Clinical Significance of White Matter Lesions in Idiopathic Sudden Sensorineural Hearing Loss

Background : We aimed to analyze the patient characteristics in accordance with white matter lesions and confirm whether white matter lesions affect final treatment outcomes in idiopathic sudden sensorineural hearing loss. Methods: Medical records of 126 patients treated for unilateral idiopathic sudden sensorineural hearing loss and who underwent magnetic resonance imaging of the brain at an otology clinic in a university hospital from 2013 to June 2019 were reviewed. The Fazekas scale was used to evaluate the severity of white matter lesions. Complete recovery was defined if final hearing at 3 months did not exceed 25 dB. Results: Overall, 107 patients were enrolled in this study. A score of 0 on the Fazekas scale was most frequent (n = 78, 72.9%), followed by 1 (n = 17, 15.9%), and 2 (n = 12, 11.2%). Prevalence of diabetes (P = .032) and/or hypertension (P = .006) and distribution of age (P < .001) were different according to Fazekas scale scores. Hearing level in the affected side was significantly different between those with scores of 1 and 2 (P = .009). Contralateral hearing thresholds were not different according to Fazekas scale scores, but hearing on the contralateral side was significantly poorer in patients with hypertension than those without hypertension (P < .001). Regression analysis revealed that Fazekas scale score and initial hearing thresholds of the affected side were significant prognostic factors for complete recovery. Conclusion: Although the prevalence of white matter lesions in idiopathic sudden sensorineural hearing loss was not high, severe white matter lesions and accompanying cardiovascular risk factors may increase the possibility of initially worse hearing and decrease response to treatment in idiopathic sudden sensorineural hearing loss. Therefore, it might be important to control cardiovascular abnormalities in idiopathic sudden sensorineural hearing loss to achieve a better prognosis.