Prognostic impact of standard laboratory values on outcome in patients with sudden sensorineural hearing loss

BMC Ear, Nose and Throat Disorders

Orlando Guntinas-Lichius¹  Michael Kiehntopf³  Claus Wittekindt²  Julia Wittig¹ 

[1] Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, Jena D-07740, Germany;Present address: Department of Otorhinolaryngology, University Giessen, Giessen, Germany;Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, Jena, Germany

关键词: Hearing loss;    Prognostic marker;    Outcome;    Blood value;    Serology;   

Others  :  862652
DOI  :  10.1186/1472-6815-14-6

 received in 2013-09-12, accepted in 2014-07-07,  发布年份 2014

【 摘 要 】

Background

Aim of the present study was to evaluate prognostic factors, in particular standard laboratory parameters, for better outcome after idiopathic sudden sensorineural hearing loss (SSNHL).

Methods

Using a retrospective review, 173 patients were included presenting between 2006 and 2009 with unilateral SSNHL, ≥30 dB bone conduction in three succeeding frequencies between 0.125 to 8 kHz in pure tone audiometry (PTA), and a time interval between first symptoms and diagnostics ≤ 4 weeks. Hearing gain of <10 dB versus ≥10 dB in the affected ear in 6PTA values was the primary outcome criterion. Univariate and multivariate statistical tests were used to analyze predictors for better outcome.

Results

The initial hearing loss was 50.6 ± 27.2 dB. The absolute hearing gain was 15.6 ± 20.1 dB. Eighty-one patients (47%) had a final hearing gain of ≥10 dB. Low-frequency hearing loss (p <0.0001); start of inpatient treatment <4 days after onset (p = 0.018); first SSNHL (versus recurrent SSNHL, p = 0.001); initial hearing loss ≥ 60 dB (p < 0.0001); an initial quick value lower than the reference values (p = 0.040); and a pretherapeutic hyperfibrinogenemia (p = 0.007) were significantly correlated to better outcome (≥10 dB absolute hearing gain). Multivariate analysis revealed that first SSNHL (p = 0.004), start of treatment <4 days after onset (p = 0.015), initial hearing loss ≥ 60 dB (p = 0.001), and hyperfibrinogenemia (p = 0.032) were independent prognostic factors for better hearing recovery.

Conclusion

Better hearing gain in patients with hyperfibrinogenemia might be explained by the rheological properties of the applied therapy and supports the hypothesis that SSNHL is caused in part by vascular factors.

【 授权许可】

   
2014 Wittig et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ: Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012, 146(Suppl):S1-S35.
• [2]Byl FM Jr: Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984, 94:647-661.
• [3]Egli Gallo D, Khojasteh E, Gloor M, Hegemann SC: Effectiveness of systemic high-dose dexamethasone therapy for idiopathic sudden sensorineural hearing loss. Audiol Neurootol 2013, 18:161-170.
• [4]Chau JK, Lin JR, Atashband S, Irvine RA, Westerberg BD: Systematic review of the evidence for the etiology of adult sudden sensorineural hearing loss. Laryngoscope 2010, 120:1011-1021.
• [5]Cvorovic L, Deric D, Probst R, Hegemann S: Prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss. Otol Neurotol 2008, 29:464-469.
• [6]D’Hoore W, Sicotte C, Tilquin C: Risk adjustment in outcome assessment: the Charlson comorbidity index. Meth Inf Med 1993, 32:382-387.
• [7]Michel O: [The revised version of the german guidelines “sudden idiopathic sensorineural hearing loss”]. Laryngorhinootologie 2011, 90:290-293.
• [8]Plontke SK, Bauer M, Meisner C: Comparison of pure-tone audiometry analysis in sudden hearing loss studies: lack of agreement for different outcome measures. Otol Neurotol 2007, 28:753-763.
• [9]Suckfull M: Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomised multicentre trial. Lancet 2002, 360:1811-1817.
• [10]Mattox DE, Simmons FB: Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 1977, 86:463-480.
• [11]Probst R, Tschopp K, Ludin E, Kellerhals B, Podvinec M, Pfaltz CR: A randomized, double-blind, placebo-controlled study of dextran/pentoxifylline medication in acute acoustic trauma and sudden hearing loss. Acta Otolaryngol 1992, 112:435-443.
• [12]Weinaug P: [How high is the rate of spontaneous healing of sudden deafness? Comments on the contribution “Spontaneous healing of sudden deafness”]. HNO 2001, 49:431-432. discussion 3
• [13]Shaia FT, Sheehy JL: Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope 1976, 86:389-398.
• [14]Jun HJ, Chang J, Im GJ, Kwon SY, Jung H, Choi J: Analysis of frequency loss as a prognostic factor in idiopathic sensorineural hearing loss. Acta Otolaryngol 2012, 132:590-596.
• [15]Fetterman BL, Saunders JE, Luxford WM: Prognosis and treatment of sudden sensorineural hearing loss. American J Otol 1996, 17:529-536.
• [16]Aimoni C, Bianchini C, Borin M, Ciorba A, Fellin R, Martini A, Scanelli G, Volpato S: Diabetes, cardiovascular risk factors and idiopathic sudden sensorineural hearing loss: a case-control study. Audiol Neurootol 2010, 15:111-115.
• [17]Cadoni G, Scorpecci A, Cianfrone F, Giannantonio S, Paludetti G, Lippa S: Serum fatty acids and cardiovascular risk factors in sudden sensorineural hearing loss: a case-control study. Ann Otol Rhinol Laryngol 2010, 119:82-88.
• [18]Osei-Bimpong A, Meek JH, Lewis SM: ESR or CRP? A comparison of their clinical utility. Hematol 2007, 12:353-357.
• [19]Jackson CM, Esnouf MP: Has the time arrived to replace the quick prothrombin time test for monitoring oral anticoagulant therapy? Clin Chem 2005, 51:483-485.
• [20]Lin RJ, Krall R, Westerberg BD, Chadha NK, Chau JK: Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults. Laryngoscope 2012, 122:624-635.
• [21]Ballesteros F, Tassies D, Reverter JC, Alobid I, Bernal-Sprekelsen M: Idiopathic sudden sensorineural hearing loss: classic cardiovascular and new genetic risk factors. Audiol Neurootol 2012, 17:400-408.
• [22]Koenig W: Fibrin(ogen) in cardiovascular disease: an update. Thromb Haemost 2003, 89:601-609.
• [23]Suckfull M, Wimmer C, Reichel O, Mees K, Schorn K: Hyperfibrinogenemia as a risk factor for sudden hearing loss. Otol Neurootol 2002, 23:309-311.
• [24]Rudack C, Langer C, Stoll W, Rust S, Walter M: Vascular risk factors in sudden hearing loss. Thromb Haemost 2006, 95:454-461.
• [25]Ihler F, Strieth S, Pieri N, Göhring P, Canis M: Acute hyperfibrinogenemia impairs cochlear blood flow and hearing function in guinea pigs in vivo. Int J Audiol 2012, 51:210-215.
• [26]Michel O, Jahns T, Joost-Enneking M, Neugebauer P, Streppel M, Stennert E: [The Stennert antiphlogistic-rheologic infusion schema in treatment of cochleovestibular disorders]. HNO 2000, 48:182-188.