Prognostic value of initial hearing threshold and accompanying symptoms in pediatric sudden sensorineural hearing...

To evaluate the prognostic value of initial hearing threshold, accompanying symptoms, and systemic inflammatory indices in pediatric sudden sensorineural hearing loss (SSNHL), and explore whether these associations differ by age.

This retrospective cohort included 212 children with SSNHL treated between July 2015 and August 2025. Hearing recovery was classified as recovered or non-recovered. Multivariable logistic regression assessed age, sex, initial hearing threshold, time to treatment, tinnitus, vertigo, ear fullness, and hematological indices. Prespecified exploratory analyses compared children aged ≤6 years with those aged >6 years. Sensitivity analysis excluded 15 patients assessed exclusively by auditory brainstem response.

Overall, 120 patients (56.6%) recovered. A lower initial hearing threshold was independently associated with recovery in both clinical and fully adjusted models (adjusted odds ratio per 1-dB HL increase, 0.981; 95% CI, 0.969-0.995; P = 0.006 and 0.982; 95% CI, 0.969-0.995; P = 0.009, respectively). Time to treatment, accompanying symptoms, and NLR, PLR, LMR, and SII were not independently associated with recovery. In age-stratified analyses, initial hearing threshold remained significant in children aged >6 years but not in those aged ≤6 years; however, the threshold-by-age interaction was not significant (P = 0.616). Sensitivity analysis yielded consistent findings.

Initial hearing threshold was the principal independent prognostic factor for recovery in this pediatric cohort. Accompanying symptoms and systemic inflammatory indices provided little additional prognostic information. Age-stratified findings require cautious interpretation and prospective validation.