Association between right-to-left shunt and sudden sensorineural hearing loss: a propensity score matching analysis_West China Medical Journal

Authors：

HUANG Xinle ¹ ,  ZENG Xianrong ^1,2 , FAN Jiangang ³

1. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
3. Department of Otorhinolaryngology-Head and Neck Surgery, Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding?author：

ZENG Xianrong, Email: 570574804@qq.com

Keywords：

Sudden sensorineural hearing loss; right-to-left shunt; contrast transthoracic echocardiography; inner ear microcirculation disorde; internal auditory artery

DOI：

10.7507/1002-0179.202509051

Video：

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Objective To investigate the association between right-to-left shunt (RLS) and sudden sensorineural hearing loss (SSNHL) by using propensity score matching to control for confounding factors. Methods We retrospectively analyzed the clinical data of patients with SSNHL (SSNHL group) and hospitalized patients without SSNHL or cerebral infarction (control group) admitted to the Department of Hyperbaric Oxygen, Sichuan Provincial People’s Hospital between January 2022 and May 2025. All subjects underwent contrast transthoracic echocardiography to assess RLS status. According to a 1:1 ratio, the age, gender, and comorbidities of the two groups were matched using propensity score matching, in order to balance baseline characteristics. A multivariate logistic regression model was used to quantify the strength of the association between RLS and SSNHL. Results A total of 335 subjects were included. Among them, there were 189 cases in the SSNHL group and 146 cases in the control group. Before matching, there were significant differences between the two groups in age, other comorbidities, and RLS positivity rate (P<0.05), except for gender and coronary heart disease (P＞0.05). After matching, 97 pairs of patients with balanced and comparable baseline characteristics were selected. After matching, the prevalence of RLS in the SSNHL group was significantly higher than that in the control group (57.7% vs. 34.0%; χ²=10.982, P＜0.001). The results of multiple logistic regression analysis showed that RLS was associated with SSNHL. Conclusions The association between RLS and SSNHL suggests that clinicians should prioritize RLS screening in patients with SSNHL to assess potential cardio-cerebrovascular risks

Citation： HUANG Xinle, ZENG Xianrong, FAN Jiangang. Association between right-to-left shunt and sudden sensorineural hearing loss: a propensity score matching analysis. West China Medical Journal, 2026, 41(3): 442-446. doi: 10.7507/1002-0179.202509051 Copy

1.	Bai X, Chen S, Xu K, et al. N-acetylcysteine combined with dexamethasone treatment improves sudden sensorineural hearing loss and attenuates hair cell death caused by Ros stress. Front Cell Dev Biol, 2021, 9: 659486.
2.	Joshua TG, Ayub A, Wijesinghe P, et al. Hyperbaric oxygen therapy for patients with sudden sensorineural hearing loss: a systematic review and Meta-analysis. JAMA Otolaryngol Head Neck Surg, 2022, 148(1): 5-11.
3.	Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg, 2019, 161(1_suppl): S1-S45.
4.	Chen I, Eligal S, Menahem O, et al. Time from sudden sensory neural hearing loss to treatment as a prognostic factor. Front Neurol, 2023, 14: 1158955.
5.	Lee HA, Chung JH. Contemporary review of idiopathic sudden sensorineural hearing loss: management and prognosis. J Audiol Otol, 2024, 28(1): 10-17.
6.	Kovács M, Uzsaly J, Bodzai G, et al. Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: a prospective randomized trial and risk factor analysis. Am J Otolaryngol, 2024, 45(1): 104099.
7.	Frosolini A, Franz L, Daloiso A, et al. Digging into the role of inflammatory biomarkers in sudden sensorineural hearing loss diagnosis and prognosis: a systematic review and Meta-analysis. Medicina (Kaunas), 2022, 58(7): 963.
8.	Tsuzuki N, Wasano K. Idiopathic sudden sensorineural hearing loss: a review focused on the contribution of vascular pathologies. Auris Nasus Larynx, 2024, 51(4): 747-754.
9.	Aimoni C, Bianchini C, Borin M, et al. Diabetes, cardiovascular risk factors and idiopathic sudden sensorineural hearing loss: a case-control study. Audiol Neurootol, 2010, 15(2): 111-115.
10.	Perlman HB, Kimura R, Fernandez C. Experiments on temporary obstruction of the internal auditory artery. Laryngoscope, 1959, 69(6): 591-613.
11.	彭靜華, 張鴻日, 段利科, 等. 合并肺水平右向左分流的隱源性缺血性腦卒中患者的臨床分析. 臨床神經病學雜志, 2023, 36(5): 347-350.
12.	Iguchi Y, Kimura K, Kobayashi K, et al. Sudden deafness and right-to-left shunts. Cerebrovasc Dis, 2008, 26(4): 409-412.
13.	楊慧娟, 喬英艷, 段銀玲, 等. 右心聲學造影檢測突發性耳聾患者右向左分流的臨床價值. 中國耳鼻咽喉顱底外科雜志, 2023, 29(6): 36-40.
14.	葉木奇, 邱益娟, 鄧聰穎, 等. 右心聲學造影評估突發性耳聾與右向左分流的相關性. 中國超聲醫學雜志, 2024, 40(12): 1354-1357.
15.	Capuano L, Cavaliere M, Lopardo D, et al. Right-to-left shunt and idiopathic sudden sensorineural hearing loss. Acta Otorhinolaryngol Ital, 2019, 39(2): 103-106.
16.	中華耳鼻咽喉頭頸外科雜志編輯委員會, 中華醫學會耳鼻咽喉頭頸外科學分會. 突發性聾診斷和治療指南(2015). 中華耳鼻咽喉頭頸外科雜志, 2015, 50(6): 443-447.
17.	王浩, 吳偉春, 施怡聲, 等. 卵圓孔未閉右心聲學造影中國專家共識. 中國循環雜志, 2022, 37(5): 449-458.
18.	Zheng J, Zhan Y, Cheng Y, et al. Correlation between right-to-left shunt and sudden sensorineural hearing loss: Protocol for a case-control study. BMJ Open, 2023, 13(11): e070771.
19.	Sun H, Yang Y, Yang R, et al. Paradoxical embolism in juveniles and young adults with severe-to-profound sudden sensorineural hearing loss. Ear Nose Throat J, 2024: 1455613241250185.
20.	張玉順, 于生元, 董釗, 等. 卵圓孔未閉相關非卒中性疾病防治中國專家共識. 心臟雜志, 2024, 36(2): 125-134.
21.	Ciorba A, Corazzi V, Cerritelli L, et al. Patent foramen ovale as possible cause of sudden sensorineural hearing loss: a case report. Med Princ Pract, 2017, 26(5): 491-494.
22.	Schreiber BE, Agrup C, Haskard DO, et al. Sudden sensorineural hearing loss. Lancet, 2010, 375(9721): 1203-1211.
23.	Ning M, Gonzalez RG. Case records of the massachusetts general hospital. Case 34-2013. A 69-year-old man with dizziness and vomiting. N Engl J Med, 2013, 369(18): 1736-1748.
24.	武德崴, 王秀玲, 郭呈龍, 等. Ct 肺動脈造影不可見的肺動靜脈交通與心源性栓塞的關系. 中華腦血管病雜志(電子版), 2025, 19(3): 207-212.
25.	Deng W, McMullin D, Inglessis-Azuaje I, et al. Effect of patent foramen ovale closure after stroke on circulatory biomarkers. Neurology, 2021, 97(2): e203-e214.
26.	姬慧娟, 姬慶文, 鄭修振. 對比增強經顱多普勒超聲診斷心源性栓塞性腦梗死的應用價值. 醫學影像學雜志, 2023, 33(4): 680-682.
27.	Tabuchi K, Nishimura B, Tanaka S, et al. Ischemia-reperfusion injury of the cochlea: pharmacological strategies for cochlear protection and implications of glutamate and reactive oxygen species. Curr Neuropharmacol, 2010, 8(2): 128-134.
28.	Lammers MJW, Young E, Westerberg BD, et al. Risk of stroke and myocardial infarction after sudden sensorineural hearing loss:a Meta-analysis. Laryngoscope, 2021, 131(6): 1369-1377.
29.	Zhong Y, Li H, Liu G, et al. Early detection of stroke at the sudden sensorineural hearing loss stage. Front Neurol, 2023, 14: 1293102.
30.	Lee H, Sohn SI, Jung DK, et al. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke, 2002, 33(12):2807-2812.
31.	Kuo CL, Shiao AS, Wang SJ, et al. Risk of sudden sensorineural hearing loss in stroke patients: a 5-year nationwide investigation of 44, 460 patients. Medicine (Baltimore), 2016, 95(36): e4841.
32.	Saver JL. Clinical practice. Cryptogenic stroke. N Engl J Med, 2016, 374(21): 2065-2074.
33.	汪昆, 王新蘭, 丁小強, 等. 高原地區介入封堵術在偏頭痛合并卵圓孔未閉患者中的應用效果分析. 高原醫學雜志, 2023, 33(2): 23-26.
34.	Elkattawy S, Alyacoub R, Singh KS, et al. Prothrombin G20210A gene mutation-induced recurrent deep vein thrombosis and pulmonary embolism: case report and literature review. J Investig Med High Impact Case Rep, 2022, 10: 23247096211058486.
35.	Capaccio P, Ottaviani F, Cuccarini V, et al. Genetic and acquired prothrombotic risk factors and sudden hearing loss. Laryngoscope, 2007, 117(3): 547-551.
36.	Cho SH, Chen H, Kim IS, et al. Association of the 4 g/5 g polymorphism of plasminogen activator inhibitor-1 gene with sudden sensorineural hearing loss. A case control study. BMC Ear Nose Throat Disord, 2012, 12: 5.

1. Bai X, Chen S, Xu K, et al. N-acetylcysteine combined with dexamethasone treatment improves sudden sensorineural hearing loss and attenuates hair cell death caused by Ros stress. Front Cell Dev Biol, 2021, 9: 659486.
2. Joshua TG, Ayub A, Wijesinghe P, et al. Hyperbaric oxygen therapy for patients with sudden sensorineural hearing loss: a systematic review and Meta-analysis. JAMA Otolaryngol Head Neck Surg, 2022, 148(1): 5-11.
3. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg, 2019, 161(1_suppl): S1-S45.
4. Chen I, Eligal S, Menahem O, et al. Time from sudden sensory neural hearing loss to treatment as a prognostic factor. Front Neurol, 2023, 14: 1158955.
5. Lee HA, Chung JH. Contemporary review of idiopathic sudden sensorineural hearing loss: management and prognosis. J Audiol Otol, 2024, 28(1): 10-17.
6. Kovács M, Uzsaly J, Bodzai G, et al. Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: a prospective randomized trial and risk factor analysis. Am J Otolaryngol, 2024, 45(1): 104099.
7. Frosolini A, Franz L, Daloiso A, et al. Digging into the role of inflammatory biomarkers in sudden sensorineural hearing loss diagnosis and prognosis: a systematic review and Meta-analysis. Medicina (Kaunas), 2022, 58(7): 963.
8. Tsuzuki N, Wasano K. Idiopathic sudden sensorineural hearing loss: a review focused on the contribution of vascular pathologies. Auris Nasus Larynx, 2024, 51(4): 747-754.
9. Aimoni C, Bianchini C, Borin M, et al. Diabetes, cardiovascular risk factors and idiopathic sudden sensorineural hearing loss: a case-control study. Audiol Neurootol, 2010, 15(2): 111-115.
10. Perlman HB, Kimura R, Fernandez C. Experiments on temporary obstruction of the internal auditory artery. Laryngoscope, 1959, 69(6): 591-613.
11. 彭靜華, 張鴻日, 段利科, 等. 合并肺水平右向左分流的隱源性缺血性腦卒中患者的臨床分析. 臨床神經病學雜志, 2023, 36(5): 347-350.
12. Iguchi Y, Kimura K, Kobayashi K, et al. Sudden deafness and right-to-left shunts. Cerebrovasc Dis, 2008, 26(4): 409-412.
13. 楊慧娟, 喬英艷, 段銀玲, 等. 右心聲學造影檢測突發性耳聾患者右向左分流的臨床價值. 中國耳鼻咽喉顱底外科雜志, 2023, 29(6): 36-40.
14. 葉木奇, 邱益娟, 鄧聰穎, 等. 右心聲學造影評估突發性耳聾與右向左分流的相關性. 中國超聲醫學雜志, 2024, 40(12): 1354-1357.
15. Capuano L, Cavaliere M, Lopardo D, et al. Right-to-left shunt and idiopathic sudden sensorineural hearing loss. Acta Otorhinolaryngol Ital, 2019, 39(2): 103-106.
16. 中華耳鼻咽喉頭頸外科雜志編輯委員會, 中華醫學會耳鼻咽喉頭頸外科學分會. 突發性聾診斷和治療指南(2015). 中華耳鼻咽喉頭頸外科雜志, 2015, 50(6): 443-447.
17. 王浩, 吳偉春, 施怡聲, 等. 卵圓孔未閉右心聲學造影中國專家共識. 中國循環雜志, 2022, 37(5): 449-458.
18. Zheng J, Zhan Y, Cheng Y, et al. Correlation between right-to-left shunt and sudden sensorineural hearing loss: Protocol for a case-control study. BMJ Open, 2023, 13(11): e070771.
19. Sun H, Yang Y, Yang R, et al. Paradoxical embolism in juveniles and young adults with severe-to-profound sudden sensorineural hearing loss. Ear Nose Throat J, 2024: 1455613241250185.
20. 張玉順, 于生元, 董釗, 等. 卵圓孔未閉相關非卒中性疾病防治中國專家共識. 心臟雜志, 2024, 36(2): 125-134.
21. Ciorba A, Corazzi V, Cerritelli L, et al. Patent foramen ovale as possible cause of sudden sensorineural hearing loss: a case report. Med Princ Pract, 2017, 26(5): 491-494.
22. Schreiber BE, Agrup C, Haskard DO, et al. Sudden sensorineural hearing loss. Lancet, 2010, 375(9721): 1203-1211.
23. Ning M, Gonzalez RG. Case records of the massachusetts general hospital. Case 34-2013. A 69-year-old man with dizziness and vomiting. N Engl J Med, 2013, 369(18): 1736-1748.
24. 武德崴, 王秀玲, 郭呈龍, 等. Ct 肺動脈造影不可見的肺動靜脈交通與心源性栓塞的關系. 中華腦血管病雜志(電子版), 2025, 19(3): 207-212.
25. Deng W, McMullin D, Inglessis-Azuaje I, et al. Effect of patent foramen ovale closure after stroke on circulatory biomarkers. Neurology, 2021, 97(2): e203-e214.
26. 姬慧娟, 姬慶文, 鄭修振. 對比增強經顱多普勒超聲診斷心源性栓塞性腦梗死的應用價值. 醫學影像學雜志, 2023, 33(4): 680-682.
27. Tabuchi K, Nishimura B, Tanaka S, et al. Ischemia-reperfusion injury of the cochlea: pharmacological strategies for cochlear protection and implications of glutamate and reactive oxygen species. Curr Neuropharmacol, 2010, 8(2): 128-134.
28. Lammers MJW, Young E, Westerberg BD, et al. Risk of stroke and myocardial infarction after sudden sensorineural hearing loss:a Meta-analysis. Laryngoscope, 2021, 131(6): 1369-1377.
29. Zhong Y, Li H, Liu G, et al. Early detection of stroke at the sudden sensorineural hearing loss stage. Front Neurol, 2023, 14: 1293102.
30. Lee H, Sohn SI, Jung DK, et al. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke, 2002, 33(12):2807-2812.
31. Kuo CL, Shiao AS, Wang SJ, et al. Risk of sudden sensorineural hearing loss in stroke patients: a 5-year nationwide investigation of 44, 460 patients. Medicine (Baltimore), 2016, 95(36): e4841.
32. Saver JL. Clinical practice. Cryptogenic stroke. N Engl J Med, 2016, 374(21): 2065-2074.
33. 汪昆, 王新蘭, 丁小強, 等. 高原地區介入封堵術在偏頭痛合并卵圓孔未閉患者中的應用效果分析. 高原醫學雜志, 2023, 33(2): 23-26.
34. Elkattawy S, Alyacoub R, Singh KS, et al. Prothrombin G20210A gene mutation-induced recurrent deep vein thrombosis and pulmonary embolism: case report and literature review. J Investig Med High Impact Case Rep, 2022, 10: 23247096211058486.
35. Capaccio P, Ottaviani F, Cuccarini V, et al. Genetic and acquired prothrombotic risk factors and sudden hearing loss. Laryngoscope, 2007, 117(3): 547-551.
36. Cho SH, Chen H, Kim IS, et al. Association of the 4 g/5 g polymorphism of plasminogen activator inhibitor-1 gene with sudden sensorineural hearing loss. A case control study. BMC Ear Nose Throat Disord, 2012, 12: 5.

West China Medical Journal

Association between right-to-left shunt and sudden sensorineural hearing loss: a propensity score matching analysis

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