Otolaryngology, Department of Surgery, University of Melbourne.
The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Otol Neurotol. 2019 Oct;40(9):1178-1185. doi: 10.1097/MAO.0000000000002383.
To conduct systematic review and meta-analyses of preclinical studies describing the efficacy of glucocorticoids administered via different routes for hearing preservation after cochlear implantation.
A literature search was performed in PubMed to identify peer-reviewed articles published before December 31, 2017, with no language restrictions. Search components were "Cochlear implant," "Glucocorticoids," and "Hearing preservation." The results were specified for animal studies.
Original studies in which glucocorticoids were administered before or during cochlear implantation in animal models and hearing threshold shifts were measured using auditory brainstem response.
Quality of included studies was assessed using the SYstematic Review Centre for Laboratory animal Experimentation protocol. Threshold Shift reduction between the "study" and "control" groups at 1-month postimplantation was the parameter used to evaluate hearing preservation.
The random-effects models were used to combine the results of selected studies. Separate meta-analyses were performed for drug-eluting electrodes, systemic, and local administration.
Administering either systemic or topical glucocorticosteroids had a significant effect on preserving low and high-frequency hearing. Topical administration was equally effective across a range of concentration levels and provided maximal hearing preservation when applied 120 minutes before implantation. The effect of systemic treatment was achieved with high doses, equivalent to 26 mg of dexamethasone per day in humans. No significant effect was found with the use of drug-eluting electrodes and more studies are needed to characterise the utility and efficacy of this administration method.
系统评价和荟萃分析描述不同途径给予糖皮质激素在人工耳蜗植入后听力保护作用的临床前研究。
在 PubMed 中进行文献检索，以确定截至 2017 年 12 月 31 日之前发表的同行评议文章，无语言限制。搜索组件为“耳蜗植入”、“糖皮质激素”和“听力保护”。结果指定为动物研究。
在动物模型中，在人工耳蜗植入前或植入期间给予糖皮质激素，并使用听觉脑干反应测量听力阈移的原始研究。
使用 SYstematic Review Centre for Laboratory animal Experimentation 方案评估纳入研究的质量。植入后 1 个月时“研究”和“对照”组之间的阈移减少是评估听力保护的参数。
使用随机效应模型对选定研究的结果进行合并。分别对药物洗脱电极、全身和局部给药进行荟萃分析。
全身或局部给予糖皮质激素对保护低频和高频听力有显著效果。局部给药在一系列浓度水平上同样有效，在植入前 120 分钟给药时提供最大听力保护。全身治疗的效果是通过高剂量实现的，相当于每天给予 26mg 地塞米松。使用药物洗脱电极未发现显著效果，需要更多研究来描述这种给药方法的实用性和疗效。
