高压氧疗法联合类固醇治疗突发性感音神经性听力损失的临床影响：一项病例对照研究。
Clinical impact of hyperbaric oxygen therapy combined with steroid treatment for sudden sensorineural hearing loss: A case-control study.
作者信息
Sanda Naoya, Sawabe Michi, Kabaya Kayoko, Kawaguchi Momoko, Fukushima Akina, Nakamura Yoshihisa, Maseki Shinichiro, Niwa Masaki, Mori Hiroki, Hyodo Yoshiyuki, Nishiyama Kazuyoshi, Kawakita Daisuke, Iwasaki Shinichi
机构信息
Department of Otorhinolaryngology Toyota Kosei Hospital Toyota Japan.
Department of Otorhinolaryngology, Head and Neck Surgery Nagoya City University Graduate School of Medicine Nagoya Japan.
出版信息
Laryngoscope Investig Otolaryngol. 2024 Jul 3;9(4):e1297. doi: 10.1002/lio2.1297. eCollection 2024 Aug.
OBJECTIVES
The aim of present study was to evaluate the clinical efficacy of hyperbaric oxygen therapy (HBOT) as a primary therapy combined with standard systemic corticosteroid treatment for sudden sensorineural hearing loss (SSNHL) compared to treatment without the use of HBOT (non-HBOT) through clinical data and advanced analytical approaches.
STUDY DESIGN
Case-control study.
METHODS
Conducted across three Japanese medical centers involving 298 SSNHL patients diagnosed between 2020 and 2023. Inclusion criteria encompassed first onset and treatment, WHO grade 3 or 4 initial hearing impairment, receipt of systemic corticosteroid therapy within 14 days of symptom onset, and initiation of HBOT within the same timeframe for the case group. The primary outcome measure was the difference in hearing improvement (mean hearing level in decibels, dB) between the two groups, assessed by pure-tone audiometry at baseline and 3 months post-treatment, using the inverse probability of treatment weighting (IPTW) method adjusted for covariate differences.
RESULTS
The study included 67 patients in the HBOT group and 68 in the non-HBOT group. The HBOT group exhibited significantly greater hearing improvement (IPTW-adjusted difference: 7.6 dB, 95% CI 0.4-14.7; = 0.038). Patients without vertigo in the HBOT group demonstrated substantial hearing improvement (11.5 dB, 95% CI 2.3-20.6; = 0.014), whereas those with vertigo showed no significant improvement (-1.8 dB, 95% CI -11.8-8.3; = 0.729). The HBOT group also had a significantly higher association with complete recovery (IPTW-adjusted odds ratio: 2.57, 95% CI 1.13-5.85; = 0.025).
CONCLUSION
In SSHNL, HBOT combination therapy yielded slightly but significantly improved hearing outcomes compared to non-HBOT treatment.
LEVEL OF EVIDENCE
目的
本研究旨在通过临床数据和先进的分析方法，评估高压氧治疗（HBOT）作为主要治疗方法联合标准全身皮质类固醇治疗突发性感音神经性听力损失（SSNHL）的临床疗效，并与不使用HBOT的治疗方法（非HBOT）进行比较。
研究设计
病例对照研究。
方法
在日本的三个医疗中心进行，涉及298例在2020年至2023年期间被诊断为SSNHL的患者。纳入标准包括首次发病并接受治疗、世界卫生组织3级或4级初始听力损害、在症状出现后14天内接受全身皮质类固醇治疗，以及病例组在同一时间范围内开始HBOT治疗。主要结局指标是两组之间听力改善的差异（以分贝为单位的平均听力水平，dB），通过在基线和治疗后3个月进行纯音听力测定来评估，使用针对协变量差异调整的治疗加权逆概率（IPTW）方法。
结果
研究包括HBOT组67例患者和非HBOT组68例患者。HBOT组的听力改善明显更大（IPTW调整差异：7.6 dB，95%CI 0.4 - 14.7；P = 0.038）。HBOT组中没有眩晕的患者听力有显著改善（11.5 dB，95%CI 2.3 - 20.6；P = 0.014），而有眩晕的患者没有显著改善（-1.8 dB，95%CI -11.8 - 8.3；P = 0.729）。HBOT组完全恢复的关联也显著更高（IPTW调整优势比：2.57，95%CI 1.13 - 5.85；P = 0.025）。
结论
在SSNHL中，与非HBOT治疗相比，HBOT联合治疗在听力结果上有轻微但显著的改善。
证据水平
4级。
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