Difference between revisions of "Chi"
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| − | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:"><span style="color:black">Hyperbaric oxygen improved outcome when added to poly-pharmacy treatment of idiopathic sudden hearing loss.</span></span></span>'''</span> |
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| − | <span style="line-height:normal"><span style="height:68.4pt">'''<span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="height:68.4pt">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical bottom line:</span></span>'''</span></span> |
| − | <span style="line-height:normal"><span style="height:68.4pt">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="height:68.4pt">'''<span style="font-size:12.0pt"><span style="font-family:">1. Using trial criteria, a higher proportion of patients recovered completely or partially when HBOT was added to treatment with steroids, pentoxifylline and dextran.<br/> 2. The subset with complete recovery was not significantly improved with HBOT.</span></span>'''</span></span> |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Citation/s:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1.Chi TH, Chiang MC, Chen RF, Yuan CH. Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?. Journal of the Royal Army Medical Corps. 2018 May 1;164(2):69-71.<br/> '''Lead author's name and fax: '''C H Yuan han86449@gmail.com</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Three-part Clinical Question:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">For patients with idiopathic sudden sensorineural hearing loss (ISSHL), does the addition of hyperbaric oxygen to standard treatment result in any improvement in hearing?<br/> '''Search Terms:''' hearing loss, steroids, pentoxifylline</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Study:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Non-blinded pseudo-randomised trial with intention-to-treat.<br/> '''The Study Patients:''' Soldiers with ISSHL (1 to 10 days after onset) who were previously well.<br/> '''Control group''' (N = 30; 30 analysed): Prednisolone 1mg/kg/day for one week then tapered to 20mg every 3 days for a further week, pentoxifylline 400mg bd for two weeks and 500 mls IV dextran daily for one week.<br/> '''Experimental group''' (N = 30; 30 analysed): As above plus from day 8 for one week they received twice daily at 2.5 ATA for 90 minutes.</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Evidence:</span></span></span>'''</span> |
{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Outcome</span>'''</span></p> |
| − | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Time to Outcome</span>'''</span></p> |
| − | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Standard group</span>'''</span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Hyperbaric group</span>'''</span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Relative risk reduction</span>'''</span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Absolute risk reduction</span>'''</span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">NNT</span>'''</span></p> |
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| − | | rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Complete recovery</span>'''</span></p> |
| − | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">180 days</span></span></p> |
| − | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.10</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.27</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">167%</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.17</span></span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">6</span></span></p> |
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| − | | colspan="3" style="width:164.9pt; border:solid windowtext 1.0pt" width="220" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | colspan="3" style="width:164.9pt; border:solid windowtext 1.0pt" width="220" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">95% CIs:</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">-358% to 24%</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">-0.36 to 0.02</span></span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">NNT = 3 to INF</span></span></p> <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">NNH = 41 to INF</span></span></p> |
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| − | | rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family: | + | | rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Complete or partial recovery</span>'''</span></p> |
| − | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:51.55pt; border:solid windowtext 1.0pt" width="69" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">180 days</span></span></p> |
| − | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:48.05pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.47</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.80</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">71%</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.33</span></span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">3</span></span></p> |
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| − | | colspan="3" style="width:164.9pt; border:solid windowtext 1.0pt" width="220" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | colspan="3" style="width:164.9pt; border:solid windowtext 1.0pt" width="220" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">95% CIs:</span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">22% to 120%</span></span></p> |
| − | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:69.35pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">0.10 to 0.56</span></span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="98" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-family:">2 to 10</span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Comments:</span></span></span>'''<br/> <span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1. Pseudo-randomised using alternate allocation - authors suggest all eligible patients were enrolled.<br/> 2. Complete recovery is defined as a threshold of 25dB or less and partial recovery was a gain of 15dB and a final threshold between 25 and 45 dB.<br/> 3. No differences between groups at day 8 (prior to HBO) or day 13.<br/> 4. Recovery of 47% in control group is within spontaneous recovery range while 80% recovery with the addition of HBOT is higher than expected.</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Saturday, 2 January 2021<br/> '''Kill or Update By:''' January 2022</span></span></span></span> |
| + | <p style="text-align: center;"> </p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;"><span style="font-size:xx-large;">[[Audiovestibular|BACK]]</span></p> | ||
Revision as of 21:25, 1 January 2021
Hyperbaric oxygen improved outcome when added to poly-pharmacy treatment of idiopathic sudden hearing loss.
|
Clinical bottom line: 1. Using trial criteria, a higher proportion of patients recovered completely or partially when HBOT was added to treatment with steroids, pentoxifylline and dextran. |
Citation/s:1.Chi TH, Chiang MC, Chen RF, Yuan CH. Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?. Journal of the Royal Army Medical Corps. 2018 May 1;164(2):69-71.
Lead author's name and fax: C H Yuan han86449@gmail.com
Three-part Clinical Question:For patients with idiopathic sudden sensorineural hearing loss (ISSHL), does the addition of hyperbaric oxygen to standard treatment result in any improvement in hearing?
Search Terms: hearing loss, steroids, pentoxifylline
The Study:Non-blinded pseudo-randomised trial with intention-to-treat.
The Study Patients: Soldiers with ISSHL (1 to 10 days after onset) who were previously well.
Control group (N = 30; 30 analysed): Prednisolone 1mg/kg/day for one week then tapered to 20mg every 3 days for a further week, pentoxifylline 400mg bd for two weeks and 500 mls IV dextran daily for one week.
Experimental group (N = 30; 30 analysed): As above plus from day 8 for one week they received twice daily at 2.5 ATA for 90 minutes.
The Evidence:
Outcome |
Time to Outcome |
Standard group |
Hyperbaric group |
Relative risk reduction |
Absolute risk reduction |
NNT |
Complete recovery |
180 days |
0.10 |
0.27 |
167% |
0.17 |
6 |
95% CIs: |
-358% to 24% |
-0.36 to 0.02 |
NNT = 3 to INF NNH = 41 to INF | |||
Complete or partial recovery |
180 days |
0.47 |
0.80 |
71% |
0.33 |
3 |
95% CIs: |
22% to 120% |
0.10 to 0.56 |
2 to 10 | |||
Comments:
1. Pseudo-randomised using alternate allocation - authors suggest all eligible patients were enrolled.
2. Complete recovery is defined as a threshold of 25dB or less and partial recovery was a gain of 15dB and a final threshold between 25 and 45 dB.
3. No differences between groups at day 8 (prior to HBO) or day 13.
4. Recovery of 47% in control group is within spontaneous recovery range while 80% recovery with the addition of HBOT is higher than expected.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Saturday, 2 January 2021
Kill or Update By: January 2022
