Marx M, Younes E, Chandrasekhar S S, Ito J, Plontke S, O'Leary S, Sterkers O
Department of otology and neurotology, Purpan hospital, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse, France; Paul-Sabatier Toulouse 3 University, 31062 Toulouse, France.
Department of otology and neurotology, Purpan hospital, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse, France; Paul-Sabatier Toulouse 3 University, 31062 Toulouse, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1S):S23-S28. doi: 10.1016/j.anorl.2017.12.011. Epub 2018 Feb 1.
Sudden sensorineural hearing loss (SSNHL) is a common and alarming symptom that often prompts an urgent visit to an ENT specialist. Treatment of SSNHL remains one of the most problematic issues for contemporary otorhinolaryngology: although many meta-analyses and national guidelines have been issued, management is not standardized in terms of medical treatment, and duration and route of administration. We present several methodological suggestions for the study of treatments for SSNHL. These were developed from the existing level of evidence of the main treatments used in SSNHL by experts who convened at the IFOS 2017 ENT World Congress in Paris, France. All panelists agreed that one of the main limitations present in studies on SSNHL is related to the wide heterogeneity, which characterizes both the initial hearing deficit and the amount of hearing recovery. Although evidence of the efficacy of systemic steroids cannot be considered as strong enough to recommend their use, it is still the most widespread primary therapy and can be considered as the current standard of care. Therefore, systemic steroids stand as an adequate control for any innovative treatment. To reduce the number of subjects we suggest that the inclusion criteria should be restricted to moderate to profound levels of hearing loss. The efficacy of trans-tympanic steroids as a salvage therapy was suggested in several reports on small populations and needs to be confirmed with larger randomized controlled trials.
突发性感音神经性听力损失（SSNHL）是一种常见且令人担忧的症状，常常促使患者紧急就诊于耳鼻喉科专家。SSNHL的治疗仍然是当代耳鼻喉科最具问题的议题之一：尽管已经发布了许多荟萃分析和国家指南，但在药物治疗、治疗持续时间和给药途径方面，管理并不规范。我们针对SSNHL治疗研究提出了一些方法学建议。这些建议是由在法国巴黎举行的2017年国际耳科学会（IFOS）耳鼻喉世界大会上召集的专家，根据SSNHL主要治疗方法的现有证据水平制定的。所有小组成员一致认为，SSNHL研究中存在的主要局限性之一与广泛的异质性有关，这种异质性既表现在初始听力损失方面，也表现在听力恢复程度方面。尽管全身用类固醇疗效的证据不足以强烈推荐使用，但它仍然是最广泛使用的主要治疗方法，可被视为当前的标准治疗方法。因此，全身用类固醇可作为任何创新治疗的适当对照。为了减少受试者数量，我们建议纳入标准应限于中度至重度听力损失。关于经鼓膜类固醇作为挽救治疗的疗效，在一些关于小样本群体的报告中有所提及，需要通过更大规模的随机对照试验加以证实。
