Data_Sheet_1_Accelerated Long-Term Hearing Loss Progression After Recovery From Idiopathic Sudden Sensorineural Hearing Loss.docx

Background and Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is characterized by rapid onset, typically unilateral presentation, and variable recovery. This case-control observational study aimed to improve patient counseling by objectively characterizing long-term hearing loss progression following ISSNHL, using sequential audiometry in the largest-to-date cohort of patients with ISSNHL.
Methods: Patients diagnosed with ISSNHL at a tertiary referral hospital from 1994 through 2018 with sequential audiometry were studied. Case controls with sensorineural hearing loss (SNHL) were matched by age, sex, baseline hearing status, and frequency of sequential audiometry. Hearing loss progression was quantified using Kaplan–Meier (K–M) analysis to account for variable follow-up duration. A subgroup analysis was performed by age, sex, preexisting comorbidities, ISSNHL-associated symptoms, ISSNHL treatment, and degree of post-ISSNHL hearing recovery.
Results: A total of 660 patients were identified with ISSNHL. In patients with post-ISSNHL recovery to good hearing [pure tone average (PTA) <30 dB and word recognition score (WRS) > 70%], median time to progression to non-serviceable (PTA > 50 dB or WRS <50%) SNHL was 16.4 years. In patients with incomplete post-ISSNHL hearing recovery, contralateral ears were also at significantly higher risk of SNHL progression over the following 12-year period. Male sex was associated with increased risk of SNHL progression [odds ratio (OR) 3.45 male vs. female] at 5-year follow up. No other subgroup factors influenced the likelihood of SNHL progression.
Discussion and Conclusion: Patients should be counseled on continued risk to long-term hearing after stabilization of hearing post-ISSNHL, with particular emphasis on greater risk to the contralateral ear in those with incomplete ipsilateral recovery.

背景与引言：特发性突发性感音神经性听力损失（Idiopathic sudden sensorineural hearing loss, ISSNHL）以起病迅速、多为单侧受累、恢复程度不一为特征。本项病例对照观察性研究旨在通过序贯听力测听，对特发性突发性感音神经性听力损失患者发病后的长期听力损失进展情况进行客观表征，以优化患者咨询服务，本次研究纳入了迄今为止规模最大的特发性突发性感音神经性听力损失患者队列。
研究方法：纳入1994年至2018年间于某三级转诊医院确诊为特发性突发性感音神经性听力损失、且接受过序贯听力测听的患者作为研究对象。以感音神经性听力损失（sensorineural hearing loss, SNHL）患者作为病例对照，按照年龄、性别、基线听力状态、序贯听力测听频率进行匹配。采用Kaplan–Meier（K–M）分析量化听力损失进展情况，以校正随访时长的异质性。根据年龄、性别、基础合并症、特发性突发性感音神经性听力损失相关症状、治疗方案以及患侧听力恢复程度进行亚组分析。
研究结果：本研究共纳入660例特发性突发性感音神经性听力损失患者。在患侧听力恢复至良好水平[纯音听阈均值（pure tone average, PTA）<30 dB且言语识别率（word recognition score, WRS）>70%]的患者中，进展至非实用型感音神经性听力损失（纯音听阈均值>50 dB或言语识别率<50%）的中位时间为16.4年。在患侧听力恢复不完全的患者中，对侧耳在后续12年随访期间发生感音神经性听力损失进展的风险也显著升高。5年随访时，男性发生感音神经性听力损失进展的风险较女性更高[优势比（odds ratio, OR）=3.45]。其余亚组因素均未对感音神经性听力损失进展的可能性产生显著影响。
讨论与结论：临床医师应向患者告知，特发性突发性感音神经性听力损失患侧听力稳定后，仍存在长期听力受损的风险，尤其需重点向患侧听力恢复不完全的患者强调，其对侧耳的发病风险更高。