Intratympanic glucocorticosteroid therapy for idiopathic sudden hearing loss: meta-analysis of randomized controlled trials
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Background and objective: Glucocorticoids are the standard treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but whether intratympanic or systemic therapy is superior remains controversial. Previous meta-analyses of this question have omitted key clinical trials or included observational studies. Methods: English-language randomized controlled trials in OVIDSP, PUBMED, EMBASE, CINAHL and the Cochrane Library comparing intratympanic vs. systemic glucocorticoid therapy for ISSNHL were meta-analyzed using RevMan 5.3. The primary outcome of interest was improvement in pure tone average (PTA) threshold. Results: Six trials involving 248 patients receiving intratympanic steroids and 236 receiving systemic steroids were meta-analyzed. PTA thresholds were similar between the two groups at 3 months after therapy initiation (mean difference, 0.24; 95%CI -2.43 to 2.91, P=.86; I2= 54%, P=.07, random-effects model). PTA thresholds were also similar at 6 months (mean difference, 4.69, 95%CI -5.84 to 15.22, P =.38), although the results showed extremely high heterogeneity (I2= 98%). Sensitivity analysis indicated that a single trial containing 250 patients provided the strongest evidence for equivalence between the two types of therapy. Rates of recovery within 3 months (defined as PTA improvement >10 dB) were similar between the two types of therapy(OR 0.92, 95%CI 0.59 to 1.43, P=.70), with no significant heterogeneity in the pooled data (I2=1%, P=.40). Conclusion: Intratympanic and systemic steroids therapies appear to show similar short-term efficacy for restoring hearing in patients with ISSNHL. Intratympanic therapy may reduce systemic side effects associated with steroid use.
1. Lai D, Zhao F, Jalal N, Zheng Y, Intratympanic glucocorticosteroid therapy for idiopathic sudden hearing loss: meta-analysis of randomized controlled trials. Medicine. (in press).
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