Naibogllu

No additional improvement with the addition of intra-tympanic steroid to systemic steroid & hyperbaric oxygen treatment for sudden hearing loss

Clinical Bottom Line:

1. Overall both groups improved in terms of pure tone average measurement by the end of the study but there was no difference between groups. 2. In the subgroup of patients with profound hearing loss, those in the intratympanic steroid group may do better.

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Citation/s:1. Naibogllu B, Külekçi S, Sürmeli M, Verim A, Ertugay CK, Ýhvan O, Seneldir L, SZ Toros. Efficacy of multimodality approach to sudden hearing loss. The Turkish Journal of Ear, Nose and Throat. 2015; 25(2):77-81.

Lead author's name and email:Dr Onder Yhvan, onderihvan@yahoo.com Three-part Clinical Question: Does the addition of intra-tympanic steroid to systemic steroid & hyperbaric oxygen treatment improve the outcome of sudden hearing loss?

Search Terms:Hearing loss, steroid, intratympanic

The Study:Non-blinded randomised controlled trial with intention-to-treat.

The Study Patients:Patients presenting within 72 hours idiopathic hearing loss of at least 30dB over 3 contiguous test frequencies over 3 days.

Control group (N = 20; 20 analysed):Oral prednisone starting at 1mg/kg tapering over 14 days plus hyperbaric oxygen therapy (2.5atm for 90 minutes) once daily for 10 days

Experimental group (N = 38; 38 analysed):As above plus 3 intratympanic doses of 40mg prednisone commencing at the start of hyperbaric treatment and 3 days apart for subsequent doses.

The Evidence:

Outcome	Time to Outcome	Control group	Intra-tymp. group	Relative risk reduction	Absolute risk reduction	NNT
Complete recovery by Siegel's Criteria	1 month	0.30	0.29	4%	0.01	91
	95% CIs:			-79% to 86%	-0.24 to 0.26	NNT 4 to INF; NNH 4 to INF

 

Comments:

1. This study is not a trial of HBOT but rather a trial of intra-tympanic steroid

2. Methods do not describe the randomisation process or if blinded and small sample groups limit the generalisation of the study

4. Post-hoc subgroup analysis suggests the profoundly deaf subgroup had better recover with the addition of intra-tympanic steroids.

5. All patients had an MRI to exclude space occupying lesions.

6. Siegel’s criteria define complete recovery as an improvement of at least 25dB

Appraised by:Dr Katherine Witheridge Department of Diving and Hyperbaric Medicine Prince of Wales Hospital ; Friday, 4 May 2018: katherine.witheridge@health.nsw.gov.au

Kill or Update By:June 2022

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