Clinical Study of Gadolinium-Enhanced Inner Ear Magnetic Resonance Imaging for the Prognosis of Idiopathic Sudden Sensorineural Hearing Loss
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Published on: February 21, 2018
Heng Xiao1,2,3,4, Qinrong Huang2, Zheming Fang5
1Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Background:
To investigate the clinical features of patients with and without endolymphatic hydrops (EH) under idiopathic sudden sensorineural hearing loss (ISSNHL) and to evaluate the predictive value of gadolinium (Gd)-enhanced inner ear magnetic resonance imaging (MRI) in the prognosis of ISSNHL.
Methods:
Seventy ISSNHL patients were enrolled, of whom 15 (21.4%) were identified with EH via Gd-enhanced MRI. Using 1 : 1 nearestneighbor propensity score matching (PSM) based on age, sex, and body mass index (BMI), 13 matched pairs (n=26) were generated for adjusted analysis. Factors influencing hearing recovery were analyzed by univariate and multivariate analysis.
Results:
After adjusting for age, sex, and BMI using PSM, the EH group demonstrated significantly higher bilirubin levels (P=.044) and a markedly lower hearing recovery rate (P=.030) compared to the non-EH group. Univariate analysis identified that older age (P=.013), certain audiogram curve types (P=.024), a higher (poorer) initial hearing threshold (P=.002), and a positive finding on Gd-enhanced inner ear MRI (presence of EH) (P =.015) were negatively associated with hearing recovery. Multivariate logistic regression indicated that the presence of EH on MRI (odds ratio [OR]=9.80, P=.048) and increasing age (OR=0.95 per year, P=.041) were independently associated with a lower likelihood of hearing recovery.
Conclusion:
The significantly poorer hearing recovery in EH patients, even after adjusting for demographics, strengthens the evidence for EH as a negative prognostic factor. Consequently, Gd-enhanced inner ear MRI, which reliably detects EH, could serve as a novel prognostic biomarker. This tool aids in early risk stratification, identifying patients who may benefit from more aggressive or alternative treatment strategies, thereby potentially guiding a more personalized management approach for ISSNHL.
