2020.06耳鼻喉科

1. ENT Journal Reading
Presenter: FM R2盧敬文
Supervisor: VS王士豪
2020.06.29

2. JAMA Otolaryngol Head Neck Surg. 2020;146(5):421-428.

3. Sudden sensorineural hearing loss
• Identifiable cause: 10% to 15%；
vestibular schwannoma(1%), Meniére disease, autoimmune
disease, or perilymphatic fistula
• Idiopathic: 90%
within 72 hours with a decrease in hearing of at least 30 dB at 3
consecutive frequencies on PTA
Unilateral
between ages 43 to 53
Incidence: btw 5 and 20 per 100 000 person-years

4. 家庭醫學與基層醫療，27(10): 370-378

5. Standard treatment: a tapering course of oral corticosteroid
(Wilson et al, 1980)
Intratympanic treatment（IT）
• 理論上的優點：局部藥物濃度高、系統副作用小
Aim:
• 比較IT和ST（systemic treatment）對PTA平均增加dB的差異
• 比較IT,ST和CB(combined treatment)組對於聽力恢復的勝算比

6. Method
Excluded identifiable causes
Searched:
PubMed, Embase, OvidSP, CINAHL,
and Cochrane Library
• January 1, 1966, to July 1, 2018
Data of interest extracted:
• Reported PTA gain in dB from
baseline to follow-up
• the severity of the mean hearing loss
• proportion of patients achieving
complete recovery

7. the Goodman criteria of hearing loss:
mild (26 dB-40 dB),
moderate (41 dB-55 dB),
moderate to severe (56 dB-70dB),
severe (71 dB-90 dB),
profound (≥91 dB).

8. Results

9. Risk of Bias Assessment
insufficient concealment of randomization and nonmasked
personnel and patients are predominant in the current
literature,
Similarly, there were numerous unknown risks of bias because
of insufficient reporting.

10. Intratympanic Treatment vs Systemic Treatment
4 studies were eligible for analysis of differences in mean PTA gain.

11. 趨勢是ST組在PTA的dB會增加較多，但未達統計顯著

13. Combined Treatment vs Systemic Treatment

14. Combined Treatment vs Intratympanic Treatment
Neither of the 2 studies solitarily indicated any significant
difference between the treatments.

15. Discussion
1. no mean difference in average PTA gain
between the IT and ST groups based on 4 studies
2. no difference in the odds for recovery
between the IT and ST groups based on 5 studies

16. Comparison With Existing Literature
• Kosyakov et al(2011) who report baseline PTA
characteristics as a mean (SD) 41.0 (12.87)dB and
37.1(16.67) dB, respectively.
 not confined within the ISSNHL-definitory criteria of a minimum
30-dB hearing loss.
• 有一篇favor for the IT group（Qiang et al, 2017）
• 但之中包含上面那篇，及Battaglia et al(2008) defined ISSNHL as a
hearing loss of a minimum of 20 dB and not 30 dB.
 validity??

17. • time-to-treatment initiation as an important prognostic
parameter
• the mean days to treatment was 4 days in the CB group vs 11 days
in in the ST group (Battaglia et al, 2008)
 baseline discrepancy!!

18. Association With Future Clinical Practice and Research
• wide heterogeneity
Initial hearing deficit
amount of hearing recovery
• future studies should be restricted to moderate to profound
levels of hearing loss to improve the comparability.

19. Strengths and Limitations
1. 沒有安慰劑組別，無法隱藏隨機分派
2. 不同指引的完全恢復定義不一
within 25dB, 30dB, 10dB from健側耳？
3. 無法控制的異質性，來自不同評估框架的：
1. Time to treatment onset
2. Age at baseline
3. PTA at baseline

20. • older ages described in literature comprise the age
categories 70 to 79 years and 80 to 89years
nor is presbycusis a relevant parameter
• 追蹤時間長短不一，17 days -3 months
• 不同的Steroid: dexamethasone vs methylprednisolone
 文獻甚少討論這部份

21. Key Points
It also found no evidence that combining the 2 administration
routes improved hearing recovery.
 Future research and guidelines should determine
which patient groups should be allocated
to receive what administration.
(eg, systemic corticosteroids in elderly patients may be associated
with increased risk of adverse effects, and so these patients should
be treated intratympanically).

22. Thank you for
your attention.