Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis | Otolaryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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    Original Investigation
    March 12, 2020

    Intratympanic vs Systemic Corticosteroids in First-line Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
    • 2Department of Otorhinolaryngology, Region Hospital Holstebro, Holstebro, Denmark
    JAMA Otolaryngol Head Neck Surg. 2020;146(5):421-428. doi:10.1001/jamaoto.2020.0047
    Key Points

    Question  Is the outcome of first-line treatment of idiopathic sudden sensorineural hearing loss associated with how the corticosteroid is administered?

    Findings  This systematic review and meta-analysis of 7 randomized clinical trials did not find evidence that recovery from moderate to severe hearing loss was different in patients for whom corticosteroids were administered intratympanically vs systemically. It also found no evidence that combining the 2 administration routes improved hearing recovery.

    Meaning  Future research and guidelines should determine which patient groups should be allocated to receive what administration (eg, systemic corticosteroids in elderly patients may be associated with increased risk of adverse effects, and so these patients should be treated intratympanically).

    Abstract

    Importance  To our knowledge, evidence-based recommendations on the intratympanic vs systemic administration of corticosteroids for the treatment of idiopathic sudden sensorineural hearing loss remain unestablished, and contradictory conclusions have been reported in previous meta-analyses.

    Objective  To compare recovery from idiopathic sudden sensorineural hearing loss based on systemic, intratympanic, or a combined treatment with corticosteroids as first-line treatment.

    Data Sources  We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Embase, OvidSP, CINAHL, and Cochrane Library from January 1, 1966, to July 1, 2018. This study was registered in the International Prospective Register of Systematic Reviews (CRD42018109314).

    Study Selection  We included randomized studies. Included studies must have excluded identifiable causes. Corticosteroids must have been administered solitarily. We excluded studies that did not define hearing loss as a minimum 30 dB within 72 hours.

    Data Extraction and Synthesis  We identified 170 titles, of which 56 (32.9%) were eligible for full-text screening. We independently extracted data. We applied a fixed-effects model to investigate our objectives.

    Main Outcomes and Measure  We aimed to (1) estimate the difference in mean pure tone average (PTA) gain in decibels from intratympanic treatment vs systemic treatment and (2) investigate odds ratios for recovery between the different treatment groups.

    Results  We included 7 eligible studies. A total of 710 patients were allocated to receive either intratympanic treatment (IT group, 235 [33%]), systemic treatment (ST group; 325 [46%]) or combined intratympanic and systemic treatment (CB group; 150 [21%]). The PTA was measured by taking the mean of 4 frequencies: 4 studies measured at 500, 1000, 2000, and 3000 Hz and 3 studies measured at 500, 1000, 2000, and 4000 Hz. The ST group had a 2.01-dB higher PTA gain (95% CI, −5.61 dB to 1.59 dB; P = .96; I2 = 0%) compared with the IT group and the odds for achieving complete recovery was not significantly different at an odds ratio of 0.94 (95% CI, 0.61 to 1.44; P = .19; I2 = 34.5%). For the CB group vs the ST group, the odds ratio was 1.11 (95% CI, 0.68 to 1.82; P = .75; I2 = 0%). The analysis of the CB group vs IT group comprised only 2 studies.

    Conclusions and Relevance  This study does not suggest that corticosteroid delivered intratympanically is more beneficial than systemic treatment in the case of moderate to severe idiopathic sudden sensorineural hearing loss. There were no indications that combined treatment was associated with improved hearing outcomes compared with either systemic or intratympanic treatment.

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