Difference between revisions of "Cvorovic"
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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:">Both hyperbaric oxygen and intratympanic steroid injection improved hearing thresholds in patients with sudden idiopathic hearing loss.</span></span>'''</span> |
| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">Clinical bottom line:</span>'''</span></span> |
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| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">1. HBOT and ITS seemed to improve sudden sensorineural hearing loss to a similar extent</span>'''</span></span> |
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| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">Citation/s:</span>'''<span style="font-family:">1. Cvorovic L, Jovanovic MB, Milutinovic Z, Arsovic N, Djeric D. Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss. Otology & Neurotology. 2013 Aug 1;34(6):1021-6.<br/> '''Lead author's name and fax: '''Ljiljana Cvorovic cvorcica@yahoo.com</span></span></span> |
| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">Three-part Clinical Question:</span>'''<span style="font-family:">For patients with idiopathic sudden sensorineural hearing loss (ISSHL) and failure to respond to intravenous/oral steroids, does hyperbaric oxygen or intratympanic steroid administration result in improved hearing?<br/> '''Search Terms:''' ISSHL; steroids; intratympanic steroids</span></span></span> |
| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">The Study:</span>'''<span style="font-family:">Non-blinded randomised controlled trial with intention-to-treat.<br/> '''The Study Patients:''' Patients with ISSHL and failure to respond with at least 10dB threshold improvement with 3 days of IV steroid followed by 3 further days of oral steroid.<br/> '''Control group''' (N = 25; 25 analysed): Intratympanic steroids four times in 13 days at a dose of around 2 mg each time.<br/> '''Experimental group''' (N = 25; 25 analysed): 100% oxygen breathing at 2 ATA for 60 minutes daily, Monday to Friday.</span></span></span> |
| − | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:">The Evidence:</span>'''</span></span> |
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| − | | rowspan="2" style="width:146.25pt" width="195" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | rowspan="2" style="width:146.25pt; border:solid windowtext 1.0pt" width="195" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Measure</span></span>'''</span></p> |
| − | | colspan="2" style="width:83.5pt" width="111" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | colspan="2" style="width:83.5pt; border:solid windowtext 1.0pt" width="111" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">ITS Group</span></span>'''</span></p> |
| − | | colspan="2" style="width:69.4pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | colspan="2" style="width:69.4pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">HBOT Group</span></span>'''</span></p> |
| − | | rowspan="2" style="width:62.25pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | rowspan="2" style="width:62.25pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Difference</span></span>'''</span></p> |
| − | | rowspan="2" style="width:80.1pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | rowspan="2" style="width:80.1pt; border:solid windowtext 1.0pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span>'''</span></p> |
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| − | | style="width:33.9pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:33.9pt; border:solid windowtext 1.0pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p> |
| − | | style="width:48.1pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.1pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p> |
| − | | style="width:19.75pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:19.75pt; border:solid windowtext 1.0pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p> |
| − | | style="width:48.15pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p> |
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| − | | style="width:146.25pt" width="195" | | + | | style="width:146.25pt; border:solid windowtext 1.0pt" width="195" | |
| − | <span style=" | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Pure tone average threshold at 4 weeks (dB) at 2kHz</span></span>'''</span> |
| − | | style="width:33.9pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:33.9pt; border:solid windowtext 1.0pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">16.35</span></span></span></p> |
| − | | style="width:48.1pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.1pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">9.3</span></span></span></p> |
| − | | style="width:19.75pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:19.75pt; border:solid windowtext 1.0pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">11.41</span></span></span></p> |
| − | | style="width:48.15pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">4.91</span></span></span></p> |
| − | | style="width:62.25pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:62.25pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">4.94</span></span></span></p> |
| − | | style="width:80.1pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:80.1pt; border:solid windowtext 1.0pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">-26.5 to 36.4</span></span></span></p> |
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| − | | style="width:146.25pt" width="195" | | + | | style="width:146.25pt; border:solid windowtext 1.0pt" width="195" | |
| − | <span style=" | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">Pure tone average threshold at 4 weeks (dB) at 4kHz</span></span>'''</span> |
| − | | style="width:33.9pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:33.9pt; border:solid windowtext 1.0pt" width="45" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">17.50</span></span></span></p> |
| − | | style="width:48.1pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.1pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">11.00</span></span></span></p> |
| − | | style="width:19.75pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:19.75pt; border:solid windowtext 1.0pt" width="26" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">12.67</span></span></span></p> |
| − | | style="width:48.15pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:48.15pt; border:solid windowtext 1.0pt" width="64" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">10.17</span></span></span></p> |
| − | | style="width:62.25pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:62.25pt; border:solid windowtext 1.0pt" width="83" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">4.83</span></span></span></p> |
| − | | style="width:80.1pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style=" | + | | style="width:80.1pt; border:solid windowtext 1.0pt" width="107" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:" times="" new="" roman",serif"="">-59.0 to 68.7</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-family: | + | <span style="line-height:normal">'''<span style="font-family:"><span style="color:white">Comments:</span></span>'''<br/> <span style="font-size:medium;"><span style="font-family:">1. Small study with baseline differences between groups.<br/> 2. Both IT steroids and HBO were associated with an improvement over time but the level of recovery was very similar. ITS may be more effective at lower frequencies and HBOT at higher.<br/> 3. The SDs above have been calculated from the graphical results - numbers not stated in the paper.<br/> 4. There is no placebo or no treatment group with which to compare these results. Both groups could reflect natural history of ISSHL.</span></span></span> <span style="font-size:medium;">'''<span style="line-height:107%"><span style="font-family:">Appraised by:</span></span>'''<span style="line-height:107%"><span style="font-family:">Mike Bennett m.bennett@unsw.edu.au; Sunday, 31 May 2020</span></span><br/> '''<span style="line-height:107%"><span style="font-family:">Kill or Update By:</span></span>'''<span style="line-height:107%"><span style="font-family:">May 2022<br/> </span></span></span> |
| − | <span style="font-size:medium;">'''<span style="line-height:107%"><span style="font-family: | ||
Revision as of 01:22, 31 May 2020
Both hyperbaric oxygen and intratympanic steroid injection improved hearing thresholds in patients with sudden idiopathic hearing loss.
Clinical bottom line:
|
1. HBOT and ITS seemed to improve sudden sensorineural hearing loss to a similar extent |
Citation/s:1. Cvorovic L, Jovanovic MB, Milutinovic Z, Arsovic N, Djeric D. Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss. Otology & Neurotology. 2013 Aug 1;34(6):1021-6.
Lead author's name and fax: Ljiljana Cvorovic cvorcica@yahoo.com
Three-part Clinical Question:For patients with idiopathic sudden sensorineural hearing loss (ISSHL) and failure to respond to intravenous/oral steroids, does hyperbaric oxygen or intratympanic steroid administration result in improved hearing?
Search Terms: ISSHL; steroids; intratympanic steroids
The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Patients with ISSHL and failure to respond with at least 10dB threshold improvement with 3 days of IV steroid followed by 3 further days of oral steroid.
Control group (N = 25; 25 analysed): Intratympanic steroids four times in 13 days at a dose of around 2 mg each time.
Experimental group (N = 25; 25 analysed): 100% oxygen breathing at 2 ATA for 60 minutes daily, Monday to Friday.
The Evidence:
Measure |
ITS Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Pure tone average threshold at 4 weeks (dB) at 2kHz |
16.35 |
9.3 |
11.41 |
4.91 |
4.94 |
-26.5 to 36.4 |
|
Pure tone average threshold at 4 weeks (dB) at 4kHz |
17.50 |
11.00 |
12.67 |
10.17 |
4.83 |
-59.0 to 68.7 |
Comments:
1. Small study with baseline differences between groups.
2. Both IT steroids and HBO were associated with an improvement over time but the level of recovery was very similar. ITS may be more effective at lower frequencies and HBOT at higher.
3. The SDs above have been calculated from the graphical results - numbers not stated in the paper.
4. There is no placebo or no treatment group with which to compare these results. Both groups could reflect natural history of ISSHL. Appraised by:Mike Bennett m.bennett@unsw.edu.au; Sunday, 31 May 2020
Kill or Update By:May 2022
