Analysis Of Clinical Characteristics,Prognosis,and Their Influencing Factors Of Patients With Sudden Sensorineural Hearing Loss And Age-related Hearing Loss

Objective:To explore the clinical characteristics,prognosis,and their influencing factors,and provide the basis for the individualized prevention and treatment of elderly patients with sudden sensorineural hearing loss(SSNHL)and age-related hearing loss(ARHL)by the retrospective analysis of hospitalized cases aged over 60 years old in the department of Otorhinolaryngology,Head and Neck Surgery of the Affiliated Hospital of Southwest Medical University from January 2014 to December 2022.Methods:1.Clinical data and grouping.222 elderly patients aged 60～83 years with sudden hearing loss were analyzed retrospectively in the Affiliated Hospital of Southwest Medical University from January 2014 to December2022.Patients were divided into ARHL and SSNHL(n=105),and Elderly with SSNHL groups(n=117).The clinical data of two groups were collected.2.Research contents.The differences in gender,ear orientation,concomitant symptoms such as tinnitus,stuffiness and vertigo,hospitalizing time,degree of hearing loss,clinical type,concomitant chronic diseases such as hypertension and diabetes,blood routine,and blood lipids were compared between ARHL and SSNHL,and elderly with SSNHL groups.Finally,the clinical characteristics,prognosis,and their influencing factors were analyzed in ARHL and SSNHL group.3.Statistical methods.SPSS 27.0 software was applied for data analysis.The measurement data were described by median(lower and upper quartile).Moreover,the Mann-Whitney U rank sum and Kruskal-Wallis test was used respectively for two independent samples,and three or more groups.Meanwhile,the count data for non-hierarchical categories were described as the number of cases and percentages(%),and analyzed by chi-square test.On the other hand,the Mann-Whitney U and Kruskal-Wallis test was used respectively for the rank data of 2,and 3 or more groups.Finally,Spearman’s rank correlation was used for correlation analysis.P<0.05 was defined as statistical significance for all tests.Results:1.The general clinical data.First,there were 58(55.2%)and61(52.1%)males,47(44.8%)and 56 females(47.9%)respectively in ARHL and SSNHL,and elderly with SSNHL group.Second,there were 45(42.8%)and 52(44.4%),60(57.1%)and 65(55.6%)respectively in the right and left ear of ARHL and SSNHL,and elderly with SSNHL groups.Third,there were68(64.8%)and 79(67.5%),37(35.2%)and 38(32.5%)respectively at up to and more than 7 days for the hospitalizing time of ARHL and SSNHL,and elderly with SSNHL groups.Finally,there were no statistical differences between the two groups in the gender(X~2=0.214,P=0.644),ear orientation(X~2=0.057,P=0.812),and hospitalizing time(X~2=0.188,P=0.664).2.The concomitant symptoms and chronic diseases.There were 80(76.2%)and 96(82.1%),32(30.5%)and 36(30.8%),and 41(39.0%)and 44(37.6%)cases respectively with tinnitus,ear stuffiness and vertigo in ARHL and SSNHL,and elderly with SSNHL groups.Furthermore,There were 19(18.1%)and 27(23.1%),and 38(36.2%)and 36(30.8%)patients respectively with diabetes and hypertension in ARHL and SSNHL,and elderly with SSNHL groups.Finally,there were statistical differences between the two groups in tinnitus(X~2=1.157,P=0.282),ear stuffiness(X~2=0.002,P=0.962),vertigo(X~2=0.049,P=0.825),and no statistical differences in hypertension(X~2=0.372,P=0.392)and diabetes(X~2=0.836,P=0.361).3.The clinical classification.There were 1(1.0%)and 4(3.4%),13(12.4%)and 12(10.3%),61(58.1%)and 45(38.5%),and 30(28.5%)and 56(47.8%)cases respectively for low-frequency descending,high-frequency descending,flat descending,and total deafness types in ARHL and SSNHL,and elderly with SSNHL groups.Moreover,there was a statistical difference between the two groups in clinical classification(Z=-2.277,P=0.023).On one hand,the flat descending type was the main classification,followed by total deafness,high-and low-frequency descending types in ARHL and SSNHL group.On the other hand,the main classification was total deafness type,followed by flat,high-and low-frequency descending types in the elderly with SSNHL group.4.The degree of hearing loss.There were 4(3.8%)and 4(3.4%),28(26.7%)and 29(24.8%),42(40.0%)and 26(22.2%),and 31(29.5%)and 58(49.6%)cases respectively for mild,moderate,severe and extremely severe hearing loss in ARHL and SSNHL,and elderly with SSNHL groups.And there was a statistical significance between the two groups in the degree of hearing loss(Z=-2.122,P=0.034).5.The prognosis.There were 17(16.2%)and 10(8.5%),22(20.1%)and 16(13.7%),21(19.0%)and 27(23.1%),and 45(43.8%)and 64(54.7%)respectively for cured,significantly effective,effective,and ineffective in ARHL and SSNHL,and elderly with SSNHL groups.Moreover,and the total effective rate was 56.2%and 45.3%respectively in the two groups,and there was no statistical difference between the two groups in the total efficacy(X~2=6.194,P=0.103).6.The blood routine-related indicators.There were no statistical differences in WBC(Z=-0.436,P=0.663),NEU(Z=-1.483,P=0.138),LYM(Z=-0.804,P=0.422),MONO(Z=-0.273,P=0.887),and PLT(Z=-1.681,P=0.093)between ARHL and SSNHL,and elderly with SSNHL groups.7.The blood lipid levels.There were no statistical differences in TC(Z=-0.500,P=0.613)and TG(Z=-0.356,P=0.772)between ARHL and SSNHL,and elderly with SSNHL groups.8.The influencing factors for degree of hearing loss in ARHL and SSNHL group.The statistical results showed that there was no significant correlation between the degree of hearing loss,and WBC(r_s=-0.036,P=0.715),NEU(r_s=-0.111,P=0.260),LYM(r_s=-0.102,P=0.299),MONO(r_s=0.059,P=0.551),PLT(r_s=-0.060,P=0.542),NLR(r_s=-0.082,P=0.405),PLR(r_s=-0.026,P=0.790),TC(r_s=-0.154,P=0.116)and TG(r_s=-0.180,P=0.066)respectively.9.The influencing factors for clinical classification in ARHL and SSNHL group.From the statistical results,there was no significant correlation between the clinical classification,and WBC(r_s=0.057,P=0.516),NEU(r_s=-0.037,P=0.708),LYM(r_s=-0.053,P=0.589),MONO(r_s=0.064,P=0.517),PLT(r_s=0.110,P=0.265),NLR(r_s=-0.073,P=0.458),PLR(r_s=0.129,P=0.189),TC(r_s=-0.121,P=0.217)and TG(r_s=-0.166,P=0.090)respectively.10.The effect of general data on the prognosis of ARHL and SSNHL group.First,there were 35(58.3%)and 23(51.1%)males and 25(41.7%)22(48.9%)females in the total effective and ineffective groups.Second,there were 24(40.0%)and 21(46.7%),36(60.0%)and 24(53.3%)respectively in the right and left ear of two groups.Third,there were 47(78.3%)and 21(46.7%),and 13(21.7%)and24(53.3%)at up to and more than 7 days for the hospitalizing time of the total effective and ineffective groups.There were no statistical differences in the gender(X~2=0.542,P=0.461)and ear orientation(X~2=0.467,P=0.495),and was statistical significance in the hospitalizing time(X~2=11.299,P<0.001)between the total effective and ineffective groups.By Spearman’s rank correlation analysis,the hospitalizing time was negatively correlated with prognosis(r_s=-0.273,P=0.005).11.The effects of concomitant symptoms and chronic diseases on the prognosis of ARHL and SSNHL group.There were 45(75.0%)and 35(77.8%),19(31.7%)and 13(28.9%),and 18(30.0%)and 23(51.1%)cases respectively with tinnitus,ear stuffiness and vertigo in the total effective and ineffective groups.At the same time,there were 25(41.7%)and 13(28.9%),and 9(15.0%)and 10(22.2%)cases respectively with hypertension and diabetes in two groups.And there were no statistical differences in tinnitus(X~2=0.109,P=0.741),ear stuffiness(X~2=0.094,P=0.760),hypertension(X~2=1.819,P=0.178)and diabetes(X~2=0.905,P=0.341),and was statistical significance in vertigo(X~2=4.815,P=0.028)in the total effective and ineffective groups.12.The effect of the degree of hearing loss on the prognosis of ARHL and SSNHL group.There were 50.0%,29.6%,57.1%,and 83.9%,and 50%,71.4%,42.9%,and 16.1%respectively for the mild,moderate,severe and extremely severe hearing loss in total effective and ineffective groups.From Mann-Whitney U test results,there was a statistical significance in degree of hearing loss(Z=-4.095,P<0.001)between groups.13.The effect of blood routine-related indexes on the prognosis of ARHL and SSNHL group.The Kruskal-Wallis test showed that there were no statistical differences in WBC(H=9.662,P=0.053),NEU(H=5.295,P=0.151),LYM(H=1.555,P=0.670),MONO(H=1.091,P=0.779),PLT(H=4.274,P=0.236),NLR(H=1.131,P=0.770)and PLR(H=4.894,P=0.180)of different efficacy groups.Meanwhile,the Mann-Whitney U test results showed that there were statistical differences in WBC(Z=-3.069,P=0.002)and NEU(Z=-2.276,P=0.023)counts,and no statistical differences in LYM(Z=-0.774,P=0.439),MONO(Z=-1.007,P=0.314),PLT(Z=-1.276,P=0.202),PLR(Z=-0.560,P=0.575)and NLR(Z=-1.030,P=0.303)between the total effective and ineffective groups.By Spearman’s rank correlation analysis,the prognosis were negatively correlated with WBC(r_s=-0.301,P=0.002)and NEU(r_s=-0.223,P=0.022).And LYM(r_s=-0.076,P=0.442),MONO(r_s=-0.099,P=0.316),PLT(r_s=-0.125,P=0.204),NLR(r_s=-0.101,P=0.305),and PLR(r_s=-0.055,P=0.578)were not significantly correlated with the prognosis.14.The effect of blood lipids on the prognosis of ARHL and SSNHL group.The Kruskal-Wallis test results showed that there were no statistical differences in TC(H=6.872,P=0.076)and TG(H=4.098,P=0.251)levels of the different efficacy groups.However,from the Mann-Whitney U test results,there was a statistical difference in TC(Z=-2.007,P=0.045),and no statistical significance in TG(Z=-1.292,P=0.196)level between the total effective and ineffective groups.Moreover,TC(r_s=-0.197,P=0.044)was negatively correlated,and TG(r_s=-0.127,P=0.198)was not significantly correlated with prognosis by Spearman’s rank correlation analysis.Conclusion:1.The main classification was total deafness type,and the main degree of hearing loss was severe in patients with ARHL and SSNHL.2.There was a higher incidence rate of vertigo in patients with ARHL and SSNHL.3.Inflammatory indexes and blood lipids levels were not correlated with the degree of hearing loss and clinical classification in patients with ARHL and SSNHL.5.There were some influencing factors such as the hospitalizing time,vertigo,degree of hearing loss,white blood cells,neutrophils,and total cholesterol in the prognosis.And the hospitalizing time,white blood cells,neutrophils and total cholesterol were negatively correlated with the prognosis of patients with ARHL and SSNHL.