A nnU-Net-based clinical radiomics model for predicting poor prognosis in sudden deafness.

Objective:To analyze the magnetic resonance hydrography results of the inner ear in patients with total deafness-type sudden sensorineural hearing loss , and to explore the incidence and correlation with therapeutic efficacy in patients with internal auditory canal vascular loops. Methods:Audiological and imaging data were collected from 517 patients with sudden sensorineural hearing loss who were hospitalized in our hospital. All patients underwent T2WI rapid imaging sequence MRI examination, and the vascular loops of the patients were graded according to the Chavda grading method. The impact of different grades of vascular loops on the clinical characteristics and prognosis of the patients was analyzed. Statistical methods such as chi-square test and non parametric rank sum test to analyze the impact of internal auditory canal vascular loops on the clinical characteristics and hearing prognosis of patients with sudden total deafness. Results:From May 2009 to June 2024, a total of 517 hospitalized patients with sudden deafness were analyzed. It was found that: ①110 patients had abnormal hydrography in the internal auditory canal, including 32 patients with mastoiditis, 30 patients with sinus, ethmoid sinus, and maxillary sinus abnormalities, 15 patients with semicircular canal abnormalities, 7 patients with high jugular bulb, and 18 patients with fine or poorly displayed internal auditory canal nerves; ②276 patients with sudden sensorineural hearing loss accompanied by vascular loops, including 156 ears on the affected side and 158 ears on the healthy side with Chavda classification of grade Ⅰ; 104 ears on the affected side and 83 ears on the healthy side with type Ⅱvascular loops; There were 16 ears on the affected side of type Ⅲ and 14 ears on the healthy side. There was no significant difference in the distribution of vascular loops between the patient and the affected side（P>0.05）; ③The frequency of vascular loops in female patients is higher than that in males（P<0.05）, but no significant differences were found in the degree of hearing loss and hearing outcomes at different frequencies among patients with different grades of vascular loops（P>0.05）. ④The incidence of tinnitus in patients with vascular loop grades Ⅰ-Ⅲ was 92.9%, 83.7%, and 100.0%, respectively. There was a statistically significant difference in the incidence of tinnitus among patients with different grades of vascular loops（P<0.05）. Conclusion:For patients with sudden total deafness, more attention should be paid to their inner ear magnetic resonance imaging results. The vascular loop of the internal auditory canal is a possible cause of tinnitus in some patients with sudden total deafness.

A 62-year-old woman presented with four months of progressive bilateral hearing loss. Her history is notable for breast cancer treated with chemotherapy over the past year, and she has no history of previous ear problems. Initially, she did not seek treatment for her hearing issue as it was considered to be a side effect of her ongoing chemotherapy treatment. Recently, however, she developed a severe headache with rapidly worsening bilateral hearing loss, imbalance, and left-sided facial droop. She reported intermittent bilateral aural pressure since the onset of her hearing loss but denied otalgia, dizziness, vertigo, or tinnitus. Microscopic ear exam and complete head and neck exam were normal at the time of presentation. Her audiogram at presentation is shown in Figure 1.Figure 1: The patient's audiogram at presentation. Hearing loss, cancer, paralysis.Figure 2: Axial (horizontal) (A) T1 post-gadolinium MRI demonstrating enhancement (white) bilaterally in the IACs, indicating tumor, and (B) T2 MRI at presentation showing no distinct tumor in the IACs, which were fluid-filled (white). Hearing loss, cancer, paralysis.Figure 3: Axial (horizontal) post-gadolinium TI MRI five months prior to presentation showing no obvious tumor. Some small faint contrast enhancement (light gray) is visible, possibly representing an early tumor in the right IAC (arrow, left side of the image). Hearing loss, cancer, paralysis.Figure 4: Coronal (vertical) post-gadolinium T1 MRI five months prior to presentation showing faint contrast enhancement (light gray), possibly representing early tumor in the left IAC. Hearing loss, cancer, paralysis.Figure 5: Axial (horizontal) T2 MRI five months prior to presentation, showing no obvious tumor. The left IAC (right side of the image) is not seen given the rotation of the patient in the scanner. Note the bright signal created by fluid in the horizontal semicircular canal and cochlea. Hearing loss, cancer, paralysis.DIAGNOSIS: METASTATIC BREAST CANCER Sudden bilateral hearing loss is commonly due to a systemic process such as a metabolic or an auto-immune disorder. It is necessary to perform a metabolic workup and to obtain imaging in any patient presenting with sudden bilateral hearing loss, particularly in the context of known malignancy. The metabolic workup includes looking at blood sugar, cholesterol, red blood cells, platelets, and markers of autoimmunity (e.g., sedimentation rate, CRP, ANCA, etc.). In addition, infectious etiologies need to be evaluated such as HIV, Lyme, syphilis, meningitis, etc. Clinical history should also be assessed for ototoxic pharmacologic substances such as aminoglycoside antibiotics and chemotherapy agents such as cisplatin. For this patient, we obtained an MRI of the internal auditory canals (IACs) (Fig. 2), which showed bilateral lesions of contrast enhancement in the IACs. By comparison, only a small amount of contrast enhancement was evident on her MRI five months prior to presentation (Figs. 3, 4, 5). The type of MRI ordered in these clinical scenarios has important implications for the resolution of anatomic detail that will be visible. With a standard MRI of the brain, 5-mm tissue slices are used in various sequences to produce a single image. In these relatively large slices, small abnormalities in the IACs, cochlea, and vestibule may be missed, and a standard brain MRI may even fail to visualize the IACs altogether. If a non-contrast brain MRI is all that is available, then the T2 sequence is the best set of images to evaluate the IACs for a tumor. Normally, the IACs are mostly filled with cerebrospinal fluid (CSF). In the T2 sequence, an IAC tumor will appear dark, while CSF appears white. With contrast, the mass lesion will appear white due to its high vascularity and uptake of the contrast material (gadolinium). On IAC screening MRI protocol, the T1 post-contrast MRI is performed with 3-mm slices, which provide more details than a brain MRI. While newer brain MRI protocols utilize even thinner imaging slices (e.g., 1-mm with multiplanar reformation sequence [MPR]) to reveal more structural detail, the temporal bone region can sometimes appear indistinctly. For these reasons, another option for evaluating tumors of the inner ear is through an MRI of the IAC using the T2-weighted fast spin-echo (FSE) protocol. The T2-weighted FSE MRI, also referred to as three-dimensional constructive interference in steady-state (CISS) MRI or 3D MPR/FIESTA, has the ability to show high-resolution details of cranial nerves and spaces involving or adjacent to the inner ear structures. On CISS MRI, potential tumors appear dark, and CSF and inner ear fluids appear bright. The majority of IAC and cerebellopontine angle (CPA) lesions are benign tumors, such as meningioma and vestibular schwannoma. Less than one percent of CPA lesions involve metastases to the IAC, with the most common sources being breast cancer, lung cancer, gastric cancer, and melanoma. The possible routes of temporal bone metastasis are hematogenous dissemination, direct extension from local preexisting lesions, and leptomeningeal carcinomatosis through CSF spread. Although leptomeningeal carcinomatosis occurs in only five percent of cancer patients, it is being diagnosed with increasing frequency as both patient life expectancy and quality of neuroimaging studies have improved over the years. For metastases involving the IAC, neoplastic spread into the meninges and CSF is generally considered the primary mechanism of bilateral tumor deposits. Patients with IAC metastases most commonly present with bilateral and rapidly progressing sudden sensorineural hearing loss (SSNHL), facial nerve palsy, and tinnitus. This etiology of SSNHL at presentation is unknown but recent studies have shown some correlation with migraine (Arch Otolaryngol Head Neck Surg. 2002 Oct;128[10]:1213, 1215). The mechanism is likely due to a change in hearing from vascular changes to the cochlea from trigeminal nerve activation. Neoplasms cause two percent of cases of sudden hearing loss. Although malignancy is implicated in only a minority of cases, the presence of bilateral SSNHL should raise strong suspicion and prompt further investigation into a neoplastic process. Metastasis from multiple myeloma, breast (Laryngoscope. 2021 Jan;131[1]:E283-E288), gastric, lymphoma, and pancreatic cancer have all been reported to manifest with central nervous system dysfunction, including SSNHL. In rare cases, hearing loss, tinnitus, vertigo, and facial paralysis may be the only presenting symptoms, and clinicians should always consider occult disease in the differential diagnosis. Given her history and imaging findings, our patient was diagnosed with metastatic breast cancer in her bilateral IACs. It is often difficult to differentiate between IAC metastasis and primary benign tumors such as vestibular schwannoma. However, combined with the clinical history, certain radiographic features may help aid in the diagnosis. On both T1- and T2-weighted MRI, vestibular schwannoma generally shows a homogenous and isointense signal compared to gray matter with strong post-contrast enhancement. MRI findings suggestive of IAC metastasis include the presence of thick linear or nodular leptomeningeal contrast enhancement. Further favoring leptomeningeal carcinomatosis, as in our patient, are MRI findings of irregular nodular enhancement around the IAC in the dura. The contrast enhancement in Figure 2A is due to the tumor involving the dura of the IAC, since Figure 2B shows that the tumor is not within the IAC and the IAC is filled with CSF (white on the image). It is important to note that these distinctive features may not always be observed on MRI, making it imperative for clinicians to perform a thorough history and physical examination with special attention given to patients with a history of primary malignancy. The MRI from five months prior at the onset of hearing loss showed some faint enhancement, which was probably an early tumor involving the IAC dura (Figs. 3, 4, 5). Prompt diagnosis of leptomeningeal carcinomatosis with lumbar puncture and morphologic examination of CSF is critical to preventing the irreversible neurologic dysfunction that can result from further spread. Unfortunately, the prognosis of leptomeningeal carcinomatosis from breast cancer is very poor, with median survival ranging from four to six weeks without treatment. Several treatment options exist, including intrathecal chemotherapy and radiation; however, these options are largely palliative and have little effect on survival. Additional treatments such as corticosteroids may be considered to improve functional status and symptoms such as hearing loss, as in our patient. BONUS ONLINE VIDEOS: VISUAL DIAGNOSIS Read this month's Clinical Consultation case, then watch the accompanying videos from Hamid R. Djalilian, MD, to review the patient's imaging for yourself. Video 1. Axial (horizontal) post-gadolinium MRI five months prior to presentation showing a possible early tumor. Video 2. Coronal (vertical) post-gadolinium MRI five months prior to presentation showing a possible early tumor. Video 3. Axial (horizontal) T2 MRI five months prior to presentation showing no obvious tumor. Video 4. Axial (horizontal) post-gadolinium MRI at the time of presentation showing a bilateral tumor. Video 5. Coronal (vertical) post-gadolinium MRI at time of presentation showing a bilateral tumor. Video 6. Axial (horizontal) T2 MRI at presentation showing a bilateral tumor. Watch the patient videos online at thehearingjournal.com

Sensorineural Hearing Loss After Dental Extraction Under General Anesthesia: Report of a Case

Sudden Sensorineural Hearing Loss: Otolaryngologic and Audiologic Options

An entity of episodic vertigo of delayed onset following sudden deafness and sensorineural hearing loss after mumps is described. Data on five patients with sudden dafnfess and three patients with sensorineural hearing loss after mumps are presented. The latency between sudden onset of sensorineural hearing loss and the onset of the vertigo varied from four days to six years.There is no patient with sudden deafness who had a history of vestibular symptoms at the time of the sudden loss of hearing. Two out of three patients who had sensorineural hearing loss after mumps had a simultaneous involvement of the vestibular apparatus, with transient vertigo. The episodic vertigo, delayed in onset after sudden sensorineural hearing loss in the eight patients was usually spontaneous. Postural vertigo was noted in only one patient.The nature of the inner ear pathology responsible for the episodic vertigo in these patients is speculative. One patient after sudden deafness had an episodic vertigo accompanied by tinnitus in the previously deafened ear. The characteristics of vertigo in this patient are indistinguishable from those seen in cases of Meniere's disease. The pathophysiology of the vertigo in this patient was found to be related to endolymphatic hydrops.The delay of four days to six years between the sudden onset of hearing loss and the later onset of ipsilateral otogenic vertigo is puzzling. Schuknecht and others have suggested that viral labyrinthitis is the likely etiology of sudden deafness. Cochleosaccular degeneration is a common finding in documented viral labyrinthitis. Zajtchuk stated that the pathophysiology of viral labyrinthitis involves an acute stage and a chronic stage. In the chronic stage, degeneration process of neural elements, new bone formation and fibrous tissue take place in the membranous labyrinth. Thus, episodic vertigo may be the result of a progressive inner ear degeneration after sudden sensorineural hearing loss.

Objective To explore the feasibility of constructing a machine learning classification model for unilateral sudden sensorineural hearing loss (SSHL) patients and normal controls based on diffusion tensor imaging. Methods Prospective collection of 84 patients with untreated SSHL were recruited from the otolaryngology department of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between June 2013 to May 2015 as the SSHL group. Meanwhile, a total of 63 healthy volunteers who were no any ear disease history, and the hearing function were confirmed with pure tone audiometry, were collected as the control group. All subjects underwent a brain DTI scan. The data were divided into the training set and validation set according to the ratio of 7 to 3, that was, the training set contained 58 cases of SSHL patients and 44 control groups, and the validation set included 26 cases of SSHL patients and 19 control groups. A vector which included the DTI parameters such as fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity was constructed with the software R. The LASSO regression of machine learning method was used to perform feature dimensionality reduction and construct a classification model. The training set samples were used to map the nomogram based on the multivariate logistic analysis method, the validation set and the AUC were used to evaluate the prediction ability of the nomogram, and the calibration curve was used to evaluate the model. Results From the 200 feature vectors including the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values of each brain region, after each dimension reduction process, a total of six features were retained, which were the MD of left superior corona radiate and right superior fronto-occipital fasciculus, the AD of the body of corpus callosum, and the RD of left inferior cerebellar peduncle, left superior corona radiate and right posterior limb of internal capsule. The six features of patients with unilateral SSHL were higher than the control group, and the difference was statistically significant (P<0.05). Based on this, a two-class model is constructed and a nomogram is drawn. The sensitivity, specificity, accuracy and AUC of the training set were 93.1% (54/58), 72.7% (32/44), 84.3% (86/102) and 0.854, respectively; the sensitivity, specificity, accuracy and AUC of validation set were 80.8% (21/26), 84.2% (16/19), 82.2% (37/45), 0.870, respectively. Nomogram could significantly improve the classification efficiency of the control group and patients, and the model with the LASSO method showed a higher prediction curve than other models. Conclusions The machine learning classification model based on DTI metrics can effectively distinguish patients with unilateral sudden sensorineural deafness from healthy control people. Key words: Hearing loss, sensorineural; Diffusion tensor imaging; Machine learning; Classification; Nomogram; Decision curve analysis

In sudden and asymmetrical progressive sensorineural hearing loss (SNHL), magnetic resonance imaging (MRI) is required to evaluate retrocochlear pathology and, with recent advances in MRI techniques, inner ear pathology. Given the limited literature regarding inner ear pathology associated with SNHL, we aimed to assess the incidence of retrocochlear and inner ear pathology, and congenital malformation on MRI in sudden SNHL (SSNHL) and progressive SNHL. A total of 987 acoustic neuroma (AN) protocol MRI internal acoustic meatus studies performed at our institution to investigate SNHL between January 2013 and December 2015 inclusive were identified. Following categorization for indication of SSNHL versus progressive asymmetrical SNHL, MRIs with retrocochlear or inner ear abnormality, congenital malformation or other otology-related abnormality were identified, and further data were collected for these patients including patient demographics, associated symptomatology, management and outcomes. In SSNHL, aetiological abnormality on MRI was identified for 6.9% patients with AN present on 4% overall. 3.2% of MRIs for progressive asymmetrical SNHL identified a causative lesion with 2.3% of scans overall diagnosing AN. The incidence of congenital inner ear malformation on MRI in the setting of SSNHL and progressive asymmetrical SNHL are 1.7% and 0.6%, respectively. This is the first retrospective study of inner ear MRI abnormalities in both SSNHL and progressive asymmetrical SNHL in Australia and one of the largest cohorts published in the literature to date. MRI must be performed in the setting of SNHL to ensure aforementioned and rarer causative lesions are identified.

BACKGROUND AND PURPOSE: Bladder cancer (BC) exhibits pronounced tumor heterogeneity, which poses a persistent clinical challenge for accurate prognostic prediction and monitoring. This study aims to develop and validate an interpretable machine learning model that leverages radiomics features to predict BC outcomes, while also investigating associated genetic signatures and their relationship with tumor immunity. METHODS: RNA-seq data were acquired from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO). Clinicopathological parameters and radiomics features for bladder cancer (BC) cases were obtained from TCGA and The Cancer Imaging Archive (TCIA). Differentially expressed genes (DEGs) were identified from both TCGA and GEO datasets. Key radiomics features were selected through univariate Cox regression followed by LASSO-Cox regression, while independent clinicopathological prognostic factors were determined using univariate and multivariate Cox regression analyses. A support vector machine (SVM)-based prognostic model was developed by integrating clinicopathological and radiomics features. The performance of this model was evaluated against three other machine learning models using ROC curves, accuracy, precision, and F1-score. Feature importance scores were computed, and model interpretability was enhanced using SHapley Additive exPlanations (SHAP). Based on the feature importance coefficients derived from the SVM model, BC patients were classified into distinct risk groups. Subsequently, radiomics-associated DEGs were analyzed to pinpoint key genes linked to imaging phenotypes. These genes were subjected to functional annotation via Gene Ontology (GO), pathway enrichment analysis using KEGG, gene set enrichment analysis (GSEA), and immune infiltration analysis to investigate potential patterns of immune cell enrichment. RESULTS: After rigorous screening, 91 bladder cancer patients with high-quality enhanced CT images, complete clinicopathological data, and RNA sequencing profiles were included in the study. These patients were randomly allocated to a training set and a validation set at a 7:3 ratio to develop an SVM-based model for estimating the 5-year overall survival (OS) in muscle-invasive bladder cancer. The model demonstrated robust predictive performance, with an area under the ROC curve (AUC) of 0.861, an accuracy of 0.889, a precision of 0.790, and an F1 score of 0.837. Decision curve analysis (DCA) confirmed the model’s significant net clinical benefit. Through integrated analyses of TCGA (n = 406) and GEO (n = 175) datasets, we identified 500 DEGs, which were refined to 240 radiomics-associated DEGs based on SVM-derived risk stratification. Immune infiltration analysis revealed that levels of NK cells, M0 macrophages, memory B cells, and activated dendritic cells were significantly higher in normal tissues compared to tumor tissues, indicating an immunologically favorable tumor microenvironment. Additionally, pathway analysis showed significant enrichment of immune-related pathways among the radiomics-associated genes. CONCLUSION: We identified gene markers associated with radiomic features, which may yield biological insights into imaging phenotypes and could potentially support the prognostic relevance of radiomics-based models.

A 19-year-old woman presented with an 11-month history of sudden-onset left sided hearing loss accompanied by vertigo and headache. Audiometric testing revealed profound left- sided hearing loss. A contrast-enhanced MRI of the internal auditory canal performed 5 months after symptom onset was interpreted as showing a vascular loop, probably the anterior inferior cerebellar artery, abutting and indenting on the left vestibulocochlear nerve; and a prominent and high-riding left jugular bulb. In this study, the internal auditory canals were assessed to be of normal width, with walls that were smooth and sharply defined. A cerebral CT angiogram subsequently performed did not show any abnormal findings related to the previously identified vascular loop. On the basis of these radiologic findings, the patient was advised surgery by physicians at a tertiary- care institution, presumably to address the identified vascular loop. A second opinion was sought by the patient. Review of the MRI initially focused on the axial high-resolution T2-weighted sequence (T2-DRIVE), as the fast spin-echo T2-weighted sequence has been recommended as a reliable and cost-effective MR screening protocol for the detection of masses in the IAC.1 In contrast to the official radiology report, stenosis of the left internal auditory canal by a protrusion (Figure 1, white asterisk) originating from the posteromedial wall of the internal auditory canal was noted. This protrusion, which had no MR signal intensity, appeared to abut and compress the cranial nerves within the IAC. Reconstruction of the images in non-orthogonal planes aligned with the orientation and direction of the left 8th cranial nerve showed the protrusion causing upward compression on and distortion of the nerve. (Figure 2, white arrows) Attention was directed to the axial high-resolution T1-weighted sequence (T1W-3D FFE), which revealed that the protrusion contained an isointense soft tissue structure (Figure 3, white asterisk) located within the petrous bone medial to the posterior semicircular canal. This structure appeared to be an upward extension of the jugular bulb. The axial high-resolution contrast-enhanced T1-weighted sequence (T1W-3D TFE Gd) showed smooth, vivid enhancement of the identified structure (Figure 4, black asterisk), which connected with the sigmoid sinus in lower cuts. This confirmed the presence of a high-riding jugular bulb that encroached on the internal auditory canal. Any doubt as to its true nature was dispelled by a review of the temporal bone structures on high-resolution CT which was fortunately available in the cerebral CT angiogram. This revealed a protrusion of the high-riding jugular bulb with a waist-like margin (Figure 5A and B, black arrows), allowing further characterization of the lesion as a jugular bulb diverticulum.2 A high-riding jugular bulb that projects into the middle ear is not an uncommon anatomic variation. On the other hand, a jugular bulb diverticulum, which is an outpouching of the jugular bulb that can extend superiorly, medially, and posteriorly in the petrous bone, is a true venous anomaly that has been described rarely in the medical literature.3,4 When symptomatic, patients with this anomaly can present with sensorineural hearing loss, tinnitus, vertigo and auricular pain.3-5 Proper identification of a jugular bulb diverticulum in the evaluation of a patient with neurotologic symptoms is necessary to avoid inappropriate medical and surgical intervention. As demonstrated in this patient, a jugular bulb diverticulum may not be identified by a screening MRI that utilizes only a T2-weighted sequence. T1-weighted MRI sequences with and without contrast are necessary to demonstrate its soft tissue imaging characteristics. Although not the initial imaging study of choice for sudden sensorineural hearing loss, high-resolution bone-window CT may be necessary to delineate the bony anatomy of the jugular foramen and confirm the presence of this anomaly.

Although recent advances in magnetic resonance imaging (MRI) techniques have contributed to the detection of tiny lesions in the internal auditory canal (IAC) that may be responsible for sudden sensorineural hearing loss (SSNHL), there have been relatively few studies on the clinical characteristics of intra-labyrinthine hemorrhage (ILH) and labyrinthitis versus those regarding IAC tumors. Our purpose was to investigate the frequency of those IAC lesions on MRI and their clinical characteristics. Initial MRIs of 200 patients with SSNHL (93 men, 107 women; mean age = 48.61 years, range: 18–84 years), as well as detailed clinical histories, audiological examinations, and thyroid function, lipid battery, and serological tests (for viral agents and autoimmune disease), were performed. All patients were hospitalized at the time of diagnosis of SSNHL and were administered the same treatment protocol. Patients were divided into idiopathic and secondary groups according to their MRI results. After discharge, they underwent follow-up audiometry and clinical examination at predetermined intervals (2 weeks, 1, 2, 4, and 6 months, and 1 and 2 years). Propensity score-matching and receiver operating characteristics curves of the initial parameters were used for estimating clinical characteristics. Of the 200 patients, 25 (12.55%) who had abnormal findings suggesting inner ear lesions on MRI were assigned to the secondary SSNHL group; within this group, 10 patients (10/200, 5%) had a tumor invading the IAC, 7 (7/200, 3.5%) had ILH, 6 (6/200, 3%) had labyrinthitis, and 2 (1%) had a structural deformity of the IAC. The secondary group showed significantly poor recovery of hearing function compared with that in the idiopathic group. Patients with ILH or labyrinthitis showed prognoses that were equally poor as those of patients with tumors in the secondary group. Additionally, patients with such lesions showed significant canal paresis on the lesion side at an early stage and a high prevalence of benign paroxysmal positional vertigo (BPPV). In conclusion, the prevalence of non-tumorous lesions on MRI represents common findings and showed a poorer treatment response than that of vestibular Schwannoma in patients with SSNHL. Abnormal canal paresis (cut-off value of 35% on the lesioned side, sensitivity 65.2% and specificity 67%), spontaneous nystagmus directed to the contralesional side, and positional vertigo would be the clinical presentation of SSNHL with IAC lesions, in which the presence of acute prolonged vertigo or positional vertigo compatible with BPPV suggests the possibility of a non-tumorous lesion, such as ILH or a labyrinthitis rather than an IAC tumor.

Retrospectively analyzed the clinical data of sudden sensorineural hearing loss with acoustic neuroma. The clinical data of 467 cases with sudden sensorineural hearing loss were collected between Jan, 2008 and Aug, 2012. Discussed the clinical data which were diagnosed as acoustic neuroma. In 467 cases of sudden sensorineural hearing loss, nine cases were diagnosed as acoustic neuromas (9 ears, 1.93%), two males and seven females, with a age range of 28 to 57 years. Among them, seven cases accompanied with tinnitus, seven cases with vertigo. The hearing results in nine cases, two cases were found to be mild, two were moderate, four were severe, and one was profound hearling loss respectively. Hearing was classified into five types according to audiogram shape (1 of up-sloping, 1 of down-sloping, 2 of mid-frequency, 1 of profound loss, 4 of flat audiogram). Eight cases had abnormal ABR, nine cases with ear ipsilateral stapedius reflex were completely not elicited, seven cases with health ear contralateral stapedius reflex were completely not elicited. Tumors were graded by Koos Grades according to size (7 of grade I, 1 of grade II, 1 of grade IV). Seven small acoustic neuroma was taken waiting strategies. Meanwhile, we use glucocorticoid and improve the microcirculation of the inner ear medication short-termly for these patients. Four patients' hearing were improved. The initial symptoms of some acoustic neuroma are sudden hearing loss, especially the small tumors in internal auditory canal. In order to prevent misdiagnosis, MRI and ABR should be performed as a routine test for sudden sensorineural hearing loss. It is necessary to give appropriate treatment to protecting hearing for the small acoustic neuroma patients whose first symptoms are diagnosed as sudden sensorineural hearing loss.

There are higher incidence of sudden sensorineural hearing loss (SSHL) in hemodialysis (HD) patients than in the general population. Long-term outcomes of HD patients with new-onset SSHL have yet to be investigated although SSHL is considered as an independent risk of cardiovascular diseases in the general population. We examined the risks of mortality and atherosclerotic events in HD patients with new-onset SSHL in Taiwan. Cohort study. Using the Taiwan National Health Institutes Research Database, 105,243 HD patients were identified between 1997 and 2008. In total, 288 HD patients with a new diagnosis of idiopathic SSHL were enrolled and matched with 1,728 HD patients without SSHL by using propensity score matching at a ratio of 1:6. A multivariate Cox regression and a competing risk regression were used to evaluate mortality and atherosclerotic events. Results revealed a risk of mortality in HD patients with SSHL than in HD patients without SSHL (adjusted hazard ratios [aHRs] 2.22, 95% confidence interval [CI] 1.71-2.89). HD patients with SSHL had higher risks of hemorrhagic stroke (competing risk aHR 4.08, 95% CI 1.93-8.61), ischemic stroke (competing risk aHR 2.34, 95% CI 1.45-3.78), acute coronary syndrome, and peripheral arterial occlusive disease than did the HD patients without SSHL. This study is the first to signify that the risks of mortality and atherosclerotic complications in HD patients with new-onset SSHL are increased. Therefore, we should pay attention to risks of mortality and atherosclerotic events in HD patients with new-onset SSHL.

Background Sudden Sensorineural hearing loss is an ENT emergency characterized by sudden 30dB sensorineural hearing loss in at least 3 contiguous frequencies occurring over a 72hr period. SSNHL often affects healthy individuals and is a frightening symptom that prompts individual to seek urgent medical attention. It usually occurs unilaterally but bilateral cases are also noticed. AIM: The Aim of this study is to determine the treatment outcome of patients with SSNHL seen and managed at ENT Department UDUTH Sokoto within the study period. Patients and Methods This study included a total of 12 patients diagnosed with SSNHL and managed at the ENT Department of Usmanu Danfodiyo University Teaching Hospital Sokoto from September 2015 to September 2024. The cases were reviewed retrospectively based on clinical charts. Hearing improvement was evaluated in relation to Puretone audiogram results, duration between onset of SSNHL onset and time of initial treatment. Result Age 11 to 20years were commonly affected with Male to female ratio of 1:2. All the patients presented with profound sudden sensorineural hearing loss. Hearing improvement was observed in 7 of 12 (58.4%) of patients within the first 3 to 4 days of treatment followed by rapid hearing recovery. Conclusion: Sudden Sensorineural Hearing Loss often affects healthy individuals and is a frightening symptom that prompts individual to seek urgent medical attention. Patients that presented early (within 24hrs) has better chances of complete hearing recovery. Keywords: Sudden Sensorineural hearing loss, treatment, outcome, Sokoto

BackgroundThis study explores the significance of computed tomography (CT) radiomic features, along with inflammation and nutrition biomarkers, in the prognosis of postoperative patients with T3N0M0 esophageal squamous cell carcinoma (ESCC). The study aims to construct a related nomogram.MethodsA total of 114 patients were enrolled and randomly assigned to training and validation cohorts in a 7:3 ratio. Radiomic features were extracted from their preoperative chest‐enhanced CT arterial images of the primary tumor, and inflammatory and nutritional indices, including neutrophil‐to‐lymphocyte ratio (NLR), lymphocyte‐to‐monocyte ratio (LMR), platelet‐to‐lymphocyte ratio (PLR), systemic immune‐inflammation index (SII), and prognostic nutritional index (PNI), were calculated based on laboratory data from the 3 days before surgery. Intra‐class correlations coefficient (ICC) and least absolute shrinkage and selection operator (Lasso) were applied to screen valuable radiomics features predicting overall survival (OS), and the Rad‐score was calculated. In the training cohort, univariate and multivariate Cox regression analyses identified independent prognostic factors, which were adopted to establish the nomogram.ResultsEight radiomic features were selected for Rad‐score calculation. Multivariate Cox regression revealed Rad‐score, PNI, NLR, and PLR as independent prognostic factors for ESCC patients (p < 0.05). A nomogram was constructed based on these variables. The concordance index (C‐index) for the nomogram was 0.797 (95% CI: 0.726–0.868) in the training cohort and 0.796 (95% CI: 0.702–0.890) in the validation cohort. Calibration curves indicated good calibration ability, and the receiver operating characteristic (ROC) analysis demonstrated superior discriminative ability for the nomogram in comparison to the Rad‐score alone. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram.ConclusionWe developed and validated a nomogram for predicting the OS of postoperative T3N0M0 ESCC patients, integrating nutritional, inflammatory markers, and radiomic signature. The combined nomogram can serve as a robust tool for risk stratification and clinical management.

Background and Objectives:Most cases of sudden deafness remain idiopathic. The majority of these cases are unilateral in their occurrences, whereas bilateral simultaneous involvement is rarely seen. We analyzed the clinical characteristics and treatment re- sults between bilateral and unilateral sudden sensorineural hearing loss (SSNHL), and considered the possible causes and provided available data for planning the appropriate treatment for bilateral SSNHL. Subjects and Method:Three hundred forty seven patients who visited the Department of Otolaryngology in Ajou University Hospital from June, 1994 to February, 2003 were clas- sified into 3 groups. Of these 347 patients, 16 patients (32 ears) had SSNHL simultaneously in both ears (Group I), 23 patients had SSNHL sequentially in both ears (Group II), and 308 patients had unilateral SSNHL (Group III). We reviewed their charts for pure tone audiometry information, medical history and lipid panel information to compare bilateral SSNHL with unilateral SSNHL. Results:The incidence of simultaneous bilateral SSNHL (Group I) was 4.6% of overall patients with SSNHL. Bi- lateral SSNHL occurs more commonly in patients of older age, with preexisting DM. Lpid panel abnormalities were compared with unilateral SSNHL. The recovery rate of hearing in simultaneous bilateral SSNHL (Group I) was 37.5% for both ears and 62.5% of patients, compared with 56.5% in unilateral SSNHL (Group III). Conclusion:Bilateral SSNHL is a very rare disease and the outcome from treatment is important for patients' quality of life. Recognition of similarities and differences between bi- lateral and unilateral SSNHL can help in counseling and managing the patients. (Korean J Otolaryngol 2005;48:848-53)