Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Otol Neurotol. 2023 Mar 1;44(3):216-222. doi: 10.1097/MAO.0000000000003808. Epub 2023 Jan 14.
To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome.
A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days.
The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25-0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I 2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26-0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I 2 = 52.1%). The OR was 0.31 (95% CI, 0.21-0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I 2 = 0.0%).
Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome.
Level I.
研究将单侧特发性突发性聋（ISSNHL）定义为耳科急症的必要性，并确定最佳预后治疗开始的循证截止时间。
通过“PubMed”、“Embase”和“Web of Science”对“MEDLINE”进行系统文献检索，并对比较 ISSNHL 类固醇治疗结果的原始病例系列进行研究，这些病例系列的研究因素为患者就诊、诊断和治疗开始的延迟。总延迟定义为 ISSNHL 发作至首次使用类固醇剂量的天数，并分为 3 天以内、3 至 7 天、7 至 14 天和>14 天。
文献检索确定了 1469 只耳朵，我们的原始病例系列贡献了 154 只适合研究纳入的耳朵，因此共有 1623 只耳朵进行了统计分析。与第四天及以后开始治疗相比，如果在单侧听力丧失突然发生后的第三天内开始治疗，恢复的优势比（OR）为 0.42（95%置信区间[CI]，0.25-0.71）（I 2 = 40.1%）。与听力丧失后 8 天或更长时间开始治疗相比，在听力丧失突然发生后的前 7 天内开始治疗的恢复 OR 为 0.35（95% CI，0.26-0.47）（I 2 = 52.1%）。与较长的延迟相比，在事件发生后的前 14 天内开始治疗的 OR 为 0.31（95% CI，0.21-0.46）（I 2 = 0.0%）。
单侧 ISSNHL 应被视为医疗急症。在事件发生后 3 天内开始治疗预示着最佳预后。
I 级。
