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Comment
. 2024 Oct 1;150(10):896-906.
doi: 10.1001/jamaoto.2024.2598.

A Prognostic Model to Predict Hearing Recovery in Patients With Idiopathic Sudden Onset Sensorineural Hearing Loss

Rishi Mandavia  1   2   3 , Nikhil Joshi  1   2   3 , Gerjon Hannink  4 , Muhammad Nayeem Ahmed  5 , Dilen Parmar  6 , Silvia Di Bonaventura  3 , Paola Gomes  7 , Isha Iqbal  8 , James Lyles  9 , Anne G M Schilder  1   2   3 , Nishchay Mehta  1   2   3 ; SEASHEL collaborative
Affiliations
Comment

A Prognostic Model to Predict Hearing Recovery in Patients With Idiopathic Sudden Onset Sensorineural Hearing Loss

Rishi Mandavia et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: The prognosis of idiopathic sudden onset sensorineural hearing loss (iSSNHL) is uncertain, which creates challenges in clinical decision-making for ear, nose, and throat (ENT) physicians and adds to the burden of the condition experienced by patients.

Objective: To develop and internally validate a prognostic model for hearing recovery among patients with iSSNHL to support ENT surgeons in making informed and individualized treatment decisions.

Design, settings, and participants: This prognostic study and model used cohort data from the Sudden Onset Sensorineural Hearing Loss study, which included 812 patients (age ≥16 years) diagnosed with iSSNHL at 76 National Health Service ENT departments in the UK from December 2019 to May 2022. Nine variables previously reported as independent prognostic factors for complete recovery of patients with iSSNHL were selected for inclusion. The final model was internally validated using bootstrapping with 500 repetitions, then coefficients were adjusted for the degree of optimism in the model. The model intercept was reassessed after adjustment of model coefficients. Impact of individual predictors was evaluated by estimating odds ratios with corresponding 95% CIs. Model performance was re-evaluated after internal validation and expressed by discrimination, calibration, and clinical utility. Data analyses were performed from March 2022 to April 2024.

Intervention: Routine treatment (per National Health Service standards), including oral steroids and intratympanic steroid injections.

Main outcome and measures: Complete hearing recovery defined as a return to within 10 dB of the patient's before iSSNHL hearing levels at all frequencies in the affected ear at 6 to 16 weeks after iSSNHL symptom onset.

Results: The study sample included 498 patients (mean [SD] age, 58.7 [16.0] years; 215 [46.9%] females and 243 [53.1%] males) who met the criteria for inclusion in the model. Of those, 210 (46%) were classified as having experienced complete hearing recovery. Five variables were found to be independent predictors for complete hearing recovery: steroid treatment within 7 days from symptom onset (OR, 5.23 vs no treatment ), lower severity of hearing loss at presentation (OR, 0.19 if loss is mild), absence of vertigo (OR, 0.56 vs no vertigo), younger patient age (OR, 0.64 per year), and a history of cardiovascular disease (OR, 1.84 vs no cardiovascular disease). The model showed good performance after internal validation with a c-index of 0.77 (95% CI, 0.7-0.81). Predictions for complete recovery aligned well with observed complete recovery rates, and greater clinical utility than treat all or treat none strategies was shown.

Conclusion and relevance: This prognostic model evaluated in this study may be able to assist ENT surgeons in making informed treatment decisions for individual patients with iSSNHL. It is available online at no cost.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Schilder reported advisory fees from Julius Clinical Scientific outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Graphical Representation of Relative Strength of Each Individual Predictor of Hearing Recovery
Whiskers indicate 95% CIs.
Figure 2.
Figure 2.. Calibration Plot of Internally Validated Prognostic Model
Flexible calibration (Loess) curve indicates how well our model predicts complete recovery against an ideal predictor (ideal curve).
Figure 3.
Figure 3.. Decision-Curve Analysis to Examine Clinical Utility for the Model
Decision-curve analysis comparing the net benefits of 2 prognostic models; ie, SEASHEL calculator (dark blue) and a model including the strongest predictor time to first treatment (light blue) across a range of threshold probabilities. The x-axis represents the threshold probability—the probability at which a decision to treat a patient is made. The y-axis represents the net benefit, calculated as a function of true positives and false positives, adjusted for the relative harm of false positives vs false negatives. Curves that lie above the treat none (black) and treat all (gray) lines indicate a net-positive benefit. The highest curve at any given threshold probability highlights the model with the greatest clinical utility at that specific threshold, aiding in optimal decision-making.
See this image and copyright information in PMC

Comment on

  • Predicting Hearing Recovery for Patients With iSSNHL.
    Smetak MR, Jiramongkolchai P, Herzog JA. Smetak MR, et al. JAMA Otolaryngol Head Neck Surg. 2024 Oct 1;150(10):906-907. doi: 10.1001/jamaoto.2024.2634. JAMA Otolaryngol Head Neck Surg. 2024. PMID: 39235805 No abstract available.

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