicavam em um melhor ou pior prognóstico com o tratamento da surdez súbita. RESULTADOS: Os níveis da RNL são muito mais altos em pacientes com SS, em comparação com o grupo controle. De forma semelhante, níveis médios da RNL são mais altos nos pacientes não recuperados, em comparação com os recuperados (p = 0,001). Essas diferenças entretanto, não foram observadas em relação aos níveis de VPM (p > 0,05). CONCLUSÃO: RNL é um indicador rápido e confiável no que diz respeito ao diagnóstico e prognóstico de SS; por outro lado, VPM pode ser um indicador menos importante neste aspecto.

Investigation of neutrophil-to-lymphocyte ratio and mean platelet volume in sudden hearing loss.

INTRODUCTION: Several theories attempt to explain the pathophysiology of sudden hearing loss. OBJECTIVE: The objective of this study was to investigate the possible role of inflammation and atherothrombosis in sudden hearing loss patients through the neutrophil-to-lymphocyte ratio and mean platelet volume. METHODS: Study design - retrospective cross-sectional historical cohort. This study was conducted on two groups: one with 59 individuals diagnosed with sudden hearing loss, and other with 59 healthy individuals with the same characteristics of gender and age distribution, neutrophil-to-lymphocyte ratio and mean platelet volume levels were measured in patients diagnosed with sudden hearing loss as well as in the control group, and it was verified whether these results interfered for a better or worse prognosis with treatment of sudden deafness. RESULTS: Neutrophil-to-lymphocyte ratio levels are much higher in patients diagnosed with sudden hearing loss compared to the control group. Similarly, mean levels of neutrophil-to-lymphocyte ratio are higher in non-recovered versus recovered patients (p=0.001). However, we could not find a correlation with mean platelet volume levels (p>0.05). CONCLUSION: Neutrophil-to-lymphocyte ratio is a quick and reliable indicator regarding diagnosis and prognosis of sudden hearing loss; on the other hand, mean platelet volume may be considered a less important indicator in this aspect.

Glucocorticoid influence on prognosis of idiopathic sudden sensorineural hearing loss / Influência dos corticosteroides no prognóstico auditivo da perda auditiva neurossensorial súbita idiopática

INTRODUCTION: Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined when a loss of at least 30 dB occurs in over 3 continuous frequencies, in up to 72 hours, of which etiology is not established, despite adequate investigation. Different types of treatment regimens have been proposed, but only glucocorticoids have shown some evidence of benefit in the literature. OBJECTIVE: To analyze whether the type of treatment or time of treatment with glucocorticoids have any influence on hearing recovery in ISSHL. METHODS: Observational retrospective cohort study. One hundred twenty-seven patients with ISSHL, treated at outpatient clinics between the years 2000 and 2010, were studied. We evaluated the prognostic correlation of the type of treatment and time to treatment with glucocorticoids and ISSHL. RESULTS: The absolute hearing gain and the relative hearing gain was as follows: 23.6 dB and 37.2%. Complete recovery was observed in 15.7% of patients, significant recovery in 27.6% and recovery in 57.5%. CONCLUSION: In this study, there was no difference between the use and nonuse of glucocorticoids in hearing improvement. However, when started within seven days after onset, the use of glucocorticoids was a factor of better prognosis. .

INTRODUÇÃO: A perda auditiva neurossensorial súbita idiopática (PANSSI) é definida pela queda dos limiares auditivos tonais de, pelo menos, 30 dB em três frequências contíguas em até 72 horas e apesar de uma investigação apropriada, a etiologia da lesão não é encontrada. Diversos tipos de tratamentos já foram idealizados para a PANSSI, no entanto, os corticosteroides são os que encontram as melhores evidências de efetividade na literatura. OBJETIVO: Avaliar se o tipo de tratamento e o tempo de demora em iniciar o tratamento com corticosteroides têm correlação com a melhora dos limiares auditivos na PANSSI. MÉTODOS: Estudo de coorte retrospectivo observacional. Foram avaliados 127 pacientes com PANSSI provenientes do ambulatório entre os anos de 2000 e 2010. Foi avaliada a correlação prognóstica do tipo de tratamento e tempo de demora para o início de tratamento e a PANSSI. RESULTADOS: As taxas de recuperação absoluta e relativa foram 23,6 dB e 37,2% respectivamente. Apresentaram melhora completa 15,7% dos pacientes, 27,6% apresentaram melhora significativa e 57,5% melhora. CONCLUSÃO: Neste estudo, não houve diferença entre o uso ou não de corticosteroide na melhora auditiva. Contudo, quando iniciado até sete dias, o uso de corticosteroide foi fator de melhor prognóstico. .

Fatores prognósticos em perda auditiva neurossensorial súbita: estudo retrospectivo usando efeitos de interação / Prognostic factors in sudden sensorineural hearing loss: a retrospective study using interaction effects

O significado prognóstico de vertigem em pacientes com perda auditiva neurossensorial súbita idiopática (PANSI) continua a ser uma questão controversa. OBJETIVO: Este trabalho tem como objetivo verificar a diferença entre um grupo com vertigem e um grupo sem vertigem e analisar a validação da vertigem como fator prognóstico em pacientes com PANSI. MÉTODO:Este estudo envolveu 183 pacientes com PANSI. O teste t foi utilizado para comparar o grupo A (PANSI com vertigem, n = 31) e o grupo B (PANSI sem vertigem, n = 152). Também queremos verificar os efeitos de interação entre vertigem e outros fatores prognósticos por meio de análise de regressão múltipla. RESULTADOS: Houve uma diferença significativa entre o grupo A e o grupo B: o nível auditivo inicial do grupo A foi menor do que no grupo B, e seu início de tratamento também foi menor. Além disso, a vertigem em si não afetou a melhora da audição, mas a variável de interação entre vertigem e nível de audição inicial afetou significativamente a melhora da audição. CONCLUSÃO: As características clínicas dos pacientes com vertigem não afetaram diretamente a melhora da audição de pacientes com PANSI; no entanto, vertigem teve uma influência sobre a PANSI por meio de sua interação com os níveis iniciais de audição.

The prognostic significance of vertigo in patients with idiopathic sudden sensorineural hearing loss (SSNHL) remains a matter of debate. OBJECTIVE: This paper aims to verify the difference between a group with vertigo and a group without vertigo, and to analyze vertigo's validation as a prognostic factor in patients with SSNHL. METHOD: This study involved 183 patients with SSNHL. A t-test was used to compare group A (SSNHL with vertigo, n = 31) and group B (SSNHL without vertigo, n = 152). Also we want to verify the interaction effects between vertigo and other prognostic factors using multiple regression analysis. RESULTS: There was a significant difference between group A and group B: the initial hearing level of group A was lower than group B, and their treatment onset was also shorter. In addition, vertigo itself didn't affect hearing improvement, but the interaction variable between vertigo and initial hearing level did affect hearing improvement significantly. CONCLUSION: The clinical characteristics of patients with vertigo did not directly affect hearing improvement with SSNHL; however, vertigo had an influence on SSNHL though its interaction with the initial hearing levels.

Comparação entre critérios de recuperação auditiva na perda neurossensorial súbita / Comparison of hearing recovery criteria in sudden sensorineural hearing loss

Inúmeros métodos de análise da recuperação auditiva na perda auditiva neurossensorial súbita idiopática (PANSI) dificultam a comparação adequada dos diversos tratamentos encontrados na Literatura. OBJETIVO: Comparar diversos critérios de recuperação auditiva na PANSI, baseados na Literatura. MATERIAL E MÉTODO: Foi realizado um estudo clínico observacional de coorte, a partir de um protocolo prospectivo, em pacientes com PANSI, atendidos entre 2000 e 2010. Foram comparados cinco critérios de recuperação auditiva significativa e quatro critérios para recuperação completa, pela audiometria tonal, por meio de teste não paramétrico e de comparações múltiplas, ambos com um nível de significância de 5%. Após determinação do critério de recuperação auditiva mais rígido, foram adicionados parâmetros da audiometria vocal. RESULTADOS: Houve diferença significativa, entre esses critérios (p < 0,001), quando analisados em conjunto. A recuperação auditiva para, pelo menos, grau leve, ocorreu em apenas 35 (27,6%) pacientes. Ao adicionarmos parâmetros da audiometria vocal, apenas 34 pacientes (26,8%) tiveram melhora significativa. CONCLUSÕES: Existe falta de uniformidade entre os critérios de recuperação auditiva utilizados pela literatura. O critério de mudança de categoria funcional para um grau, pelo menos leve, foi o mais rígido. O uso da audiometria vocal não foi fundamental para definir recuperação auditiva significativa.

The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature. OBJECTIVE: This paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature. MATERIALS AND METHODS: This is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added. RESULTS: There was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement. CONCLUSIONS: There is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.