Work

Paired-ear tympanometric pressure patterns and hearing recovery in unilateral sudden sensorineural hearing loss: a retrospective cohort study

Year: 2026

Type: article

Abstract: Background: Sudden sensorineural hearing loss (SSNHL) remains difficult to phenotype and predict. Tympanometry is routinely performed, yet its quantitative pressure information is largely discarded once conductive hearing loss is excluded. We used a paired-ear strategy to compare middle-ear pressure between the affected and contralateral ears in unilateral SSNHL. Methods: We retrospectively studied 203 adults with unilateral SSNHL and bilateral tympanometric peak pressure (TPP) measurements. Rather than relying on a single abnormality threshold, we integrated signed interaural differences, absolute pressure asymmetry, laterality-aware pressure phenotypes, and threshold-sensitivity analyses. Among patients with follow-up audiometry, hearing recovery was quantified as both continuous hearing gain and clinically meaningful ≥15-dB improvement, and was further examined in relation to categorical and continuous TPP phenotypes. Results: = 0.410), indicating no consistent affected-ear pressure abnormality at the population level. Laterality-aware classification identified affected-ear-only negative pressure in 14 patients (6.9%) and contralateral-ear-only negative pressure in 11 patients (5.4%). This subgroup would be largely invisible using conventional single-ear classification. Across complementary binary, continuous, and multivariable analyses, tympanometric pressure showed no robust relationship with short-term hearing recovery, and this conclusion remained stable across alternative pressure thresholds. Conclusion: Unilateral SSNHL is not characterized by a universal middle-ear pressure abnormality. Paired-ear assessment can identify individual differences in middle-ear pressure that may be overlooked by single-ear classification. However, baseline TPP was not clearly associated with short-term hearing recovery in this cohort.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1982019