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Inpatient treatment of idiopathic sudden sensorineural hearing loss in Thuringia: a population-based study
18 April 2018 (online)
Objectives: The clinical guideline on idiopathic sudden sensorineural hearing loss (ISSNHL) from 2010 already dramatically changed the indication for inpatient treatment for ISSNHL. The inpatient treatment of ISSNHL in the following years was analyzed.
Material and Methods:
A retrospective population-based study in Thuringia in 2011 and 2012 was performed on all 490 inpatients treated for ISSNHL (51% females, median age: 60 years. The association between analyzed parameters and the probability of recovery was tested using univariable and multivariable statistics.
The inpatient treatment rate for ISSNHL with prednisolone was 11.23 per 100,000. 172 patients (35%) had an outpatient treatment prior to inpatient treatment. The initial prednisolone dosage varied from 100 – 500 mg. For pure-tone audiometry (PTA) of the three most affected frequencies (3PTAmax), the initial median hearing loss was 66.67 dB, the median absolute hearing gain ΔPTAabs was 10.0 dB, and the median relative hearing gain in relation to the contralateral side ΔPTArel contral was 30.86%. Half of the patients (51%) reached a ΔPTAabs of ≥10 dB. Only 2 of 5 patients recovered to a ΔPTArel contral ≥50% or reached ≤10 dB of contralateral ear. The multivariate analysis revealed that an ISSNHL on the left side (Hazard ratio [HR)= 1.6.88; confidence interval [CI]= 1.161 – 2.454), no down-sloping audiogram type (HR = 2.016; CI = 1.391 – 2.921), and no prior outpatient prednisolone treatment (HR = 2.374; CI = 1.505.-3.745) were independent factors associated with better recovery (ΔPTAabs ≥10 dB).
The population-based recovery rate was much worse than reported in clinical trials. More standardization and clearer criteria for outpatient therapy, inpatient therapy and salvage therapy are needed.