Blood biomarkers of response to concomitant intratympanic and systemic corticosteroids treatment for idiopathic sudden sensorineural hearing loss

Purpose: To evaluate the prognostic value of hematological inflammatory biomarkers in predicting hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with combined systemic and intratympanic corticosteroids. Methods: This retrospective study included 125 patients diagnosed with ISSNHL between 2012 and 2021 who received both oral prednisone and intratympanic methylprednisolone. Clinical data and pre-treatment blood samples were collected. Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Hearing outcomes were classified as complete, partial, or no recovery based on pure tone average (PTA) thresholds. Univariate and multivariable logistic regression analyses were performed to identify predictors of recovery. Results: Of the 125 patients, 33 (26.4%) had no recovery, 50 (40.0%) partial recovery, and 42 (33.6%) complete recovery. Dizziness, current smoking, delayed treatment initiation (> 7 days), elevated triglycerides (≥ 98 mg/dL), and high PLR (≥ 142) were independently associated with a lower probability of hearing recovery. A higher LMR (≥ 3.0) showed a positive trend but did not reach statistical significance in adjusted models. Conclusions: In patients with ISSNHL treated with dual-route corticosteroids, several clinical and hematologic factors, particularly elevated PLR and delayed treatment, are independently associated with reduced odds of hearing recovery. Inflammatory blood markers may serve as accessible prognostic tools to support early risk stratification.