Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis

Abstract

Objective

Approximately 30–50% of sudden sensorineural hearing loss (SSNHL) patients show poor response to systemic steroid therapy. Additionally, the most appropriate treatment for patients with refractory sudden sensorineural hearing loss (RSSNHL) is unknown. This study aimed to explore the best treatment for RSSNHL.

Design

Using a frequentist contrast-based model and PRISMA guidelines, this study compared five salvage regimes: intratympanic injection of steroids (ITS), hyperbaric oxygen (HBO) therapy, post auricle steroid injection (PSI), ITS combined with HBO therapy, and continued systemic steroids.

Study sample

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomised controlled trials and cohort studies comparing treatment regimens for RSSNHL.

Results

Compared with the control group (no additional treatment), PSI and ITS demonstrated significant improvements. The mean hearing gain was greater after PSI (11.1 dB [95% CI, 4.4–17.9]) than after ITS (7.7 dB [95% CI, 4.8–10.7]). When a restricted definition of RSSNHL was used, the ITS + HBO therapy showed the largest difference in improvement for pure tone average compared with the control group (14.5 dB [95% CI, 4.2–25.0]).

Conclusions

The administration of either PSI or ITS leads to the greatest therapeutic effect in patients with RSSNHL. However, a consensus on the definition of RSSNHL is needed.

Keywords:

• continued systemic steroids
• hyperbaric oxygen (HBO) therapy
• intratympanic injection of steroid (ITS)
• ITS combined with HBO therapy
• network meta-analysis
• post auricle steroid injection (PSI)
• refractory sudden sensorineural hearing loss

Acknowledgements

We thank Yu-Kang Tu, PhD for suggestions in data synthesis and statistical analysis.

Author contributions

Conception and design: Chuan-Yi Lin, MD; Po-Hsiu Kuo, PhD. Collection and assembly of data: Chuan-Yi Lin, MD; Chia-Hao Chang, MD. Data analysis and interpretation: Chuan-Yi Lin, MD; Chia-Hao Chang, MD; Chen-Jung Chang; Po-Hsiu Kuo, PhD. Administrative support: Jenq-Yuh Ko, MD, PhD; Szu-Yuan Wu, MD, MPH, PhD. Manuscript writing: Chuan-Yi Lin, MD; Szu-Yuan Wu, MD, MPH, PhD; Po-Hsiu Kuo, PhD. Final approval of manuscript: All authors.

Disclosure statement

The authors have no potential conflicts of interest to declare.