ABSTRACT
Objective. Our aim was to explore the relationship between vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss.
Data Source. Eligible studies were identified from the “PubMed”, “EMBASE”, and “Web of Science” databases from January 2000 to September 2023.
Study Selection. Studies were selected from all original and retrospective or prospective studies that focused on the relationship between vertigo and hearing prognosis in patients with sudden sensorineural hearing loss.
Data Extraction and Synthesis. Observational metrics for data extraction included type of study, number of subjects with or without vertigo, treatment regimen, definition of pure tone hearing thresholds, criteria for hearing improvement, treatment duration, follow-up time, and age distribution of subjects. Meta-analysis was performed using Stata 15 software.
Main Outcome and Measure. Association of vertigo symptoms and the prognosis of hearing indicators in patients with sudden sensorineural hearing loss.
Results. A total of 4290 patients with sudden sensorineural hearing loss were identified in 23 studies. The hearing recovery rate was 40.8% in the group with vertigo and 53.76% in the group without vertigo. Vertigo was significantly associated with poorer hearing recovery (OR = 2.13; 95% CI, 1.63-2.79; I2 = 68.3%). Subgroup analyses revealed similar results for medication (OR=2.65; 95% CI, 1.84-3.83; I2 = 50.8%). However, an attenuated association between vertigo and the prognosis of sudden sensorineural hearing loss was observed in the subgroups treated with drugs combined with hyperbaric chambers (OR= 1.76; 95% CI, 0.75-4.15; I2 = 84.9%) and drugs combined with intratympanic injections (OR= 1.62; 95% CI, 1.02-2.58; I2 = 65.6%).
Conclusions and Relevance. Our study suggested that vertigo may be a negative factor in sudden sensorineural hearing loss.Based on the results of the subgroup analysis,the combined treatment regimen has better efficacy in patients with sudden sensorineural hearing loss with vertigo.
Keywords. Sudden sensorineural hearing loss, ISSNHL, vertigo, steroid, intratympanic injection, hyperbaric oxygen chamber, meta-analysis
INTRODUCTION
Sudden sensorineural hearing loss(SSHL)referred to a 72-hour hearing loss of 30 dB at least, in 3 consecutive frequencies within a period of 72 hours. The etiology of most cases is unknown, and 71% of cases are categorized as idiopathic[1]. In addition, the underlying pathologic mechanisms are not fully understood, and currently proposed hypotheses include viral infections, microcirculatory disorders, and autoimmune diseases[2]. The ambiguous etiology has led to a failure to develop uniform standards for its treatment options. The heterogeneity of sudden sensorineural hearing loss itself has led to discussions focused on treatment options and the prognosis of this disease being fraught with contradictions.
One way to characterize vertigo is as a feeling of movement, usually with rotation. It is considered a sign of vestibular impairment[3]. Among the discussions of SSHL, vertigo is widely reported to be a negative predictor of hearing recovery[4]. One possible hypothesis is that vertigo is due to disease of the vestibular portion of the inner ear. SSHL with vertigo has a worse prognosis in patients in whom the inner ear vestibule and cochlea are involved than in patients with only cochlear involvement and sudden sensorineural hearing loss without vertigo[5]. However, at the same time, some researchers hold the opposite opinion: they do not consider vertigo a sign of poor prognosis for SSHL and believe that vertigo is not significantly related to hearing recovery[6-8].
To verify whether vertigo is a poor prognostic sign of SSHL, in 2018, YU et al. reported their meta-analysis of the literature related to SSHL. The literature included 10 studies involving 4814 patients suffering from SSHL. These authors found that vertigo was obviously connected with poorer hearing recovery (OR=2.22; 95% CI, 1.54-3.20; I2 = 74%) [9]. This report seems to argue what everyone expected before, but it does not represent a definitive conclusion. With the passage of 5 years, research on SSHL has improved, and interventions involving the Intratympanic injection of steroid hormones (ICs) and hyperbaric oxygen chamber therapy (HBOT) for treating SSHL have gained increasing amounts of attention. Therefore, our research group conducted an update of the meta-analysis of Yu et al. taking into account these new studies.
METHODS
This study was reported in accordance with the PRISMA (2020)[10] statement and was successfully registered on the Systematic Evaluation Register (CRD42024496989).