Jônatas Bussador do Amaral, Tracy Lima Tavares Soeiro, Marina Cançado Passarelli Scott, Flávia Tatiana Pedrolo Hortense, Flávia Alencar de Barros, Carolina Nunes França, Luiz Henrique da Silva Nali, André Luis Lacerda Bachi, Elizabeth Cristina Perez, Sujana S. Chandrasekhar, Norma de Oliveira Penido
Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that can substantially impair communication and quality of life. Recovery trajectories are highly variable, and despite the widespread use of corticosteroids, the biological processes associated with hearing recovery remain incompletely characterized. In this longitudinal study, we quantified inflammatory, metabolic, vascular, and regulatory mediators: total cholesterol, HDL, LDL, triglycerides, glucose, IL-6, IL-8, IL-12p70, IL-10, GM-CSF, CXCL10, IFN-α2, IFN-β, IFN-λ1, VEGF, and Klotho, in 65 patients with acute SSNHL who all received a standardized corticosteroid regimen, using multiplex immunoassay, ELISA, and colorimetric assays at 7, 30, and 120 days. Trajectories were compared between patients with complete or significant recovery and those with partial or no recovery. Although several mediators changed significantly over time, their absolute concentrations overlapped between outcome groups, limiting their standalone prognostic value. By contrast, biomarker co-variation differed by outcome: patients with favorable recovery showed progressive attenuation of IL-6-centered inflammatory correlations and evolving interferon and immune-metabolic associations, whereas poor-recovery patients retained more persistent correlations. Klotho declined over time only in recovered patients, in whom it correlated early with VEGF. These findings suggest that recovery is better reflected by temporal changes in biomarker correlation patterns than by isolated mediator levels, supporting longitudinal and integrative biomarker assessment.