Sudden sensorineural hearing loss

Objective To identify, evaluate, and review randomized controlled trials (RCTs) on the treatment of sudden sensorineural hearing loss (SSHL). Data Sources A MEDLINE search and hand search were conducted to identify RCTs published between January 1966 and February 2006 in the English language on the treatment of SSHL. Search terms included hearing loss , sensorineural (MeSH term), sensorineural hearing loss (text words), and sudden deafness (text words). Study Selection Prospective RCTs on the treatment of patients diagnosed as having SSHL. Data Extraction One independent observer extracted study data. Validity was evaluated using standard criteria. Characteristics and results were reviewed systematically. Data Synthesis A total of 21 RCTs were identified regarding various treatments, including systemic and intratympanic steroids; antiviral and hemodilution agents; mineral, vitamin, and herbal preparations; batroxobin; carbogen; and hyperbaric oxygen. All studies used audiometric outcome measures. Only 2 studies used identical criteria to define SSHL. The method of randomization was described in 2 studies. Validity scores ranged from 2 to 8 (of 9). Positive results were reported favoring systemic steroids, intratympanic steroids, batroxobin, magnesium, vitamin E, and hyperbaric oxygen, although there were serious limitations in each study with a positive finding. There was no difference in audiometric outcomes reported across all studies of antiviral and hemodilution agents and no difference in one study of systemic steroids vs placebo. Conclusions To our knowledge, no valid RCT exists to determine effective treatment of SSHL. Systemic steroids cannot be considered the gold standard of treatment of SSHL, given the severe limitations of the landmark study supporting their use.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/484748/ooa70023_573_581.pdf

Treatment of sudden sensorineural hearing loss: I. A systematic review.

Objective To pool and meta-analyze the results of all randomized controlled trials (RCTs) on treatment of sudden sensorineural hearing loss (SSHL). Data Sources A MEDLINE search and hand search were conducted to identify RCTs published between January 1966 and February 2006 in the English language on the treatment of SSHL. Search terms included hearing loss , sensorineural (MeSH term), sensorineural hearing loss (text words), and sudden deafness (text words). Study Selection Prospective RCTs on the treatment of patients diagnosed as having sudden sensorineural hearing loss. Data Extraction A meta-analysis using the random effects model was conducted when data existed for 2 or more studies. Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported. Data Synthesis Twenty RCTs were identified, of which 5 met inclusion criteria for meta-analysis. Pooling of data from 2 RCTs that compared steroids with placebo showed no difference between treatment groups (OR, 2.47; 95% CI, 0.89-6.84; P >=.08). No difference existed between patients treated with antiviral plus steroid therapy vs placebo plus steroid therapy (OR, 0.92; 95% CI, 0.29-2.92: P =.88). Finally, there was no difference between subjects treated with steroids vs subjects treated with any other active treatment (OR, 1.27; 95% CI, 0.64-2.55; P =.50). Conclusions Despite the traditional practice in North America of treating of SSHL with systemic steroids, a meta-analysis revealed no evidence of benefit of steroids over placebo. There was also no difference in the addition of antiviral therapy to systemic steroids, nor was there difference between systemic steroids and other active treatment.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/484749/ooa70024_582_586.pdf

Treatment of sudden sensorineural hearing loss: II. A Meta-analysis.

There is no consensus regarding treatment modalities for idiopathic sudden sensorineural hearing loss (SNHL) In order to evaluate the effectiveness of steroid or carbogen inhalation therapies, a prospective double-blind placebo controlled study was designed All 41 patients enrolled in the study had unilateral SNHL with no prior history of SNHL, otological pathological history or otoscopic findings Patients were assigned to four treatment groups: prednisone tablets, placebo tablets, carbogen inhalation or room air inhalation All were treated for 5 days The audiometric data at admission was compared to that at day 6 and to data collected at follow-up (average 33 days) Results revealed no significant difference between the groups for early or late audiometric outcome Age, time from onset of symptoms to initiation of treatment, tinnitus, audiogram configuration, and the presence of vertigo at onset did not significantly affect the outcome The discrimination scores that were poor in all patient groups on admission improved within days in all groups These findings suggest that steroids or carbogen inhalation have no therapeutic advantage over placebo Also, regardless of treatment modality, hearing continued to improve for at least a month after treatment was stopped

Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study

With the published clinical data to hand on the therapeutic results of patients with idiopathic sudden hearing loss, acoustic trauma or noise-induced hearing loss, it may be confirmed that 65% of those polypragmatically treated patients demonstrated a hearing improvement of 19 +/- 4 dB In 35% of the cases, no hearing improvement was detected independent of the drugs administered This corresponds to the results obtained from placebo-treated patients who demonstrated a hearing improvement of 20 +/- 2 dB in 61% of cases and no hearing gain in 39% of cases (fig 1) A different set of results was obtained from patients with a hearing loss who were treated either with prednisolone or placebo The percentage of patients who achieved normal hearing again in the placebo-treated group amounted to 31% and 38% and in the verum-treated group 50% and 78% It may be concluded that a placebo therapy is equally effective to that of all nonsteroidal drugs Problems arise when comparing non-treated patients since information on spontaneous remission rates differs greatly in the references, ie between 25-68% for spontaneous full remissions and 47-89% for spontaneous partial remissions From a statistical view, 35% and 39% of patients experienced no success with nonsteroidal drugs or placebo, respectively These patients can still be helped with HBO therapy 18 patients only underwent primary HBO therapy In all other 50 studies evaluated here with a total of 4, 109 patients suffering from idiopathic sudden hearing loss, acoustic trauma or noise-induced hearing loss and/or tinnitus, HBO therapy was administered as a secondary therapy, ie following unsuccessful conventional therapy If the onset of affliction was more than 2 weeks but no longer than 6 weeks, one half of the cases showed a marked hearing gain (in at least 3 frequencies of more than 20 dB), one-third showed a moderate improvement (10-20 dB) and 13% showed no hearing improvement at all (fig 2) 4% no longer experienced tinnitus, 813% observed an intensity decrease and 12% an intensity increase of their tinnitus condition 135% remained unchanged (fig 2) If HBO therapy was administered at a later stage, but still within 3 months following onset of affliction, 13% showed a definite improvement in hearing, 25% a moderate improvement and 62% no improvement at all 7% no longer suffered from tinnitus, 44% reported an intensity decrease, a similar percentage noticed no change and 5% a temporary deterioration of their tinnitus condition If the onset of affliction was longer than 3 months up to several years, no hearing improvement can be expected in the majority of patients (fig 3); however, one third of the cases reported an intensity decrease of tinnitus, 60-62% reported no change and 4-7% noticed a temporary intensity increase (fig 4) In conclusion, it may be deduced that HBO therapy is recommended and warranted in those patients with idiopathic sudden deafness, acoustic trauma or noise-induced hearing loss within 3 months after onset of disorder

Effect of hyperbaric oxygen therapy in comparison to conventional or placebo therapy or no treatment in idiopathic sudden hearing loss, acoustic trauma, noise-induced hearing loss and tinnitus. A literature survey.

Twenty-seven patients suffering from sudden sensorineural hearing loss (SHL) were randomly assigned to one of two groups: a treatment group (n = 13) receiving intravenous procaine and low-molecular-weight dextran, and a placebo control group (n = 14). The effect of treatment was analyzed by means of an analysis of variance and covariance procedures. Results indicated nonsignificant differences between the groups on all outcome indices measured. Sex, age, time since the onset of symptoms to the initiation of therapy, audiogram configuration, and initial severity of hearing loss did not significantly affect the results. These findings suggest that the therapeutic effects of this vasodilator are not superior to a placebo.

Vasoactive therapy versus placebo in the treatment of sudden hearing loss: a double-blind clinical study.

In this study, the results of 76 revision stapes surgeries performed from 1974 to 1992 were reviewed. Either the KTP or the argon laser was used in 40 operations. Prosthesis problems were the most common cause for revision (63%) followed by eroded/necrotic incus (29%) and adhesions (29%). Overall "success" in air-bone gap closure (air-bone gap < or = 10 dB) was 46% for first revisions and 33% for second or greater revisions. The "improvement" rate (air-bone gap < or = 20 dB) was 65% for first revisions and 53% for second or greater revisions. There was no statistically significant difference in hearing results between laser surgery and conventional technique. However, an absence of adhesions was noted when the laser had been used in the primary procedure.

Erez Bendet

Papers

Vasoactive therapy versus placebo in the treatment of sudden hearing loss: a double-blind clinical study.

Revision stapes surgery with and without laser: A comparison