Combined Intratympanic and Systemic Use of Steroids as a First-Line Treatment for Sudden Sensorineural Hearing Loss: A Meta-Analysis of Randomized, Controlled Trials.

Objective: To compare the efficacy of combination therapy (combined intratympanic and systemic use of steroids, CT) with systemic steroid therapy (SST) as a primary treatment for sudden sensorineural hearing loss (SSNHL). Methods: An electronic database search (PubMed, Embase, Cochrane Library, and CNKI databases) was performed. Review Manger 5.3 was used for data synthesis. Data were collected on the following outcomes of interest: the proportion of patients with hearing improvement, changes in pure tone averages (PTA), and speech discrimination score (SDS). Results: A total of 14 RCTs including 756 subjects allocated to CT and 638 to SST were selected. The proportion of patients with hearing improvement as outcome measure was observed in 13 studies, which resulted in an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.95-2.1). The PTA changes (in dB) as outcome measure was observed in 12 studies, which resulted in mean difference (MD) 13 (95% CI: 9.24-16.77). SDS changes (in %) as outcome measure were reported in five studies, which resulted in MD 15.72 (95% CI: 5.11-26.33). Conclusion: CT seems to confer a certain degree of benefit as a primary treatment of SSNHL as compared with SST. Further validation based on high quality studies is required. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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