Scoring System for Predicting No Hearing Recovery in Unilateral Idiopathic Sudden Sensorineural Hearing Loss

Eka Dian Safitri, Kuntjoro Harimurti, Respati W Ranakusuma, Widayat Alviandi, Jenny Bashiruddin, Ary I Safitri


Background: The varying degrees of hearing recovery in idiopathic sudden sensory neural hearing loss (ISSHL) patients indicate the need of model to predict no hearing recovery. We aimed to aid in the counseling of ISSHL patients about their recovery chances by developing a simple clinical scoring system to predict no hearing recovery using clinical information available at first visit. Methods: A retrospective cohort study, using medical records was conducted from January 2017-May 2019 in Cipto Mangunkusumo General Hospital and Proklamasi Ear, Nose, Throat, Head and Neck (ENT-HN) Surgery Specialized Hospital in Jakarta, Indonesia. The outcome measure is no hearing recovery and we built the prediction score developed based on multiple logistic regression analyses and tested for discriminative ability. There were 183 adults unilateral ISSHL patients included in the study. Results: The proportion of no hearing recovery was 56%. The independent predictors were older age 30-60 years and >60 years old (Odds Ratio 4.0; 95% CI 1.4-11.8; p=0.012 and OR 5.3; 95% CI 1.5-18.4; p=0.008, respectively) as compared with 18-<30 years old, later onset (onset 15-60 days and >60 days had OR 5.4; 95% CI 1.7-16.9; p=0.004 and OR 12.6; 95% CI 2.9-54.6; p=0.001, respectively, as compared with onset < 3 days), and presence of vertigo (OR 2.3; 95% CI 1.1-4.6; p=0.026). Prediction scores ranged from 3 to 12, with three categories for age, four for onset, and two for the presence of vertigo. The predictions showed adequate calibration and good discriminative ability (AUC 0.77). Conclusion:Using information of age, onset and presence of vertigo at first visit, ISSHL patient with increased risk of no hearing recovery can be identified with moderate accuracy. This prediction model could help clinician in predicting patients’ prognosis.



idiopathic sudden sensory neural hearing loss; score system; no hearing recovery


Stachler RJ, Chandrasekhar SS, Archer SM, et al. Clinical practice guideline: Sudden hearing loss. Otolaryngol Neck Surg [Internet]. 2012 [cited 2018 Dec 9];146(1S):1–35. Available from:

Alexander TH, Harris JP. Incidence of sudden sensorineural hearing loss. Otol Neurotol. 2013;34(9):1586–9.

Ding X, Zhang X, Huang Z, plasticity XF-N, 2018 undefined. The characteristic and short-term prognosis of tinnitus associated with sudden sensorineural hearing loss. HindawiCom [Internet]. 2018;2018. Available from:

Hikita-Watanabe N, Kitahara T, Horii A, Kawashima T, Doi K, Okumura SI. Tinnitus as a prognostic factor of sudden deafness. Acta Otolaryngol. 2010;130(1):79–83.

Michiba T, Kitahara T, Hikita-Watanabe N, et al. Residual tinnitus after the medical treatment of sudden deafness. Auris Nasus Larynx [Internet]. 2013;40(2):162–6. Available from:

Wei BPC, Stathopoulos D, O’Leary S. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev. 2013;2013(7).

Filipo R, Attanasio G, Russo FY, Viccaro M, Mancini P, Covelli E. Intratympanic steroid therapy in moderate sudden hearing loss: A randomized, triple-blind, placebo-controlled trial. Laryngoscope. 2013;123(3):774–8.

Crane RA, Camilon M, Nguyen S, Meyer TA. Steroids for treatment of sudden sensorineural hearing loss: A meta-Analysis of randomized controlled trials. Laryngoscope. 2015;125(1):209–17.

Eftekharian A, Amizadeh M. Pulse steroid therapy in idiopathic sudden sensorineural hearing loss: A randomized controlled clinical trial. Laryngoscope. 2016;126(1):150–5.

Han X, Yin X, Du X, Sun C. Combined intratympanic and systemic use of steroids as a first-line treatment for sudden sensorineural hearing loss: A meta-analysis of randomized, controlled trials. Otol Neurotol. 2017;38(4):487–95.

Rauch S. Clinical practice. Idiopathic sudden sensorineural hearing loss. N Engl J Med. 2008;359:833–40.

Ryu IY, Park SH, Park EB, Kim HJ, Kim SH, Yeo SG. Factors prognostic of season-associated sudden sensorineural hearing loss: A retrospective observational study. J Audiol Otol. 2017;21(1):44–8.

Yu H, Li H. Association of vertigo with hearing outcomes in patients with sudden sensorineural hearing loss a systematic review and meta-analysis. JAMA Otolaryngol - Head Neck Surg. 2018;144(8):677–83.

Lee HY, Kim DK, Park YH, Cha WW, Kim GJ, Lee SH. Prognostic factors for profound sudden idiopathic sensorineural hearing loss: a multicenter retrospective study. Eur Arch Oto-Rhino-Laryngology. 2017;274(1):143–9.

Brian C. J. Moore. The Psychophysics of Tinnitus. In: Jos J. Eggermont F-GZ, Arthur N. Popper RRF, editors. New York: Tinnitus, Springer Science, Business Media New York; 2012. p. 189–211.

American Speech-Language-Hearing Association (n.d.). Hearing loss in adults (Practice Portal) [Internet]. /Practice-Portal/Clinical-Topics/Hearing-Loss/. [cited 2021 Dec 10]. Available from:

Xie Y, Orabi NA, Basura GJ, Zwolan TA. Outcomes of unilateral idiopathic sudden sensorineural hearing loss : Two decades of experience. 2019;693–702.

Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA. Declining prevalence of hearing loss in US adults aged 20 to 69 years. JAMA Otolaryngol - Head Neck Surg. 2017;143(3):274–85.

Chen C, Shi G, He M, et al. Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study. Acta Otolaryngol [Internet]. 2019;139(11):959–65. Available from:

Čvorović L, Eric D, Probst R, Hegemann S. Prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss. Otol Neurotol. 2008;29(4):464–9.

Anyah A, Mistry D, Kevern E, Markiewicz K. Idiopathic sudden sensorineural hearing loss: average time elapsed before presentation to the otolaryngologist and effectiveness of oral and/or intratympanic steroids in late presentations. Cureus. 2017;9(12).

Nosrati-Zarenoe R. Idiopathic sudden sensorineural hearing loss: corticosteroid treatment, the diagnostic protocol and outcome. Medicine. 2011.

Tabuchi K, Nishimura B, Tanaka S, Hayashi K, Hirose Y, Hara A. Ischemia-reperfusion injury of the cochlea: pharmacological strategies for cochlear protection and implications of glutamate and reactive oxygen species. Current Neuropharmacology. 2010;8.

Tabuchi K, Kusakari J, Ito Z, Takahashi K, Wada T, Hara A. Effect of nitric oxide synthase inhibitor on cochlear dysfunction induced by transient local anoxia. Acta Otolaryngol. 1999;119(2):179–84.

Park HM, Jung SW, Rhee CK. Vestibular diagnosis as prognostic indicator in sudden hearing loss with vertigo. Acta Oto-Laryngologica. 2001;Suppl;80–3.

Murofushi T, Barbara M, Li H, Yu H. Vestibular dysfunctions in sudden sensorineural hearing loss: A systematic review and meta-analysis. 2018 [cited 2020 Jan 6];9:45. Available from:

Niu X, Zhang Y, Zhang Q, et al. The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss. Acta Otolaryngol. 2016;136(3):225–31.

Korres S, Stamatiou GA, Riga M, Xenelis J. Prognosis of patients with idiopathic sudden hearing loss: Role of vestibular assessment. J Laryngol Otol. 2011;125(3):251–7.

Menezes AS, Ribeiro D, Lima A, Miranda D, Guimarães J, Dias L. SCORE risk scale as a prognostic factor after sudden sensorineural hearing loss. Eur Arch Oto-Rhino-Laryngology [Internet]. 2019;276(10):2739–45. Available from:

Wang C Te, Huang TW, Kuo SW, Cheng PW. Correlation between audiovestibular function tests and hearing outcomes in severe to profound sudden sensorineural hearing loss. Ear Hear. 2009;30(1):110–4.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.