Sudden sensorineural hearing loss in children: clinical characteristics and age-related prognosis

Abstract

Background and objectives: Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there are few studies on SSNHL in the pediatric population

research on treatment and prognosis in this area is limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children with SSNHL. Methods: A retrospective review of medical records of 67 pediatric patients (67 ears) in three hospitals of Seoul National University from January 2005 to August 2016 was performed to analyze patients' clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1 mg/kg), and intratympanic steroid injection was done in 17 patients. Audiologic evaluation was carried out after treatment according to Siegel's criteria, and hearing recovery was defined as complete recovery and partial recovery. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescent group (age > 12 years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to hearing recovery, and evaluation was made regarding possible prognostic factors. Results: The recovery rate in the 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescent group (p=0.038). While presence of vertigo did not significantly correlate with prognosis (p=0.430), presence of tinnitus was significantly associated with hearing recovery (p=0.007). Audiologic assessment revealed that a low initial hearing threshold, high speech discrimination score and descending type of audiogram were positively associated with hearing recovery (p=0.002, p=0.003 and p=0.029, respectively). The route of steroid administration was not significantly related to prognosis (p=0.205), and intratympanic steroid injection had no significant effect on treatment outcome (p=0.187). Cochlear enhancement on magnetic resonance imaging was found in 6 patients among 45 patients who had inner ear magnetic resonance imaging. Conclusion: The childhood group had worse treatment outcomes than the adolescent group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.