耳后与全身应用类固醇治疗突发性聋：随机对照试验的系统评价和荟萃分析。

Postauricular versus systemic use of steroids for sudden hearing loss: A systematic review and meta-analysis of randomized controlled trials.

机构信息

Department of Otolaryngology Head and Neck Surgery, Hanzhong People's Hospital, Hanzhong, Shaanxi, China.

Chongqing Medical University, Chongqing, China.

出版信息

Medicine (Baltimore). 2023 Aug 11;102(32):e34494. doi: 10.1097/MD.0000000000034494.

DOI:10.1097/MD.0000000000034494

PMID:37565890

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10419441/

Abstract

BACKGROUND

Sudden sensorineural hearing loss (SSNHL) can be debilitating and is one of the most common otological diseases. Steroids play an important role in its treatment. There are many ways to administer steroids, and the efficacy and safety of different administration routes remain unclear. This meta-analysis aimed to investigate the effect and safety of different types of steroid delivery administration for the treatment of SSNHL.

METHODS AND ANALYSIS

We searched the Weipu, Wanfang, Chinese Biomedical Literature, National Knowledge Infrastructure, Web of Science, Embase and PubMed databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of postauricular injection and systemic steroid administration. Review Manager 5.4 software was used for data synthesis, which included the recovery rate (RR) of reported hearing improvement and change level in pure-tone audiometry (PTA). Subgroup analyses were performed based on different drugs, basic treatment, initial PTA, drug administration methods, onset time, and treatment course. Stata 15.1 software was used for analyses of publication bias and sensitivity.

RESULTS

Our meta-analysis included 38 studies involving 3609 patients with SSNHL. In all included studies, the risk difference (RD) using reported improvement as an outcome measure was 0.12 for postauricular injection administration compared with systemic therapy (95% confidence interval [CI] = 0.008, 0.16, P < .00001, I2 = 59%). When examining PTA changes as an outcome measure (19 studies), the mean difference was 6.06 (95% CI = 3.96, 8.16, P < .00001, I2 = 70%). The RD for hearing improvement was compared among different factors, and the results showed that postauricular injection is superior to systemic steroid administration.

CONCLUSION

Postauricular injection may be safer and more effective treatment than systemic therapy as a treatment for SSNHL.

摘要

背景

突发性聋（SSNHL）可导致残疾，是最常见的耳科疾病之一。类固醇在其治疗中起着重要作用。有许多方法可以给予类固醇，不同给药途径的疗效和安全性尚不清楚。本荟萃分析旨在研究不同类型类固醇给药途径治疗 SSNHL 的效果和安全性。

方法和分析

我们检索了维普、万方、中国生物医学文献、中国知网、Web of Science、Embase 和 PubMed 数据库，以寻找糖皮质激素治疗 SSNHL 的随机对照试验（RCT），比较耳后注射和全身类固醇给药的疗效。使用 Review Manager 5.4 软件对数据进行综合分析，包括听力改善的恢复率（RR）和纯音听阈（PTA）的变化水平。根据不同药物、基础治疗、初始 PTA、药物给药方法、发病时间和治疗疗程进行亚组分析。使用 Stata 15.1 软件分析发表偏倚和敏感性。

结果

本荟萃分析纳入了 38 项研究，共 3609 例 SSNHL 患者。在所有纳入的研究中，与全身治疗相比，耳后注射给药的风险差异（RD）为 0.12（95%置信区间[CI] = 0.008，0.16，P <.00001，I2 = 59%）。当以 PTA 变化作为观察指标时（19 项研究），平均值差为 6.06（95%CI = 3.96，8.16，P <.00001，I2 = 70%）。不同因素之间的听力改善 RD 比较结果表明，耳后注射优于全身类固醇给药。