Lei
No advantage of hyperbaric oxygen over intra-tympanic steroids for refractory sudden sensorineural hearing loss.
|
1. No difference was found in the response to intra-tympanic steroids versus HBOT. |
Citation/s:1. Lei X, Feng Y, Xia L, Sun C. Hyperbaric Oxygen Therapy Versus Intratympanic Steroid for Salvage Treatment of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. Otol Neurotol. 2021;42(8):e980-e986
Lead author's name and email: Changling Sun winterc126@sina.com or Xia Ling xldiicii@163.com
Three-part Clinical Question:For patients refractory to early treatment for acute sensorineural hearing loss, does the administration of salvage HBOT compared to intra-tympanic steroids, result in any clinical improvement?
Search Terms: ISSHL, Steroids, Intra-tympanic
The Review:
Data Sources: : Medline,
Study Selection: Included trials were randomized controlled trials, retrospective or prospective cohort studies that compared the efficacy of HBOT and ITS as salvage treatment for refractory SSNHL. Trials were excluded if essential data could not be fully extracted or other publication types. Six studies were included, two RCTs and four cohort/non-random studies.
Data Extraction: Patients with refractory ISSHL. Outcomes were proportion with hearing recvery (individual study defined) and pure tome average changes.
The studies were multiple independent reviews of individual reports. They were tested for heterogeneity.
The Evidence:
Outcome |
Time to Outcome |
Typical ITS rate |
Typical HBO rate |
RRR |
NNT |
P-value |
|
Proportion of patients with improved hearing |
end of therapy |
0.42 |
0.37 |
1.09 |
21 |
0.86 |
95% CIs: |
0.83 to 1.42 |
15 to inf | ||||
Mean Pure Tone Average Improvement (presumed Db): MD 0.55, [95% CI: –1.76 to 2.86] in favour of ITS, p = 0.64.
Comments:
1. 37.1% of HBOT group improved versus 42% of the ITS group despite being refractory to earlier treatment. This may represent the natural history or a roughly equal treatment effect. It is not clear all patients were idiopathic SSHL.
2. Both treatments were generally well-tolerated.
3. The definition of 'refractory' here is 'inadequate response to conventional system treatments'. These treatments include steroids, vasodilators, antivirals and HBOT.
4. HBOT is considerably more expensive and time-consuming in most situations than ITS.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Thursday, 20 January 2022
Kill or Update By: January 2024
