Meliante Piero Giuseppe, D'Avino Luigi, Barba Giuseppe, Covelli Edoardo, Petrella Carla, Barbato Christian, Minni Antonio
Department of Neuroscience, Mental Health and Sensory Organs (N.E.S.M.O.S.), Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Division of Otorhinolaryngology, Head and Neck Surgery, "V. Monaldi" Hospital, A.O.R.N. dei Colli, Naples, Italy.
Front Neurol. 2025 Jul 15;16:1627892. doi: 10.3389/fneur.2025.1627892. eCollection 2025.
Sudden sensorineural hearing loss (SSNHL) affects up to 27 per 100,000 people annually, with more than half not regaining full hearing after following standard therapy. Identifying effective salvage treatments for refractory cases is critical to improve outcomes and reduce long-term auditory disability. This systematic review aims to assess the effectiveness of current salvage treatments for SSNHL unresponsive to first-line systemic corticosteroid therapy, and to develop an evidence-based treatment algorithm.
A comprehensive search of PubMed, Embase, and Cochrane Library was performed for English language articles published between January 2010 and April 2025. Studies eligible for inclusion were clinical trials and large case series that evaluated salvage interventions in patients with SSNHL who were unresponsive to systemic therapy. Risk of bias was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool.
A total of 41 articles met the inclusion criteria. Intratympanic steroids (ITS), including methylprednisolone and dexamethasone, showed consistent effectiveness, with methylprednisolone achieving better results ( < 0.05). Hyperbaric oxygen therapy (HY) was also effective, particularly at low frequencies. Combined ITS and HY yielded the best results in word recognition and pure-tone average (PTA) improvement, although they were not always statistically better than monotherapy. Early initiation of ITS was associated with improved outcomes, and ITS proved especially effective for high-frequency SSNHL and tinnitus ( = 0.002). Non-invasive therapies, such as constraint-induced sound therapy (CIST), have been promising in improving outcomes by decreasing maladaptive cortical reorganization. Additional emerging treatments [e.g., insulin-like growth factor 1 (IGF-1), urokinase, and surgical interventions] show potential but need further validation.
ITS and HY, especially when combined, are the most effective salvage therapies for refractory SSNHL. Methylprednisolone may offer better outcomes than dexamethasone, and early intervention continues to be a crucial prognostic factor. CIST showed promising potential in reducing cortical maladaptation to sound deprivation.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025645069, Identifier, CRD42025645069.
突发性感音神经性听力损失（SSNHL）每年影响多达每10万人中有27人，超过半数患者在接受标准治疗后无法恢复完全听力。确定针对难治性病例的有效挽救治疗对于改善预后和减少长期听觉残疾至关重要。本系统评价旨在评估当前针对对一线全身用糖皮质激素治疗无反应的SSNHL的挽救治疗的有效性，并制定基于证据的治疗算法。
对2010年1月至2025年4月发表的英文文章全面检索PubMed、Embase和Cochrane图书馆。符合纳入标准的研究为评估对全身治疗无反应的SSNHL患者挽救干预措施的临床试验和大型病例系列。使用干预性非随机研究的偏倚风险（ROBINS-I）工具评估偏倚风险。
共有41篇文章符合纳入标准。鼓室内注射类固醇（ITS），包括甲泼尼龙和地塞米松，显示出一致的有效性，甲泼尼龙效果更佳（<0.05）。高压氧治疗（HY）也有效，尤其是在低频方面。联合ITS和HY在言语识别和纯音平均听阈（PTA）改善方面效果最佳，尽管并不总是在统计学上优于单一疗法。早期开始使用ITS与改善预后相关，并且ITS对高频SSNHL和耳鸣特别有效（=0.002）。无创治疗，如强制性诱导声疗法（CIST），在通过减少适应性不良的皮质重组改善预后方面很有前景。其他新兴治疗方法[如胰岛素样生长因子1（IGF-1）、尿激酶和手术干预]显示出潜力，但需要进一步验证。
ITS和HY，尤其是联合使用时，是难治性SSNHL最有效的挽救治疗方法。甲泼尼龙可能比地塞米松效果更好，早期干预仍然是一个关键的预后因素。CIST在减少皮质对声音剥夺的适应性不良方面显示出有前景的潜力。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025645069，标识符，CRD42025645069。
