Frailty and Steroid Treatment Outcomes in Patients with Sudden Sensorineural Hearing Loss

Abstract

Objective:

To investigate the relationship between frailty and steroid treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL).

Study Design:

Retrospective cohort study

Setting:

Tertiary-care institution.

Patients:

185 adult patients (≥19 years) with unilateral SSNHL presenting January 1, 2017 to May 24, 2023, stratified by 5-Factor Modified Frailty Index (mFI5).

Interventions:

Oral prednisone and/or intratympanic dexamethasone.

Main Outcome Measures:

Post-treatment changes in pure-tone average (PTA), speech reception threshold (SRT), and word recognition scores (WRS).

Results:

Female and younger patients were significantly less frail than male and older patients (P = .004, P < .001 respectively). Patients with higher frailty scores (≥2) were less likely to receive oral steroids (59.6% vs 82.8%, P = .004), though equally likely to receive intratympanic steroids (P = 1.000). However, patients classified as frail (≥1) were not more likely to receive intratympanic steroids alone compared to combination therapy (P = .220). Higher frailty scores were significantly associated with metabolic syndrome (P = .002), but specific treatment patterns in diabetic patients could not be delineated as treatment was individualized. Dizziness (P = .650) and vertigo (P = .200) did not correlate with frailty or treatment outcomes. The number of comorbidities increased with higher frailty scores (P < .001) but did not directly correlate with SSNHL outcomes. No significant differences were observed in audiometric outcomes (PTA/SRT/WRS) based on patient frailty scores across all comparisons (P’s > .05).

Conclusions:

While we found an association between frailty scores and treatment selection for SSNHL, we did not find a significant association between frailty scores and treatment outcomes. Therefore, treatment may be individualized in frail patients without compromising audiometric outcomes.