鼓室内及全身联合使用类固醇作为突发性感音神经性听力损失的一线治疗：随机对照试验的荟萃分析

Combined Intratympanic and Systemic Use of Steroids as a First-Line Treatment for Sudden Sensorineural Hearing Loss: A Meta-Analysis of Randomized, Controlled Trials.

作者信息

Han Xue, Yin Xiao, Du Xiaodong, Sun Changling

机构信息

*Medical College of Jiangnan University †Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, China.

出版信息

Otol Neurotol. 2017 Apr;38(4):487-495. doi: 10.1097/MAO.0000000000001361.

DOI:10.1097/MAO.0000000000001361

PMID:28207624

Abstract

OBJECTIVE

To compare the efficacy of combination therapy (combined intratympanic and systemic use of steroids, CT) with systemic steroid therapy (SST) as a primary treatment for sudden sensorineural hearing loss (SSNHL).

METHODS

An electronic database search (PubMed, Embase, Cochrane Library, and CNKI databases) was performed. Review Manger 5.3 was used for data synthesis. Data were collected on the following outcomes of interest: the proportion of patients with hearing improvement, changes in pure tone averages (PTA), and speech discrimination score (SDS).

RESULTS

A total of 14 RCTs including 756 subjects allocated to CT and 638 to SST were selected. The proportion of patients with hearing improvement as outcome measure was observed in 13 studies, which resulted in an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.95-2.1). The PTA changes (in dB) as outcome measure was observed in 12 studies, which resulted in mean difference (MD) 13 (95% CI: 9.24-16.77). SDS changes (in %) as outcome measure were reported in five studies, which resulted in MD 15.72 (95% CI: 5.11-26.33).

CONCLUSION

CT seems to confer a certain degree of benefit as a primary treatment of SSNHL as compared with SST. Further validation based on high quality studies is required.

摘要

目的

比较联合治疗（鼓室内和全身联合使用类固醇，CT）与全身类固醇治疗（SST）作为突发性感音神经性听力损失（SSNHL）主要治疗方法的疗效。

方法

进行电子数据库检索（PubMed、Embase、Cochrane图书馆和中国知网数据库）。使用Review Manger 5.3进行数据合成。收集以下感兴趣的结果的数据：听力改善患者的比例、纯音平均值（PTA）的变化和言语辨别得分（SDS）。

结果

共选择了14项随机对照试验，包括756名分配至CT组的受试者和638名分配至SST组的受试者。13项研究观察了以听力改善为结果指标的患者比例，得出优势比（OR）为2.50（95%置信区间[CI]：1.95 - 2.1）。12项研究观察了以PTA变化（dB）为结果指标的情况，得出平均差（MD）为13（95%CI：9.24 - 16.77）。五项研究报告了以SDS变化（%）为结果指标的情况，得出MD为15.72（95%CI：5.11 - 26.33）。