ENT Department, Lister Hospital, 33 Wetherby Close, SG1 5RX, Stevenage, Hertfordshire, UK.
Eur Arch Otorhinolaryngol. 2012 Feb;269(2):363-80. doi: 10.1007/s00405-011-1738-0. Epub 2011 Aug 19.
Over 60 years since its first report, sudden sensorineural hearing loss (SSNHL) still represents an ill-explained condition, with potentially devastating effects for the quality of life of previously well patients. The present study critically reviewed the available evidence regarding the efficacy of intra-tympanic steroid administration in the treatment of SSNHL. Factors affecting that efficacy were also explored. The literature was systematically reviewed in Medline and other database sources until July 2011, and analyzed through critical analysis of pooled data. The study selection included multi-center prospective randomized control trials, prospective randomized comparative, prospective comparative and prospective studies, retrospective comparative and retrospective studies. The total number of analyzed studies was 43. Intra-tympanic steroids appear to be effective as primary (strength of recommendation A), or salvage treatment (strength of recommendation B) in SSNHL. It is difficult to draw definite conclusions regarding the efficacy of combination therapy. The identification of a time window for effective treatment in the former two approaches yields a grade C strength of recommendation. Primary intra-tympanic treatment is the most effective modality in terms of complete hearing recovery (34.4% cure rate). There is not enough evidence to attribute treatment failures to impaired permeability of the round window membrane. Most complications of intra-tympanic treatment are minor, temporary, and conservatively managed. Intra-tympanic steroids can theoretically provide a more organ-specific treatment in patients with SSNHL. The observation that they seem effective both as primary and salvage treatment modalities with a very low complication rate may have serious implications for current clinical practice.
自首次报告以来的 60 多年中，突发性聋（SSNHL）仍然是一种解释不清的病症，可能会对先前健康患者的生活质量产生毁灭性的影响。本研究对鼓室内类固醇给药治疗 SSNHL 的疗效的现有证据进行了批判性回顾，并探讨了影响疗效的因素。在 2011 年 7 月之前，我们在 Medline 和其他数据库中进行了系统的文献检索，并通过对汇总数据的批判性分析进行了分析。研究选择包括多中心前瞻性随机对照试验、前瞻性随机对照比较、前瞻性比较和前瞻性研究、回顾性比较和回顾性研究。分析的研究总数为 43 项。鼓室内类固醇似乎是有效的，无论是作为一线（推荐强度 A）还是二线（推荐强度 B）治疗 SSNHL。联合治疗的疗效很难得出明确的结论。在前两种方法中，确定有效的治疗时间窗口产生了 C 级推荐强度。在完全听力恢复方面，一线鼓室内治疗是最有效的治疗方法（治愈率 34.4%）。没有足够的证据表明圆窗膜通透性受损是导致治疗失败的原因。鼓室内治疗的大多数并发症是轻微的、暂时的，并且采用保守的方法进行管理。鼓室内类固醇理论上可以为 SSNHL 患者提供更具器官特异性的治疗。它们似乎作为一线和二线治疗模式都有效，且并发症发生率非常低，这一观察结果可能对当前的临床实践产生严重影响。
