Prognostic value of initial hearing threshold and accompanying symptoms in pediatric sudden sensorineural hearing loss: An age-stratified analysis using a 6-year cutoff

OBJECTIVE: To evaluate the prognostic value of initial hearing threshold, accompanying symptoms, and systemic inflammatory indices in pediatric sudden sensorineural hearing loss (SSNHL), and explore whether these associations differ by age. METHODS: This retrospective cohort included 212 children with SSNHL treated between July 2015 and August 2025. Hearing recovery was classified as recovered or non-recovered. Multivariable logistic regression assessed age, sex, initial hearing threshold, time to treatment, tinnitus, vertigo, ear fullness, and hematological indices. Prespecified exploratory analyses compared children aged ≤6 years with those aged >6 years. Sensitivity analysis excluded 15 patients assessed exclusively by auditory brainstem response. RESULTS: Overall, 120 patients (56.6%) recovered. A lower initial hearing threshold was independently associated with recovery in both clinical and fully adjusted models (adjusted odds ratio per 1-dB HL increase, 0.981; 95% CI, 0.969-0.995; P = 0.006 and 0.982; 95% CI, 0.969-0.995; P = 0.009, respectively). Time to treatment, accompanying symptoms, and NLR, PLR, LMR, and SII were not independently associated with recovery. In age-stratified analyses, initial hearing threshold remained significant in children aged >6 years but not in those aged ≤6 years; however, the threshold-by-age interaction was not significant (P = 0.616). Sensitivity analysis yielded consistent findings. CONCLUSION: Initial hearing threshold was the principal independent prognostic factor for recovery in this pediatric cohort. Accompanying symptoms and systemic inflammatory indices provided little additional prognostic information. Age-stratified findings require cautious interpretation and prospective validation.