Shemirani Nima L, Schmidt Madeline, Friedland David R
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Otolaryngol Head Neck Surg. 2009 Jan;140(1):86-91. doi: 10.1016/j.otohns.2008.09.022.
To assess and compare the current management of sudden sensorineural hearing loss (SSHL) between primary care physicians and general otolaryngologists.
Written survey of physician practice patterns.
A multiple choice and Likert scale survey was mailed to 1306 otolaryngologists and primary care physicians in the upper midwest with respect to management of SSHL.
A significant number of general practitioners treat SSHL independent of an otolaryngologist. General practitioners are significantly less impressed than otolaryngologists that steroids are an effective treatment (P < 0.0001). Over 98 percent of otolaryngologists use oral steroids as compared with 73 percent of general practitioners treating on their own. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone whereas lower doses and medrol dosepaks are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond one week of onset of hearing loss whereas general practitioners overwhelmingly will only treat within the first week. Approximately 50 percent of otolaryngologists add antiviral medications in contrast to 16 percent of generalists.
The approach to SSHL differs between otolaryngologists and general practitioners. The lack of strong evidence-based guidelines for the treatment of SSHL may underlie the variability in management by first line providers.
评估并比较初级保健医生和普通耳鼻喉科医生对突发性感音神经性听力损失（SSHL）的当前治疗方法。
医生执业模式的书面调查。
针对SSHL的治疗方法，向中西部上游地区的1306名耳鼻喉科医生和初级保健医生邮寄了一份包含多项选择题和李克特量表的调查问卷。
大量全科医生在没有耳鼻喉科医生参与的情况下治疗SSHL。与耳鼻喉科医生相比，全科医生对类固醇作为一种有效治疗方法的印象明显较差（P < 0.0001）。超过98%的耳鼻喉科医生使用口服类固醇，而自行治疗的全科医生中这一比例为73%。绝大多数耳鼻喉科医生开始治疗时使用至少60毫克的泼尼松，而全科医生更常用较低剂量和甲泼尼龙剂量包。耳鼻喉科医生更有可能在听力损失发作一周后使用类固醇进行治疗，而全科医生绝大多数只在第一周内进行治疗。大约50%的耳鼻喉科医生会加用抗病毒药物，相比之下，普通医生这一比例为16%。
耳鼻喉科医生和全科医生对SSHL的治疗方法不同。缺乏关于SSHL治疗的强有力的循证指南可能是一线医疗服务提供者治疗方法存在差异的原因。
