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Idiopathic sudden sensorineural hearing loss (ISSNHL) is a rare but potentially devastating condition. For patients presenting with this condition, prognosis is of paramount importance. Wu et al begin to address this issue by retrospectively studying 17 potential prognostic factors for ISSNHL in a case series of 323 patients. Included were those 13 years or older, with a maximum interval to treatment of 30 days, no history of previous ear surgery/ear inflammation/head trauma/fluctuating hearing loss/acoustic neuroma, and complete data sets. The standard local treatment protocol was: three days of 10mg/day IV dexamethasone, reduced over the subsequent one week; and oral neurotrophic factor daily for one month (80mg Extract of Ginkgo Biloba Leaves tds; 500microg Mecobalamin tds). Additionally, 61.6% patients underwent hyperbaric oxygen therapy daily for a mean of 6.77 days. Cases were classified into four types according to Chinese Guidelines for Sudden Deafness, the most common in this series (58.6%) being total deafness type (TDT) (mean pure-tone thresholds of 81dB or above, and hearing loss across all frequencies). Following treatment, 41.4% patients showed improved hearing. Multivariate regression analysis identified five of the 17 factors examined as independent prognostic factors: age, interval to treatment onset, low-density lipoprotein, vertigo and classification of hearing loss. These variables were used to produce a normogram (C-index: 0.798, 95% CI: 0.750-0.845), permitting clinicians to plot the values of the five risk factors in question in order to calculate the probability of treatment failure for individual patients. While this normogram will clearly need to be tested further, it is an exciting new gadget in the otologist’s toolbox: in time, it may not only help lift the fog regarding who is and is not likely to benefit from active treatment, but also assist in correctly tailoring treatment regimens for different types of ISSNHL.

Prognosis of Idiopathic Sudden Sensorineural Hearing Loss: The Nomogram Perspective.
Wu H, Wan W, Jiang H, Xiong Y.
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Lucy Dalton

QEH Birmingham, UK.

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