Difference between revisions of "Cekin"

(Imported from Wikispaces)
 
 
Line 1: Line 1:
−
'''<span style="font-size: 14pt;">No evidence of benefit with hyperbaric oxygen therapy for sudden hearing loss.</span>'''
 
  
−
**<span style="font-size: 11pt;">Bottom line</span>'''
+
<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">No evidence of benefit with hyperbaric oxygen therapy for sudden hearing loss.</span></span>'''</span>
−
# <span style="font-size: 11pt;">Statistically non-significant small benefit for those treated with HBOT. </span>
 
  
−
**<span style="font-size: 11pt;">Citations</span>'''
+
<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Bottom Line:</span></span>'''</span>
−
<span style="font-size: 11pt;">Çekin E, Cincik H, Ulubil SA, Gungor A. Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. The journal of laryngology and otology 2009; 123: 609-12.</span>
 
  
−
**<span style="font-size: 11pt;">Three-part clinical question</span>'''
+
#<span style="line-height:normal"><span style="tab-stops:list 36.0pt"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">Statistically non-significant small benefit for those treated with HBOT.</span></span></span></span>  
−
<span style="font-size: 11pt;">For patients with sudden hearing loss within 3 days of onset, does the application of hyperbaric oxygen combined with systemic corticosteroid therapy, compared to corticosteroid therapy alone, improve hearing recovery. </span>
 
  
−
**<span style="font-size: 11pt;">Search Terms</span>'''
+
----
−
<span style="font-size: 11pt;">Sudden Hearing Loss, Inner Ear</span>
 
  
−
**<span style="font-size: 11pt;">The study</span>'''
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Citations:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.'''Çekin E, Cincik H, Ulubil SA, Gungor A. Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. The journal of laryngology and otology 2009; 123: 609-12.</span></span></span>
−
<span style="font-size: 11pt;">Non-blinded randomised controlled trial. Intention to treat not stated.</span>
 
  
−
**<span style="font-size: 11pt;">The study patients</span>'''
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Three-part clinical question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">For patients with sudden hearing loss within 3 days of onset, does the application of hyperbaric oxygen combined with systemic corticosteroid therapy, compared to corticosteroid therapy alone, improve hearing recovery.</span></span></span>
−
<span style="font-size: 11pt;">Males and females aged 18-82 with sudden onset hearing loss either or both ears, within 3 days. Hearing loss defined as loss of at least 30dB in three frequencies within three days of enrolment. </span>
 
−
<span style="font-size: 11pt;">EXPERIMENTAL GROUP (n=36), 100% oxygen at 2.5 ATA for 90 minutes, 10 daily sessions over 10 days plus prednisolone 1mg/kg starting dose reducing over three weeks plus famotidine 40mg daily. </span>
 
−
<span style="font-size: 11pt;">CONTROL GROUP (n=21) Drugs as above but no HBOT.</span>
 
  
−
**<span style="font-size: 11pt;">The evidence:</span>'''
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Sudden Hearing Loss, Inner Ear</span></span></span>
  
−
{|
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Non-blinded randomised controlled trial. Intention to treat not stated.</span></span></span>
−
| '''<span style'''"font-size: 10pt;">Outcome</span>''' || '''<span style'''"font-size: 10pt;">Time to Outcome</span>''' || '''<span style'''"font-size: 10pt;">Control Group Rate</span>''' || '''<span style'''"font-size: 10pt;">HBOT Group Rate</span>''' || '''<span style'''"font-size: 10pt;">Relative Risk Reduction</span>''' || '''<span style'''"font-size: 10pt;">Absolute Risk Reduction</span>''' || '''<span style="font-size: 10pt;">NNT</span>'''  
+
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The study patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Males and females aged 18-82 with sudden onset hearing loss either or both ears, within 3 days. Hearing loss defined as loss of at least 30dB in three frequencies within three days of enrolment.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control Group (n=21):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Prednisolone 1mg/kg starting dose reducing over three weeks plus famotidine 40mg daily.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO Group (n=36):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">As above plus 100% oxygen at 2.5 ATA for 90 minutes, 10 daily sessions over 10 days.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The evidence:</span></span>'''</span>
 +
 
 +
{| class="Table" style="border: 1pt solid windowtext; width: 741px;"
 
|-
 
|-
−
| '''<span style'''"font-size: 10pt;">Improved with treatment* </span>''' || <span style'''"font-size: 10pt;">10 days </span> || <span style'''"font-size: 10pt;">0.71</span> || <span style'''"font-size: 10pt;">0.83</span> || <span style'''"font-size: 10pt;">14%</span> || <span style'''"font-size: 10pt;">0.12</span> || <span style="font-size: 10pt;">8</span>  
+
| style="width: 151px; border: 1pt solid windowtext;" width="120" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>
 +
| style="width: 83px; border: 1pt solid windowtext;" width="68" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
 +
| style="width: 57px; border: 1pt solid windowtext;" width="68" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control Group</span></span>'''</span></p>
 +
| style="width: 74px; border: 1pt solid windowtext;" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBOT Group</span></span>'''</span></p>
 +
| style="width: 106px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative Risk Reduction</span></span>'''</span></p>
 +
| style="width: 112px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute Risk Reduction</span></span>'''</span></p>
 +
| style="width: 104px; border: 1pt solid windowtext;" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p>  
 
|-
 
|-
−
|^  |||||| <span style'''"font-size: 10pt;">95% CIs:</span> || <span style'''"font-size: 10pt;">-13% to 42%</span> || <span style'''"font-size: 10pt;">-0.11 to 0.35</span> || <span style'''"font-size: 10pt;">NNT ''' 3 to INF; NNH ''' 9 to INF</span>  
+
| rowspan="2" style="width: 151px; border: 1pt solid windowtext;" width="120" |  
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Complete or moderate improvement with treatment</span></span>'''</span>
 +
 
 +
| style="width: 83px; border: 1pt solid windowtext;" width="68" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">10 days</span></span></span></p>
 +
| style="width: 57px; border: 1pt solid windowtext;" width="68" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.71</span></span></span></p>
 +
| style="width: 74px; border: 1pt solid windowtext;" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.83</span></span></span></p>
 +
| style="width: 106px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">14%</span></span></span></p>
 +
| style="width: 112px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.12</span></span></span></p>
 +
| style="width: 104px; border: 1pt solid windowtext;" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">8</span></span></span></p>  
 
|-
 
|-
 +
| colspan="3" style="width: 228px; border: 1pt solid windowtext;" width="201" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CIs:</span></span></span></p>
 +
| style="width: 106px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-13% to 42%</span></span></span></p>
 +
| style="width: 112px; border: 1pt solid windowtext;" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.11 to 0.35</span></span></span></p>
 +
| style="width: 104px; border: 1pt solid windowtext;" width="72" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 3 to INF; NNH 9 to INF</span></span></span></p>
 
|}
 
|}
−
<span style="font-size: 10pt;">*Complete or ‘moderate’ improvement</span>
 
  
−
**<span style="font-size: 11pt;">Comments</span>'''
+
&nbsp;
−
# <span style="font-size: 11pt;">Large difference in patient numbers between treatment and control arms is not explained. </span>
+
 
−
# <span style="font-size: 11pt;">Time period of outcome assessment not defined (possibly at 10 days).</span>
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Comments:</span></span>'''</span>
−
# <span style="font-size: 11pt;">Reducing dose of prednisolone regimen not stated.</span>
+
 
−
# <span style="font-size: 11pt;">Average mean audiometry quoted in dB, but how many frequencies affected not described.</span>
+
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Large difference in patient numbers between treatment and control arms is not explained.</span></span></span>
−
# <span style="font-size: 11pt;">Power calculation is inadequately described – no suggestion what effect they were aiming to confirm.</span>
+
 
−
# <span style="font-size: 11pt;">12 years to collect data at a single centre</span>
+
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2, Time period of outcome assessment not defined (possibly at 10 days).</span></span></span>
−
# <span style="font-size: 11pt;">Two patients in study group recruited outside the protocol period</span>
+
 
−
# <span style="font-size: 11pt;">Some discrepancy between text and Table II results. </span>
+
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. Reducing dose of prednisolone regimen not stated.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">4. Average mean audiometry quoted in dB, but how many frequencies affected not described.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">5. Power calculation is inadequately described – no suggestion what effect they were aiming to confirm.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">6. 12 years to collect data at a single centre and two patients recruited outside the protocol period</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">7. Some discrepancy between text and Table II results.</span></span></span>
 +
 
 +
&nbsp;
  
−
**<span style="font-size: 11pt;">Appraised by</span>'''<span style="font-size: 11pt;">: D. Smart Monday 1st August 2016</span>
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">D. Smart, Monday 1st August 2016</span></span><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">[mailto:dsmart@iinet.net.au| <span style="color:blue">dsmart@iinet.net.au</span>]</span></span></span>
−
<span style="font-size: 11pt;">Email : <span style="text-decoration: none;">[[mailto:dsmart@iinet.net.au | dsmart@iinet.net.au]]</span></span>
 
  
−
**<span style="font-size: 11pt;">Kill or Update by :</span>'''<span style="font-size: 11pt;"> June 2020</span>
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Kill or Update by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">June 2022</span></span></span>
  
−
[[File:sumhorsa.gif|center]]
+
[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
−
<span style="display: block; text-align: center;">[[Audiovestibular | BACK]]</span>
+
<span style="display: block; text-align: center;"><span style="font-size:xx-large;">[[Audiovestibular|BACK]]</span></span> <span style="display: block; text-align: center;"></span>
−
<span style="display: block; text-align: center;">
 
−
</span>
 

Latest revision as of 01:45, 30 September 2021

No evidence of benefit with hyperbaric oxygen therapy for sudden hearing loss.

Clinical Bottom Line:

  1. Statistically non-significant small benefit for those treated with HBOT.

Citations:1.Çekin E, Cincik H, Ulubil SA, Gungor A. Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. The journal of laryngology and otology 2009; 123: 609-12.

Three-part clinical question:For patients with sudden hearing loss within 3 days of onset, does the application of hyperbaric oxygen combined with systemic corticosteroid therapy, compared to corticosteroid therapy alone, improve hearing recovery.

Search Terms:Sudden Hearing Loss, Inner Ear

The study:Non-blinded randomised controlled trial. Intention to treat not stated.

The study patients:Males and females aged 18-82 with sudden onset hearing loss either or both ears, within 3 days. Hearing loss defined as loss of at least 30dB in three frequencies within three days of enrolment.

Control Group (n=21):Prednisolone 1mg/kg starting dose reducing over three weeks plus famotidine 40mg daily.

HBO Group (n=36):As above plus 100% oxygen at 2.5 ATA for 90 minutes, 10 daily sessions over 10 days.

The evidence:

Outcome

Time to Outcome

Control Group

HBOT Group

Relative Risk Reduction

Absolute Risk Reduction

NNT

Complete or moderate improvement with treatment

10 days

0.71

0.83

14%

0.12

8

95% CIs:

-13% to 42%

-0.11 to 0.35

NNT 3 to INF; NNH 9 to INF

 

Comments:

1. Large difference in patient numbers between treatment and control arms is not explained.

2, Time period of outcome assessment not defined (possibly at 10 days).

3. Reducing dose of prednisolone regimen not stated.

4. Average mean audiometry quoted in dB, but how many frequencies affected not described.

5. Power calculation is inadequately described – no suggestion what effect they were aiming to confirm.

6. 12 years to collect data at a single centre and two patients recruited outside the protocol period

7. Some discrepancy between text and Table II results.

 

Appraised by:D. Smart, Monday 1st August 2016dsmart@iinet.net.au

Kill or Update by:June 2022

Sumhorsa.gif

BACK

Retrieved from "http://hboevidence.wikis.unsw.edu.au/index.php?title=Cekin&oldid=1154"