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Cited by 9Vestibular and auditory disordersHearing, Cochlea, Tinnitus, GeneticsHearing Loss and Rehabilitation

Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review

Open access
Jeon, So Young, Kang, Dae Woong, Kim, Sang Hoon, Byun, Jae Yong, Yeo, Seung Geun·2022·Journal of Clinical Medicine
DOI 10.3390/jcm11051453PMC PMC8910997
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Abstract

Although idiopathic sudden sensorineural hearing loss (ISSNHL) is uncommon, recurrent ISSNHL is even rarer. The knowledge about factors associated with patient recovery from recurrent episodes is needed to counsel and treat the patients. Medical records of patients admitted for high dose oral steroid therapy for recurrent ISSNHL between January 2009 and December 2021 were reviewed. Their demographic and clinical characteristics, co-morbid symptoms, and audiologic results were analyzed. The 38 patients admitted for treatment of recurrent ISSNHL included 14 men and 24 women. Recovery rates after the first and recurrent episodes of ISSNHL were 78.9% and 63.2%, respectively. Patients who recovered after recurrent episodes showed significantly higher rates of ear fullness symptoms and early treatment onset than those who did not recover (p < 0.05 each). Of the 30 patients who recovered after the first episode, those who had ear fullness symptoms (p < 0.05, odds ratio (OR) 0.1, 95% confidence interval (CI) 0.01–0.76) and who showed a lower initial hearing threshold (p < 0.05, OR 1.06, 95% CI 1.01–1.12) during the recurrent episode showed significantly better or similar recovery than after the first episode. Ear fullness symptoms and less initial hearing loss were associated with a more favorable prognosis after intial than after recurrent ISSNHL.

AI snapshot

Written from the paper’s full text.

TL;DR

In 38 patients with recurrent idiopathic sudden sensorineural hearing loss (ISSNHL), recovery was 78.9% after the first episode and 63.2% after recurrence. Ear fullness and earlier treatment onset were associated with recovery after recurrence, while higher initial hearing loss predicted poorer recovery after recurrence than after the first episode.

Key findings

  • Among 38 recurrent ISSNHL patients (14 men, 24 women), 30 (78.9%) recovered after the first episode and 24 (63.2%) recovered after the recurrent episode.
  • Patients who recovered after recurrence had more frequent ear fullness (91.7% vs. 28.6%, p < 0.05), shorter treatment onset (5.6 vs. 16.7 days, p < 0.05), and shorter recovery time (1.3 vs. 3.1 months, p < 0.05) than those who did not recover.
  • Of 30 patients who recovered after the first episode, 18 (60.0%) had better or similar recovery after recurrence, while 12 (40.0%) had poorer recovery; poorer recovery was associated with less frequent ear fullness (50% vs. 88.9%, p < 0.05) and higher mean initial hearing threshold (57.2 vs. 40.1 dB, p < 0.05).
  • Adjusted analysis found ear fullness at recurrence associated with lower risk of poorer recovery (OR 0.1, 95% CI 0.01–0.76) and higher hearing loss at recurrence associated with higher risk (OR 1.06, 95% CI 1.01–1.12). The systematic review included 9 studies; reported recovery from recurrent ISSNHL ranged from 43.4% to 78.6%, and one study reported a second recurrence rate of 21.4%.

Methods

  • Retrospective review of medical records of patients admitted for high-dose oral steroid therapy for recurrent ISSNHL between January 2009 and December 2021 at Kyung-Hee Medical Center and Gang-dong Kyung-Hee Medical Center; exclusions included vertigo, chronic otitis media, middle ear surgery history, CNS disorders, tumors, or progressive sensorineural hearing loss.
  • Treatment was 1 mg/kg/day oral methylprednisolone for four days followed by tapering; hearing was assessed by daily pure-tone audiometry using the six-division method, and recovery was classified by Siegel’s criteria (complete, partial, slight, no recovery; complete/partial/slight grouped as recovery).
  • Statistical comparisons used Fisher’s exact tests and Wilcoxon rank sum tests, with multiple ordinal logistic regression adjusted for age and sex; a systematic review followed PRISMA and searched SCOPUS, PubMed, and the Cochrane Library for “recurrent sudden hearing loss” before 1 September 2021.

Limitations

  • The authors state that the study analyzed only patients with recurrent ISSNHL, lacked comparison with patients who had a single ISSNHL episode, was retrospective and may have selection bias, needed longer-term serial follow-up to classify further recurrence, and had a small sample with a higher proportion of females.
  • Evident from the text: the sample size is small (38 patients), limiting statistical power and generalizability; the systematic review identified only 9 eligible studies, and two provided recurrence-rate data rather than recovery-rate data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/jcm11051453

Cites

35 of 36 references verified1 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 43 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § 4. Discussion · p. 7

    Starting treatment after 10 days is a negative prognostic factor for ISSNHL.

    “starting treatment after 10 days is a negative prognostic factor [20]”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Edizer, 2015, Recovery of idiopathic sudden sensorineural hearing loss, J. Int. Adv. Otol. source
  • Findingown data
    § Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review · p. 1

    Higher hearing loss at the time of ISSNHL recurrence was associated with a higher risk of poorer recovery after the recurrent episode (OR 1.06, 95% CI 1.01-1.12).

    “Of the 30 patients who recovered after the first episode, those who had ear fullness symptoms ( p &lt; 0.05, odds ratio (OR) 0.1, 95% confidence interval (CI) 0.01-0.76) and who showed a lower initial hearing threshold ( p &lt; 0.05, OR 1.06, 95% CI 1.01-1.12) during the recurrent episode showed significantly better or similar recovery than after the first episode.”
    • Also stated in: § 3. Results · p. 4 · plain
      “Higher hearing loss at the time of ISSNHL recurrence was associated with a higher risk of poorer recovery after the recurrent episode ( p &lt; 0.05, OR 1.06, 95% CI 1.01-1.12).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review · p. 1

    Patients who recovered after recurrent ISSNHL had a significantly shorter time to treatment onset than those who did not recover.

    “Patients who recovered after recurrent episodes showed significantly higher rates of ear fullness symptoms and early treatment onset than those who did not recover ( p &lt; 0.05 each).”
    • Also stated in: § 3. Results · p. 3 · plain
      “the symptom of ear fullness (91.7% vs. 28.6%; p &lt; 0.05) was significantly more frequent, time to treatment onset significantly shorter (5.6 days vs. 16.7 days, p &lt; 0.05) and recovery time significantly shorter (1.3 months vs. 3.1 months, p &lt; 0.05) in patients who did rather than did not recover after the recurrent episode”
    Quote in the paperSubstantial claim
  • Findingown data
    § 4. Discussion · p. 7

    Among patients with recurrent ISSNHL in this study, those who recovered started treatment at a mean of 5.6 days, whereas those who did not recover started at a mean of 16.7 days.

    “Among patients who experienced recurrent episodes in the present study, those who recovered started their treatment at a mean 5.6 days, whereas those who did not recover started their treatment at a mean 16.7 days”
    Quote in the paperSubstantial claim
  • Findingown data
    § 3. Results · p. 4

    Following ISSNHL recurrence, none of the 23 patients who underwent temporal bone MRI scans showed evidence of cerebellopontine angle tumors.

    “Following ISSNHL recurrence, 23 patients underwent temporal bone MRI scans to rule out brain tumors or other ear abnormalities. None of these patients showed evidence of cerebellopontine angle tumors.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 30
  • May combine two claims. 17

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § 2.3. Research on Recurrent ISSNHL · p. 3

    The systematic review was performed in accordance with the PRISMA statement.

    “This systematic review was performed in accordance with the Primary Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Liberati, 2009, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration, J. Clin. Epidemiol. source

  • May combine two claims.

    Premisecitation
    § 4. Discussion · p. 8

    Older age and HTN are significant negative prognostic factors for recovery from ISSNHL.

    “Moreover, older age and HTN are significant negative prognostic factors for recovery from ISSNHL [20,32].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [20] Edizer, 2015, Recovery of idiopathic sudden sensorineural hearing loss, J. Int. Adv. Otol. source
    • cites [32] Lionello, 2015, Uni-and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss, Eur. Arch. Otorhinol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 4. Discussion · p. 8

    ISSNHL has been reported to be associated with a history of hypertension, chronic kidney disease, diabetes mellitus, hypercholesterolemia, and stroke.

    “ISSNHL has been reported to be associated with a history of hypertension (HTN), chronic kidney disease, diabetes mellitus (DM), hypercholesterolemia, and stroke [25-29].”
    Quote in the paperNot a substantial claim1 of 5 sources checked
    • cites [25] Chang, 2014, Hypercholesterolemia is correlated with an increased risk of idiopathic sudden sensorineural hearing loss: A historical prospective cohort study, Ear Hear. source
    • cites [26] Lin, 2013, Sudden sensorineural hearing loss is correlated with an increased risk of acute myocardial infarction: A population-based cohort study, Laryngoscope source
    • cites [27] Lin, 2012, Risk of developing sudden sensorineural hearing loss in diabetic patients: A population-based cohort study, Otol. Neurotol. source
    • cites [28] Lin, 2013, Increased risk of getting sudden sensorineural hearing loss in patients with chronic kidney disease: A population-based cohort study, Laryngoscope source
    • cites [29] Lin, 2008, Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up study, Stroke source

      The Results (Table 1) show that SSNHL patients had higher rates of hypertension, diabetes, and hyperlipidemia than controls. Renal disease did not differ significantly (P=0.784), and the study links SSNHL to subsequent stroke, not a history of stroke. The paper uses hyperlipidemia rather than the narrower term hypercholesterolemia. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    Several studies have reported an association between ISSNHL and DM.

    “Several studies have reported an association between ISSNHL and DM [25-29]”
    Quote in the paperNot a substantial claim1 of 5 sources checked
    • cites [25] Chang, 2014, Hypercholesterolemia is correlated with an increased risk of idiopathic sudden sensorineural hearing loss: A historical prospective cohort study, Ear Hear. source
    • cites [26] Lin, 2013, Sudden sensorineural hearing loss is correlated with an increased risk of acute myocardial infarction: A population-based cohort study, Laryngoscope source
    • cites [27] Lin, 2012, Risk of developing sudden sensorineural hearing loss in diabetic patients: A population-based cohort study, Otol. Neurotol. source
    • cites [28] Lin, 2013, Increased risk of getting sudden sensorineural hearing loss in patients with chronic kidney disease: A population-based cohort study, Laryngoscope source
    • cites [29] Lin, 2008, Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up study, Stroke source

      The Results and Table 1 report an association: diabetes was recorded in 10.1% of SSNHL patients versus 4.3% of appendectomy patients (P<0.001). However, the Study Sample and Discussion identify patients by a sudden-hearing-loss diagnosis code, without establishing that their hearing loss was idiopathic. The source therefore supports an association for SSNHL, but not specifically for ISSNHL. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 7

    Initial profound hearing loss is negatively prognostic for recovery from non-recurrent ISSNHL.

    “Initial profound hearing loss was previously shown to be negatively prognostic for recovery from non-recurrent ISSNHL [20].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Edizer, 2015, Recovery of idiopathic sudden sensorineural hearing loss, J. Int. Adv. Otol. source

      The Results (p. 2) report that patients with profound initial hearing loss had a significantly lower complete-recovery rate, supporting the negative prognostic association. The Materials and Methods (p. 1) do not say that recurrent cases were excluded or analyze non-recurrent cases separately, so the non-recurrent qualifier is not established by this study. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data
    § Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review · p. 1

    Recovery rates after the first and recurrent episodes of ISSNHL were 78.9% and 63.2%, respectively.

    “Recovery rates after the first and recurrent episodes of ISSNHL were 78.9% and 63.2%, respectively.”
    • Also stated in: § 3. Results · p. 3 · plain
      “Thirty (78.9%) patients recovered after the first episode, whereas eight (21.1%) did not. In comparison, 24 (63.2%) patients recovered after the recurrent episode, whereas 14 (36.8%) did not.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data
    § 3. Results · p. 4

    The systematic review identified 35 papers, of which 9 (25.7%) fulfilled inclusion criteria and were reviewed.

    “Using the search term 'recurrent sudden hearing loss', 35 papers were identified from the three databases. Only nine (25.7%) of these studies fulfilled the inclusion criteria and were reviewed and these are shown in Figure 1.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 3. Results · p. 4

    In most studies, the proportion of females and males was almost the same.

    “In most studies, the proportion of females and males was almost the same.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 3. Results · p. 3

    Of the 30 patients who recovered after the first episode, 18 (60.0%) showed better or similar recovery after the recurrent episode, whereas 12 (40.0%) showed poorer recovery after the recurrent rather than after the first episode.

    “Of the 30 patients who recovered after the first episode, 18 (60.0%) showed better or similar recovery after the recurrent episode, whereas 12 (40.0%) showed poorer recovery after the recurrent rather than after the first episode (Table 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § 3. Results · p. 3

    The mean age at the first episode was 48.9 years and at the recurrent episode was 52.7 years.

    “Their mean age at the first episode was 48.9 years (range 7-69 years), and their mean age at the recurrent episode was 52.7 years (range 12-76 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 3. Results · p. 3

    Recurrences were ipsilateral in 35 (92.1%) patients and contralateral in 3 (7.9%).

    “Recurrences were ipsilateral in thirty-five (92.1%) patients and contralateral in three (7.9%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given
    § 3. Results · p. 4

    Only one study reported the second recurrence rate, which was 21.4%.

    “Only one study reported the second recurrence rate, which was 21.4%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § 3. Results · p. 4

    The included studies utilized different tests and analyzed different parameters to identify prognostic factors associated with recurrent ISSNHL.

    “These studies utilized different tests, including electrocochleography (ECohG) and vestibular-evoked myogenic potential (VEMP), and analyzed different parameters, including neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), to identify prognostic factors associated with recurrent ISSNHL.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review · p. 1

    The 38 patients with recurrent ISSNHL consisted of 14 men and 24 women.

    “The 38 patients admitted for treatment of recurrent ISSNHL included 14 men and 24 women.”
    • Also stated in: § 3. Results · p. 3 · plain
      “The 38 patients consisted of 14 (36.8%) men and 24 (63.2%) women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 4. Discussion · p. 7

    None of the six patients with poorer recovery after the recurrent episode and only four of the sixteen patients without poorer recovery after the recurrent episode who presented with ear fullness showed a low tone loss pattern.

    “none of the six patients with poorer recovery after the recurrent episode and only four of the sixteen patients without poorer recovery after the recurrent episode who presented with ear fullness showed a low tone loss pattern”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation
    § 4. Discussion · p. 8

    Statistically significant factors associated with recurrence included diabetes mellitus, hypercholesterolemia, and tinnitus.

    “Those studies found that statistically significant factors associated with recurrence included diabetes mellitus, hypercholesterolemia, and tinnitus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 1. Introduction · p. 1

    Studies analyzing long-term outcomes of ISSNHL have found that recurrence rates vary widely, ranging between 0.8% and 47%.

    “Studies analyzing long-term outcomes of ISSNHL have found that recurrence rates vary widely, ranging between 0.8% and 47% [3-8].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [3] Furuhashi, 2002, Sudden deafness: Long-term follow-up and recurrence, Clin. Otolaryngol. source
    • cites [4] Psifidis, 2006, Sudden sensorineural hearing loss: Long-term follow-up results, Otolaryngol. Head Neck Surg. source
    • cites [5] Park, 2013, Clinical analysis of recurrent sudden sensorineural hearing loss, ORL source
    • cites [6] Ohashi, 2012, Electrocochleographic findings in recurrent idiopathic sudden sensorineural hearing loss, Acta Otolaryngol. source
    • cites [7] Fushiki, 2009, Recurrence rate of idiopathic sudden low-tone sensorineural hearing loss without vertigo: A long-term follow-up study, Otol. Neurotol. source
    • cites [8] Wu, 2014, Recurrence of idiopathic sudden sensorineural hearing loss: A retrospective cohort study, Otol. Neurotol. source

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § 2.1. Study Design · p. 2

    Hearing recovery was assessed using Siegel's classification.

    “Hearing recovery was assessed using Siegel's classification [13], with patients categorized as experiencing complete, partial, slight, and no recovery for both episodes of ISSNHL.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Siegel, 1975, The treatment of idiopathic sudden sensorineural hearing loss, Otolaryngol. Clin. N. Am. source

  • Classified as probably not a substantial claim.

    Premisecitation
    § 4. Discussion · p. 7

    In general, patients with ISSNHL are advised to start treatment with oral steroids within two weeks.

    “In general, patients with ISSNHL are advised to start treatment with oral steroids within two weeks [1]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Stachler, 2012, Clinical practice guideline: Sudden hearing loss, Otolaryngol. Head Neck Surg. source

  • May combine two claims.

    Interpretationown data
    § Prognostic Factors Associated with Recovery from Recurrent Idiopathic Sudden Sensorineural Hearing Loss: Retrospective Analysis and Systematic Review · p. 1

    Ear fullness symptoms and less initial hearing loss were associated with a more favorable prognosis after initial than after recurrent ISSNHL.

    “Ear fullness symptoms and less initial hearing loss were associated with a more favorable prognosis after intial than after recurrent ISSNHL.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § 3. Results · p. 4

    Multiple regression analysis for factors associated with poorer recovery after the recurrent than after the first episode was adjusted for age and sex.

    “Based on the results of preliminary simple linear regression analysis to determine the factors associated with poorer recovery after the recurrent rather than after the first episode of ISSNHL, multiple regression analysis was performed with adjustment for age and sex (Table 4).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § 2.2. Statistical Analysis · p. 3

    Factors associated with recovery were assessed by multiple ordinal logistic regression analysis, adjusted by age and sex.

    “Factors associated with recovery were assessed by multiple ordinal logistic regression analysis, adjusted by age and sex.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    Both NLR and PLR were found to be higher in patients experiencing both the first and recurrent episodes of ISSNHL than in a normal control group.

    “Both the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were found to be higher in patients experiencing both the first and recurrent episodes of ISSNHL than in a normal control group [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Seo, 2015, Predictive value of neutrophil to lymphocyte ratio in first-time and recurrent idiopathic sudden sensorineural hearing loss, Auris Nasus Larynx. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 4. Discussion · p. 7

    Ear fullness in acute sensorineural hearing loss is not associated with auditory function on audiograms but is associated with the low-frequency region.

    “Ear fullness in acute sensorineural hearing loss was not associated with auditory function on audiograms but was associated with the low-frequency region [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Sakata, 2008, A comparison between the feeling of ear fullness and tinnitus in acute sensorineural hearing loss, Int. J. Audiol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    One previous study found no difference in outer hair cell damage, represented by evoked otoacoustic emissions, between DM patients and healthy subjects in an acute hyperglycemic clamp study.

    “one previous study [34] found no difference in the outer hair cell (OHC) damage, represented by evoked otoacoustic emissions (e-OAEs), between DM patients and healthy subjects in an acute hyperglycemic clamp study”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Sasso, 1999, Cochlear Dysfunction in Type 2 Diabetes: A complication Independent of Neuropathy and Acute Hyperglycemia, Metabolism source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § 5. Conclusions · p. 9

    The research protocol was approved by the Institutional Review Board of Kyung Hee Medical Center (2019-07-065).

    “This research protocol was approved by the Institutional Review Board of Kyung Hee Medical Center (2019-07-065).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    A previous study reported that 45% of recurrences occurred within 6 months from the first episode.

    “A previous study reported that 45% of recurrences occurred within 6 months from the first episode [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Fushiki, 2009, Recurrence rate of idiopathic sudden low-tone sensorineural hearing loss without vertigo: A long-term follow-up study, Otol. Neurotol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    Electrocochleography showed that low initial hearing level is prognostic for recovery from ISSNHL.

    “Similar to our findings, electrocochleography (ECohG) showed that low initial hearing level is prognostic for recovery from ISSNHL [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Ohashi, 2012, Electrocochleographic findings in recurrent idiopathic sudden sensorineural hearing loss, Acta Otolaryngol. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § References · p. 9

    This study only analyzed patients who experienced recurrent ISSNHL.

    “First, this study only analyzed patients who experienced recurrent ISSNHL.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § 4. Discussion · p. 8

    HTN can cause hemorrhage in the inner ear, reducing capillary blood flow and oxygen supply, and resulting in progressive or sudden sensorineural hearing loss.

    “HTN can cause hemorrhage in the inner ear, reducing capillary blood flow and oxygen supply, and resulting in progressive or sudden sensorineural hearing loss [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Siegelaub, 1974, Hearing loss in adults: Relation to age, sex, exposure to loud noise, and cigarette smoking, Arch Environ. Occup. Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § References · p. 9

    The study had a small number of subjects.

    “a small number of subjects were studied”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 8

    Analysis of data from the US National Nutrition Survey showed a link between hearing loss and high blood pressure.

    “Analysis of data from the US National Nutrition Survey showed a link between hearing loss and high blood pressure [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Agrawal, 2008, Prevalence of hearing loss and differences by demographic characteristics among US adults: Data from the National Health and Nutrition Examination Survey, 1999–2004, Arch Intern. Med. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § References · p. 9

    This study was retrospective in design, which may have introduced a potential selection bias.

    “Second, this study was retrospective in design, which may have introduced a potential selection bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning
    § References · p. 9

    Ear fullness can likely be recognized during early stages of functional loss, allowing earlier treatment and improved prognosis.

    “Although further research is needed on the mechanisms responsible for ear fullness, ear fullness can likely be recognized during early stages of functional loss, allowing earlier treatment and improved prognosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § References · p. 9

    The study had a higher proportion of females compared to males.

    “there was a higher proportion of females compared to males.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § 4. Discussion · p. 8

    Acquired and inherited cardiovascular risk factors were found to be associated with an increased risk of developing ISSNHL.

    “Moreover, acquired and inherited cardiovascular risk factors were found to be associated with an increased risk of developing ISSNHL [33].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Lin, 2012, Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults, Laryngoscope source

  • May combine two claims.

    Interpretationown data
    § References · p. 9

    A lower initial hearing level and presence of ear fullness symptom were associated with better recovery from the recurrent than from the first episode of ISSNHL.

    “A lower initial hearing level and presence of ear fullness symptom were associated with better recovery from the recurrent than from the first episode of ISSNHL.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § 4. Discussion · p. 7

    The association between ear fullness and the low-frequency region disappears after the hearing threshold stabilizes, and disappearance of ear fullness has been associated with hearing prognosis.

    “This association disappeared after the hearing threshold stabilized, and the disappearance of ear fullness has been associated with hearing prognosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. Discussion · p. 7

    Ear fullness observed in patients with endolymphatic hydrops or Meniere's disease has been associated with a pressure imbalance between the round and oval windows.

    “Ear fullness observed in patients with endolymphatic hydrops or Meniere's disease has been associated with a pressure imbalance between the round and oval windows [17,22,23].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [17] Wu, 2021, Clinical characteristics and correlation between hearing outcomes after different episodes of recurrent idiopathic sudden sensorineural hearing loss, Auris Nasus Larynx. source
    • cites [22] Gorga, 1991, Effects of stimulus phase on the latency of the auditory brainstem response, J. Am. Acad. Audiol.

      Not checked in the free run.

    • cites [23] Tonndorf, 1962, Closure of th cochlear windows: Its effect upon air- and bone-conduction, Ann. Otol. Rhinol. Laryngol. source
39 of 39

  • The paper relies on this without support.

    No study has compared the clinical features or factors associated with recovery from initial and recurrent episodes of ISSNHL.

    “Furthermore, to our knowledge, no study has compared the clinical features or factors associated with recovery from initial and recurrent episodes of ISSNHL.”

  • The paper relies on this without support.

    Knowledge about factors associated with patient recovery from recurrent episodes is needed to counsel and treat patients.

    “The knowledge about factors associated with patient recovery from recurrent episodes is needed to counsel and treat the patients.”

  • The paper relies on this without support.

    Large population studies have failed to identify factors that are prognostic or predictive of the degree of recovery from recurrent ISSNHL.

    “Large population studies have failed to identify factors that are prognostic or predictive of the degree of recovery from recurrent ISSNHL”

  • The paper relies on this without support.

    ISSNHL is an uncommon disease, and recurrent ISSNHL is very rare.

    “ISSNHL is an uncommon disease, and recurrent ISSNHL is very rare”

  • The paper relies on this without support.

    Patients with previous experience of ISSNHL may delay visits to the hospital because they become empirically accustomed to symptoms such as sudden ear fullness, tinnitus, and hearing loss.

    “Patients with previous experience of ISSNHL may delay visits to the hospital because they become empirically accustomed to symptoms such as sudden ear fullness, tinnitus, and hearing loss.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Incorrect percentage for men who recovered after recurrence

    Minor

    The recurrent-episode recovery group has 24 patients. Eight men represent 33.33% of that group, not 3.33%.

    Reported 3.33 · recomputed 33.333333

  • Incorrect hypertension percentage in Table 3

    Minor

    One patient among the 18 with no worse recovery represents 5.56%, not 5.65%.

    Reported 5.65 · recomputed 5.555556

  • Discussion reverses the ear-fullness comparison

    Minor

    The discussion says ear fullness was more frequent among patients with poorer recovery, but Table 3 reports it in 6 of 12 patients with poorer recovery versus 16 of 18 without poorer recovery.

3 of 3

Cites

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Authors
Jeon, S. Y., Kang, D. W., Kim, S. H., Byun, J. Y., & Yeo, S. G.
Affiliations
  • Department of Otorhinolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
  • Kyung Hee University (KR)
Corresponding author
Yeo, Seung Geun
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2022-03-07
Volume
11
Issue
5
Pages
1453
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm11051453
PMC
PMC8910997
OpenAlex
W4220987639
Semantic Scholar
f066132e169d1ed16fc72101d1ac1150d1d5ce0d
Cited by
9
References
35
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1
FWCI
0.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
Keywords
idiopathic sudden sensorineural hearing loss, prognosis, hearing recovery, ear fullness, treatment timing

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-22.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-22.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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