Audiogram Configuration Predicts Treatment Response in Sudden Sensorineural Hearing Loss

Objective To test whether the configuration of the initial pure tone audiogram (ascending, descending, flat or total‐deaf) predicts complete recovery and to explore its value as a building block for prognostic models. Study Design Retrospective cohort study. Setting Single tertiary care centre. Methods Adults with unilateral ISSNHL treated from January 2012 to December 2019 were categorised by audiogram configuration. Baseline characteristics and treatments were recorded. Multivariable logistic regression identified independent predictors of complete recovery; model performance was summarised by AUC and Nagelkerke R2. Results Among 487 patients (43.8% flat, 29.4% descending, 21.9% total‐deaf, 4.9% ascending), 80 (16.4%) achieved complete recovery. Complete recovery occurred in 50.0% of ascending, 25.2% flat, 9.8% descending and 0% total‐deaf. Descending (OR 0.25; 95% CI 0.15‐0.42) and total‐deaf (OR 0.05; 95% CI 0.01‐0.22) configurations independently predicted worse outcomes. Age and higher initial PTA were also negative predictors. AUC = 0.78; Nagelkerke R 2 = 0.32. Conclusion The initial audiogram configuration is an independent prognostic marker in ISSNHL. Ascending and flat patterns confer better prognosis than descending and total‐deaf patterns; such classifications should be integrated into clinical risk stratification and future predictive models.