Clinical Profiles and Prognoses of Adult Patients with Full-Frequency Sudden Sensorineural Hearing Loss in Combination Therapy

Abstract

We aimed to characterize the clinical profiles and short-term outcomes of adult patients with full-frequency idiopathic sudden sensorineural hearing loss (ISSNHL) treated uniformly with combination therapy, and to determine the prognostic predictors for the combination therapy. A total of 131 eligible cases hospitalized in our department from January 2018 to June 2021 were retrospectively reviewed. All enrolled cases received a standardized combination therapy employing intravenous methylprednisolone, batroxobin, and Ginkgo biloba extract during the 12 days of hospitalization. The clinical and audiometric profiles were compared between recovered patients and their unrecovered counterparts. The overall recovery rate was 57.3% in the study. Accompanying vertigo (odds ratio = 0.360, p = 0.006) and body mass index (BMI, odds ratio = 1.158, p = 0.016) were two independent predictors of hearing outcomes of the therapy. The male gender and cigarette-smoking history were marginally associated with good hearing prognosis (p = 0.051 and 0.070, respectively). Patients with BMI ≥ 22.4 kg/m² had a better chance of hearing recovery (p = 0.02). Conclusions: Accompanying vertigo and low BMI (<22.4 kg/m²) were independently associated with poor prognosis for full-frequency ISSNHL in combination therapy. Male gender and cigarette-smoking history might be considered positive effects on hearing prognosis.

Keywords: body mass index; full-frequency; prognosis; sudden sensorineural hearing loss; vertigo.

Figure 1

Comparison of responses of plasma fibrinogen to the combination therapy between patients with and without hearing recovery. (a) A share of 89.3% of patients with hearing recovery presented a normal value (2.0 to 4.0 g/L) of Fg1. Pearson χ² test demonstrated an equal proportion in unrecovered patients (87.5%). (b) The proportion of Fg3 above or below the critical value (<1.0 g/L) was not statistically associated with hearing outcomes. (c) Wilcoxon matched-pair signed-rank test revealed that fibrinogen levels significantly decreased after the first dose of batroxobin in all involved patients. However, there were no statistical differences in Fg1 and Fg3 between patients with opposite hearing outcomes. Data were presented as means ± SD. *** p < 0.001. (d) Kendall’s correlation analysis indicated no significant correlation between patients’ hearing improvement and the reduction of fibrinogen levels after batroxobin application.

Figure 2

The relationship between BMI and hearing outcomes by combination therapy. (a) Two independent samples t-test indicated significantly greater BMI points in patients with hearing recovery (23.5 ± 3.48 kg/m²) compared with the unrecovered counterparts (22.0 ± 2.82 kg/m²). Data are presented as means ± SD. (b) Spearman’s correlation analysis revealed a positive correlation of BMI with hearing gain by combination therapy. * p < 0.05, ** p < 0.01.

Figure 3

Comparison of serum TG (a), TC (b), HDL-C (c), and LDL-C (d) concentrations between recovered and unrecovered patients. Two independent samples t-test demonstrated that serum TC and LDL-C concentrations were significantly higher in recovered patients. Data are presented as means ± SD. * p < 0.05.

Figure 4

Correlation analysis of patients’ hearing gains with serum TG (a), TC (b), HDL-C (c), and LDL-C (d) levels showed that higher serum TC and LDL-C concentrations were correlated with more hearing gains. * p < 0.05, ** p < 0.01.

Figure 5

Independent predictive factors for hearing prognosis. (a) The forest plot illustrates the relative importance of concurrent vertigo and BMI in predicting the hearing prognosis in combination therapy. (b) The ROC curve reveals that BMI was useful in predicting the hearing outcome after treatment. The area under the curve (AUC) was 0.619 (95% CI = 0.523 to 0.715, p = 0.02).

Figure 6

Comparison of hearing outcomes among patients with disparate prognostic predictors. (a) The overall hearing recovery rates varied statistically among patients with different prognostic factors. V+B- stands for dizzy patients with BMI < 22.4 kg/m², V+B+ for dizzy patients with BMI ≥ 22.4 kg/m², V-B- for patients with no accompanying vertigo plus BMI < 22.4 kg/m², and V-B+ for patients with no accompanying vertigo plus BMI ≥ 22.4 kg/m². (b) The more predictors of good prognoses the patients possessed, the better the hearing improvements that were gained. The box boundaries indicate upper and lower quartiles (Q_U and Q_L). The line within the boxes marks the median (Mdn). The whiskers below and above the box represent the minimum and maximum. Data are presented as Mdn (IQR). ** p < 0.01.