Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2021 Jul;165(1):166-173. doi: 10.1177/0194599820976177. Epub 2020 Dec 8.
Oral corticosteroids are treatment mainstays for idiopathic sudden sensorineural hearing loss (SSNHL). Recent studies suggest that intratympanic (IT) steroid injections may be effective as an alternate or adjunctive therapy. We sought to investigate nationwide trends in treatment patterns for SSNHL.
Retrospective cross-sectional study.
A large nationwide health care claims database spanning 2007 to 2016.
Patients with SSNHL were identified from the IBM Watson Health MarketScan Database. Multivariable logistic, linear, and Cox regression were used for demographic- and comorbidity-adjusted analyses.
Overall, 19,670 patients were included. Between 2007 and 2016, use of oral corticosteroids alone decreased (83.6% to 64.6%, < .001), while use of IT corticosteroids alone and combination IT-oral corticosteroids increased (IT only, 7.9% to 15.1%, = .002; IT-oral, 8.5% to 20.4%, < .001). During the study period, time to treatment initiation decreased for both administration modalities, though more dramatically for IT corticosteroids (IT, 124.0 to 10.6 days, < .001; oral, 42.6 to 12.7 days, < .001). In patients receiving both IT and oral corticosteroids, concurrent first-line use increased (25.2% to 52.8%, < .001). Repeat injections have also become more common but may raise risk of persistent tympanic membrane perforations (vs no injection; hazard ratio [first injection] = 7.95, 95% CI = 5.54-11.42; hazard ratio [fifth or higher injection] = 17.47, 95% CI = 6.93-44.05).
SSNHL management increasingly involves early IT steroids as an alternative or adjunctive option to oral steroids. Use of repeat IT corticosteroid injections has also increased but may raise risk of persistent tympanic membrane perforations and subsequent tympanoplasty. Future decision analysis and cost-effectiveness studies are necessary to identify an optimal care pattern for SSNHL.
口服皮质类固醇是特发性突发性聋（SSNHL）的主要治疗方法。最近的研究表明，鼓室内（IT）类固醇注射可能是一种有效的替代或辅助治疗方法。我们试图调查 SSNHL 治疗模式的全国趋势。
回顾性横断面研究。
一个涵盖 2007 年至 2016 年的大型全国性医疗保健索赔数据库。
从 IBM Watson Health MarketScan 数据库中确定 SSNHL 患者。使用多变量逻辑、线性和 Cox 回归进行调整人口统计学和合并症的分析。
总体而言，共纳入 19670 名患者。在 2007 年至 2016 年期间，单独使用口服皮质类固醇的比例下降（83.6%降至 64.6%，<0.001），而单独使用 IT 皮质类固醇和联合 IT-口服皮质类固醇的比例上升（仅 IT，7.9%升至 15.1%，<0.001；IT-口服，8.5%升至 20.4%，<0.001）。在研究期间，两种治疗方式的治疗开始时间都有所缩短，但 IT 皮质类固醇的缩短更为明显（IT，124.0 天降至 10.6 天，<0.001；口服，42.6 天降至 12.7 天，<0.001）。在接受 IT 和口服皮质类固醇的患者中，同时使用一线治疗的比例增加（25.2%升至 52.8%，<0.001）。重复注射也变得更加常见，但可能会增加持续性鼓膜穿孔的风险（与无注射相比；首次注射的危险比 [first injection] = 7.95，95%CI = 5.54-11.42；第五次或更多次注射的危险比 [fifth or higher injection] = 17.47，95%CI = 6.93-44.05）。
SSNHL 的管理越来越多地涉及早期 IT 类固醇作为口服类固醇的替代或辅助选择。重复 IT 皮质类固醇注射的使用也有所增加，但可能会增加持续性鼓膜穿孔和随后鼓室成形术的风险。需要进行未来的决策分析和成本效益研究，以确定 SSNHL 的最佳治疗模式。
