Sudden Sensorineural Hearing Loss In Children:Clinical Characteristics,Etiology,Treatment Outcomes And Prognostic Factors

Objective: To investigate the clinical characteristics,etiology,treatment outcomes and prognostic factors of sudden sensorineural hearing loss(SSNHL)in children to guide the clinical diagnosis and treatment of SSNHL in the pediatric population.Methods: This study retrospectively analyzed the clinical data of 25 pediatric patients(<18 years old)diagnosed with sudden deafness in the Department of Otolaryngology,Head and Neck Surgery,Tongji Hospital,Huazhong University of Science and Technology from November 2011 to December 2017.Patients' age,gender,side of involvement,the timing of treatment initiation,pure-tone audiometry at admission and discharge,tinnitus,vertigo,ear fullness,and laboratory tests including viral panels(CMV,RV,HSV I and II type),autoimmune(C3,C4),antinuclear antibody(ANA),erythrocyte sedimentation rate(ESR),coagulation function(FIB,APTT),blood viscosity,fasting blood glucose,neutrophil count and lymphocyte count ratio(NLR),imaging including CT and MRI of middle ear or internal auditory canal and the treatment effects were analyzed.Data were compared with 149 cases of adult SSNHL patients hospitalized during the same period.Results: Unilateral SSNHL was common in 96.0% children and 93.29% adults.Unilateral sudden deafness was more common in children in the right ear(P = 0.047).There was no significant difference in SSNHL incidence between children and adults in terms of gender,treatment time,hearing threshold classification and hearingthreshold curve,tinnitus,vertigo,ear fullness(P > 0.05).Recent or previous viral infection rates(81.8%)and fasting blood glucose level(5.23 + 1.47 mmol/L)in children with SSNHL were lower than those in adult SSNHL patients(P = 0.033,P =0.033).Autoimmune abnormalities(90.0%)and plasma fibrinogen abnormalities(27.3%)were higher in children with SSNHL than those in adult SSNHL patients(40.0%,8.8%,respectively,P < 0.05).The recovery rate in children(38.4%)with SSNHL is comparable to that in adults(22.6%),but children have a higher complete rate compared to adults(26.9%,11.3%,respectively,P < 0.05).There were no significant differences in terms of gender,affected side,treatment timing,tinnitus,vertigo,stuffy ears,initial hearing threshold grade and prognosis in children with SSNHL(P > 0.05).Children with a profound audiometric curve had a worse prognosis in comparison to other types of audiometric curves(P = 0.041).Conclusions: SSNHL is most commonly unilateral.In children with unilateral SSNHL the right ear was the most affected.The most common past or recent viral infections in children with SSNHL are cytomegalovirus(CMV),rubella virus(RV)and herpes simplex virus(I and II).Children with SSNHL have a lower rate of viral infection in comparison to adults with SSNHL.Fasting blood glucose levels,complement C3,C4,and fibrinogen may be closely related to childhood SSNHL.The recovery rate in children with SSNHL is comparable to that in adults,but children have a higher complete rate compared to adults.A profound hearing curve is an unfavorable prognostic factor in both children and adults with SSNHL.Gender,affected side,timing of treatment,grade of initial hearing loss,tinnitus,vertigo and ear fullness are not related to the prognosis SSNHL in children.