Treatment outcomes for idiopathic sudden sensorineural hearing loss in dialysis patients

Abstract Idiopathic sudden sensorineural hearing loss (ISSNHL) poses a significant challenge for nephrologists in the treatment of dialysis patients. Due to limited studies comparing the treatment response between dialysis and non-dialysis patients, physicians face difficulties in managing this patient population. Therefore, this study aimed to investigate the treatment outcomes of dialysis patients with ISSNHL. This single-center, retrospective, observational study enrolled 700 patients diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Korea. Among them, 47 were dialysis patients, while 653 were non-dialysis patients. To balance pre-existing clinical characteristics, a 1:5 propensity score matching analysis was performed on the non-dialysis patients. The standard protocol involved administering high-dose systemic steroid therapy or intra-tympanic steroid injections. The pure tone average of the two groups was compared before initiating treatment, after 2 weeks, and after 2 months of treatment. The degree of improvement in the hearing was evaluated using Siegel's criteria. Before propensity score matching, the age, prevalence of diabetes or hypertension, initial hearing threshold at each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies exhibited statistically significant differences between the two groups. However, in the propensity score-matched cohort, none of the measured confounding variables showed statistically significant differences between the groups. Two months after steroid treatment, the non-dialysis patient group demonstrated a significantly higher average improvement in pure tone audiometry ( P = 0.017) and a greater percentage of complete response according to Siegel's criteria compared to the dialysis patient group (26.8% vs. 6.4%). This study suggests that dialysis patients exhibit significantly poorer treatment outcomes for ISSNHL compared to non-dialysis patients.