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Intratympanic glucocorticosteroid therapy for idiopathic sudden hearing loss: Meta-analysis of randomized controlled trials.

Abstract Glucocorticoids are the standard treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but whether intratympanic or systemic therapy is superior remains controversial. Previous meta-analyses of this question have omitted key clinical trials or included observational studies.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390288
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Intratympanic glucocorticosteroid therapy for idiopathic sudden hearing loss:
      Meta-analysis of randomized controlled trials.
PG  - e8955
LID - 10.1097/MD.0000000000008955 [doi]
AB  - BACKGROUND AND OBJECTIVE: Glucocorticoids are the standard treatment for
      idiopathic sudden sensorineural hearing loss (ISSNHL), but whether intratympanic 
      or systemic therapy is superior remains controversial. Previous meta-analyses of 
      this question have omitted key clinical trials or included observational studies.
      METHODS: English-language randomized controlled trials in OvidSP, PubMed, Embase,
      CINAHL, and the Cochrane Library comparing intratympanic versus systemic
      glucocorticoid therapy for ISSNHL were meta-analyzed using RevMan 5.3. The
      primary outcome of interest was improvement in pure tone average (PTA) threshold.
      RESULTS: Six trials involving 248 patients receiving intratympanic steroids and
      236 receiving systemic steroids were meta-analyzed. PTA thresholds were similar
      between the 2 groups at 3 months after therapy initiation (mean difference, 0.24;
      95% confidence interval [CI] -2.43 to 2.91, P = .86; I = 54%, P = .07,
      random-effects model). PTA thresholds were also similar at 6 months (mean
      difference, 4.69, 95% CI -5.84 to 15.22, P = .38), although the results showed
      extremely high heterogeneity (I = 98%). Sensitivity analysis indicated that a
      single trial containing 250 patients provided the strongest evidence for
      equivalence between the 2 types of therapy. Rates of recovery within 3 months
      (defined as PTA improvement >10 dB) were similar between the 2 types of therapy
      (odds ratio 0.92, 95% CI 0.59-1.43, P = .70), with no significant heterogeneity
      in the pooled data (I = 1%, P = .40). CONCLUSION: Intratympanic and systemic
      steroids' therapies appear to show similar short-term efficacy for restoring
      hearing in patients with ISSNHL. Intratympanic therapy may reduce systemic side
      effects associated with steroid use.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Lai, Dan
AU  - Lai D
AD  - Hearing Center/Hearing and Speech Science Laboratory, Department of
      Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, 
      Chengdu.
AD  - Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of
      Southwest Medical University, Luzhou, China.
FAU - Zhao, Fei
AU  - Zhao F
AD  - Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge,
      England.
AD  - Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University,
      Guangzhou, China.
FAU - Jalal, Nasim
AU  - Jalal N
AD  - Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge,
      England.
FAU - Zheng, Yun
AU  - Zheng Y
AD  - Hearing Center/Hearing and Speech Science Laboratory, Department of
      Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, 
      Chengdu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Glucocorticoids)
SB  - AIM
SB  - IM
MH  - Glucocorticoids/*therapeutic use
MH  - Hearing Loss, Sensorineural/*drug therapy
MH  - Hearing Loss, Sudden/*drug therapy
MH  - Humans
MH  - Injection, Intratympanic
MH  - Randomized Controlled Trials as Topic
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000008955 [doi]
AID - 00005792-201712150-00038 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e8955. doi: 10.1097/MD.0000000000008955.