**1. Introduction**

392 Hearing Loss

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Idiopathic sudden sensorineural hearing loss (ISSHL), sometimes called sudden sensorineural hearing loss (SSHL) is usually defined as loss of at least 30 dB in 3 contiguous frequencies over a period of 3 days or less.

It is difficult to estimate the efficacy of the various treatments and impact of prognostic factors for ISSHL because the natural history of ISSHL is still unknown (Fetterman et al., 1996). There have been many studies reported the effect of various treatment including systemic corticosteroids, tympanic corticosteroids injection, antiviral, anticoagulant, and vitamin etc. on ISSHL, but the results were controversial (Eisenman D., 2000).

There also have been several studies reported the prognostic factors of ISSHL (Mattox & Simmons, 1977; Shikowitz, 1991; Byl, 1984; Ceylan et al., 2007). However, the rate of spontaneous recovery of ISSHL is 45 to 65 percent (Mattox & Simmons, 1977; Eisenman D., 2000) and there is no improvement criterion that was universally accepted. Thus, the results of several studies for prognostic factors were also controversial.

Traditional Chinese Medicine (TCM) has long been widely used in East Asia. Acupuncture is frequently used for the treatment of neurological conditions (Lee et al., 2007). Since 1970s, there have been some studies which reported effect of acupuncture on ISSHL. Some studies reported positive results (Yoon et al., 2003; Ha & Choi, 2003), while the others reported the opposite trend (Vincent & Richardson, 1987; Borton, 1976).

In previous study, we demonstrated that the acupuncture treatment (AT) has some effect on ISSHL patients who did not respond to conventional therapy (Yin et al., 2010). However, the efficacy and prognostic factors of AT on ISSHL are still unclear.

This study was conducted to evaluate the effects and prognostic factors of AT for ISSHL. We analyzed variables which related to improvement in ISSHL by AT; these included gender, age, location of lesion, presence of vertigo, presence of disease (hypertension and diabetes mellitus), the time interval from the onset of hearing loss to the start of AT and severity of hearing loss on the day of the initial visit. We also analyzed our data to search the

Effects and Prognostic Factors of

**2.2 Audiological assessment** 

**2.3 Acupuncture treatment** 

**2.4 Statistical analysis** 

software for windows.

SPSS 17.0 statistical software for windows.

less than 25dB but decreased in PTA of 10 dB or more.

Acupuncture Treatment for Idiopathic Sudden Sensorineural Hearing Loss 395

All patients underwent a full physical exam as well as a routine audiological evaluation and otolaryngologic history was also recorded. Magnetic resonance images were acquired if necessary. Pure tone audiograms were conducted using a *GSI 61 audiogram (Grason-Stadler, Inc., WI, USA)* on the day of the initial visit and the day of the follow-up measurement, which was usually after 10 rounds (1st follow-up) and 20 rounds (2nd follow-up) of AT. However, the follow-up measurement was performed before 10 or 20 rounds of acupuncture for some patients who request an earlier audiogram because they felt clear improvement. If partial improvement in the audiogram was observed at the time of the first follow-up measurement, AT was continued until the second follow-up measurement. The hearing results were evaluated based on the pure tone average (PTA) of 4 frequencies (250, 500, 1000, 2000 Hz). A clear improvement of hearing was defined as a final hearing level less than 25 dB and a partial improvement of hearing was defined as a final hearing level not

All patients received the same method of AT from one TCM doctor. It was typically performed two times a week and the frequency was increased or decreased as necessary. The sterile acupuncture needles (length: 40 mm and diameter: 0.25 mm, Dondbang Co. Korea) were inserted to a depth of 10 - 30 mm until the patient felt the characteristic needling sensation of soreness, numbness or distension around the acupuncture point. Stimulated acupuncture points included GV14, GV15, GV16, GB20, GB21, BL10, SI4, SI15 and additional local points (TE21, TE22, SI19, GB2, ST7, BL2, LI20, GV20, EX-HN3) as necessary in the prone position, right after the 1st stimulated acupuncture were removed, and the liver tonification formula of Saam acupuncture theory (KI10, LR8, LU8 and LR4) (Yin CS et al., 2007) which were combined with contralateral LI4, LR3, and ST36 in the supine position. The needles were retained at each position for 10 minutes. Most patients were also administered herbal medicine individually to improve their body condition.

All continuous variables represented in this study were expressed as the means ± the standard deviation and all categorical variables were expressed as patient number and percentage (%). The differences between improvement and no improvement groups were analyzed by the independent-samples T test for all continuous variables if the distribution was normal. If the distribution was abnormal, the differences between groups were analyzed by the Mann-Whitney U test. In addition, categorical variables were analyzed using a Chi-square test or Fisher's exact test. These statistical analyses were conducted using

We also analyzed our data using the feature selection model to classify the important variables. Then, based on these important variables, we analyzed our data using a decision tree model to identify and rank prognostic factors affecting the improvement of ISSHL by AT. These calculations were performed using SPSS Clementine version 12.0 statistical

Probability values of 0.05 or less were considered statistically significant.

prognostic factors affecting the improvement of ISSHL using feature selection analysis and decision tree model.
