Department of Otolaryngology-Head and Neck Surgery, Carl Darnall Army Medical Center, Fort Hood, TX 76544, USA.
James A. Zimble Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
Mil Med. 2022 May 3;187(5-6):e661-e666. doi: 10.1093/milmed/usaa579.
To determine the efficacy of steroid and hyperbaric oxygen therapy (HBOT) in the setting of acute noise-induced hearing loss.
Systematic review and meta-analysis of noise-induced hearing loss treatment studies that reported on patients who (1) reported individual frequencies up to 8,000 Hz with mean and SDs; (2) were treated only with steroids ± HBOT; and (3) sustained acute acoustic trauma. The Newcastle-Ottawa Scale was used to assess risk of bias across cohorts. Data sources were Embase, Web of Science, Cochrane Databases (via Ovid EBM Reviews), and PubMed.
Four studies were of retrospective cohorts and one of a prospective cohort. Only one study examined blast acoustic trauma, and the remaining four examined gunfire acoustic trauma. This meta-analysis used a random-effects model for pure tone average (PTA) (0.5, 1, and 2 kHz) and "high-frequency" PTA (HPTA) (4, 6, and 8 kHz) for the five studies included. Steroid therapy demonstrated a 6.55-dB (95% CI, 0.08-13.17 dB) PTA (n = 55) improvement and a 9.02-dB (95% CI, 1.45-16.59 dB) HPTA (n = 71) improvement. Steroid with HBOT demonstrated a 7.00-dB (95% CI, 0.84-13.17 dB) PTA (n = 133) improvement and a 12.41-dB (95% CI, 3.97-20.86 dB) HPTA (n = 150) improvement. According to our statistical analysis of the pooled studies' heterogeneity, there was moderate inconsistency in the cross-study results of both treatment groups.
Steroids with or without HBOT appear to improve both low and high hearing thresholds following acoustic trauma. Future studies will require inclusion of control groups, precise definition of acoustic trauma intensity and duration, and genetic polymorphisms.
确定类固醇和高压氧治疗（HBOT）在急性噪声性听力损失中的疗效。
对仅使用类固醇±HBOT 治疗且持续发生急性声创伤的听力损失治疗研究进行系统回顾和荟萃分析，这些研究报告了（1）报告频率高达 8000Hz 的个体频率，同时报告均值和标准差；（2）报告频率高达 8000Hz 的个体频率，同时报告均值和标准差；（3）报告频率高达 8000Hz 的个体频率，同时报告均值和标准差。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估队列间的偏倚风险。数据来源为 Embase、Web of Science、Cochrane 数据库（通过 Ovid EBM Reviews）和 PubMed。
四项研究为回顾性队列研究，一项为前瞻性队列研究。仅有一项研究检查了爆炸声创伤，其余四项研究检查了枪声创伤。本荟萃分析使用随机效应模型对五项研究中的纯音平均（PTA）（0.5、1 和 2kHz）和“高频”PTA（HPTA）（4、6 和 8kHz）进行分析。类固醇治疗可使 PTA（n=55）改善 6.55dB（95%置信区间，0.08-13.17dB），HPTA（n=71）改善 9.02dB（95%置信区间，1.45-16.59dB）。类固醇联合 HBOT 可使 PTA（n=133）改善 7.00dB（95%置信区间，0.84-13.17dB），HPTA（n=150）改善 12.41dB（95%置信区间，3.97-20.86dB）。根据我们对汇总研究异质性的统计分析，两组治疗的跨研究结果存在中度不一致。
类固醇联合或不联合 HBOT 似乎可改善声创伤后的低、高频听力阈值。未来的研究需要纳入对照组、精确定义声创伤强度和持续时间以及遗传多态性。
