Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2021, Vol. 35 ›› Issue (5): 1-10.doi: 10.6040/j.issn.1673-3770.0.2021.010

    Next Articles

Intratympanic injections and systemic glucocorticoid treatment for sudden hearing loss: a systematic review and Meta-analysis

ZHONG Liping1,2, GUAN Xilong1,2, WANG Jingjing1,2, TANG Yong1,3   

  1. 1. Clinical Medical College of Changchun University of Chinese Medicine, Changchun 130117, Jilin, China;
    2. Department of Otorhinolaryngology, Jilin Province People's Hospital, Changchun 130021, Jilin, China;
    3. Department of Otorhinolaryngology, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130117, Jilin, China
  • Published:2021-09-29

PDF (PC)

200

Abstract: Objective To assess the efficacy, healing rate, and safety of intratympanic injections and systemic glucocorticoids in the initial treatment of sudden hearing loss. Methods The Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases were searched, and all RCTs involving intratympanic injection and systemic glucocorticoids in the treatment of sudden hearing loss before July 2020 were extracted. The literature was analyzed according to their inclusion and exclusion criteria, and their quality was evaluated using the Cochrane Handbook 5.1. Data were extracted and analyzed using RevMan 5.3 Meta-analysis software. Results Nine randomized controlled trials were identified, comprising three papers in Chinese and six in English.A total of 757 cases were included, of which 396 had been treated with intratympanic injections and 361 with systemic glucocorticoids. The Meta-analysis revealed no differences in the total effectiveness rate, healing rate, and mean pure tone average(PTA)gain between intratympanic injections and systemic glucocorticoid treatment(Relative Risk(RR)=1.05, 95% Confidence Interval(CI)=0.65-1.23; RR=1.01, 95%CI=0.79-1.30; and RR=1.18, 95%CI=-0.60-2.96, respectively). The subgroup analysis revealed no significant difference in PTA gain between the severe group and the moderate-to-severe group, and internal research revealed that intratympanic injections were more efficient than systemic glucocorticoids, while foreign research reported no significant difference between them. The major complications of intratympanic injection were transient vertigo and tinnitus, while the incidence of local complications was lower than that observed with systemic steroid treatment, which included high blood glucose, high blood pressure, and insomnia. Conclusion This study revealed no difference in the effectiveness and cure rates of sudden sensorineural hearing loss between intratympanic injections and systematic steroid use. Fewer side effects are associated with postauricular injections than systematic steroid therapy.

Key words: Sudden hearing loss, Glucocorticoids, Intratympanic injection, Efficacy, Meta-analysis

CLC Number: 

  • R764.43+7
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 突发性聋的诊断和治疗指南(2005年, 济南)[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(8): 569. doi:10.3760/j.issn: 1673-0860.2006.08.003. Chinese Otorhinolaryngology Head and Neck Surgery Society of Chinese Medical Association, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Guideline of diagnosis and treatment of sudden deafness(2005, Jinan)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2006, 41(8): 569. doi:10.3760/j.issn: 1673-0860.2006.08.003.
[2] Seggas I, Koltsidopoulos P, Bibas A, et al. Intratympanic steroid therapy for sudden hearing loss: a review of the literature[J]. Otol Neurotol, 2011, 32(1): 29-35. doi:10.1097/mao.0b013e3181f7aba3.
[3] Sennaro glu L, Dini FM, Sennaro glu G, et al. Transtympanic dexamethasone application in Ménière's disease: an alternative treatment for intractable Vertigo[J]. J Laryngol Otol, 1999, 113(3): 217-221. doi:10.1017/s0022215100143610.
[4] HIGGINS JPT, GREEN S(editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March2011]. The Cochrane Collaboration, 2011. Available from www.co-chrane-handbook.org.
[5] 陈声伟, 陈伟东, 林楚标, 等. 地塞米松不同途径给药治疗突发性聋的临床效果比较[J]. 中国当代医药, 2019, 26(26): 123-126. doi: 10.3969/j.issn.1674-4721.2019.26.037. CHEN Shengwei, CHEN Weidong, LIN Chubiao, et al. Clinical effect comparison of Dexamethasone on sudden deafness treated by different administration routes[J]. China Mod Med, 2019, 26(26): 123-126. doi: 10.3969/j.issn.1674-4721.2019.26.037.
[6] 付丽艳, 刘卓慧, 龙瑞清. 鼓室内与静脉注射地塞米松治疗突发性聋疗效比较[J]. 听力学及言语疾病杂志, 2018, 26(4): 350-353. doi: 10.3969/j.issn.1006-7299.2018.04.004. FU Liyan, LIU Zhuohui, LONG Ruiqing. Efficacy analysis of intratympanic and intravenous dexamethasone in idiopathic sudden sensorineural hearing loss[J]. J Audiol Speech Pathol, 2018, 26(4): 350-353. doi: 10.3969/j.issn.1006-7299.2018.04.004.
[7] 李晖, 刘莉, 郭筠芳. 鼓室注射地塞米松治疗突发性聋的疗效及影响因素分析[J]. 听力学及言语疾病杂志, 2013,21(5): 539-541. doi: 10.3969/j.issn.1006-7299.2013.05.028.
[8] Seok Ming Hong. Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSNL[J]. Otolaryngology-Head and Neck Surgery, 2009, 141:579-583.
[9] Lim HJ, Kim YT, Choi SJ, et al. Efficacy of 3 different steroid treatments for sudden sensorineural hearing loss[J]. Otolaryngol Head Neck Surg, 2013, 148(1): 121-127. doi:10.1177/0194599812464475.
[10] Tsounis M, Psillas G, Tsalighopoulos M, et al. Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial[J]. Eur Arch Otorhinolaryngol, 2018, 275(1): 103-110. doi:10.1007/s00405-017-4803-5.
[11] Tong B, Wang Q, Dai Q, et al. Efficacy of various corticosteroid treatment modalities for the initial treatment of idiopathic sudden hearing loss: a prospective randomized controlled trial[J]. Audiol Neurootol, 2021, 26(1): 45-52. doi:10.1159/000508124.
[12] Rauch SD, Halpin CF, Antonelli PJ, et al. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial[J]. JAMA, 2011, 305(20): 2071-2079. doi:10.1001/jama.2011.679.
[13] Swachia K, Sharma D, Singh J. Efficacy of oral vs. intratympanic corticosteroids in sudden sensorineural hearing loss[J]. J Basic Clin Physiol Pharmacol, 2016, 27(4): 371-377. doi:10.1515/jbcpp-2015-0112.
[14] Rajati M, Azarpajooh MR, Mouhebati M, et al. Is sudden hearing loss associated with atherosclerosis?[J]. Iran J Otorhinolaryngol, 2016, 28(86): 189-195. PMID: 27429947.
[15] Mohammed AAM. Lipid profile among patients with sudden sensorineural hearing loss[J]. Indian J Otolaryngol Head Neck Surg, 2014, 66(4): 425-428. doi:10.1007/s12070-014-0744-0.
[16] 施典羽, 杨凯, 敬光怀, 等. 特发性突聋患者外周血ET、CGRP和NO的检测分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2012, 20(4): 246-248, 245. doi: CNKI:SUN:XYJH.0.2012-04-004. SHI Dianyu, YANG Kai, JING Guanghuai, et al. The Detection and analysis of ET, CGRP, NO in the ISSHL Patients' peripheral blood[J]. 2012, 20(4): 246-248, 245. doi: CNKI:SUN:XYJH.0.2012-04-004.
[17] 赵鹏举, 刘阳, 王庆军, 等. 突发性耳聋患者内淋巴积水的客观影像检测[J]. 中华耳科学杂志, 2016,14(6): 764-768. doi: 10.3969/j.issn.1672-2922.2016.06.013. ZHAO Pengju, LIU Yang, WANG Qingjun, et al. MRI detction of endolymphatic Hydrops in patients with sudden sensorineural hearing loss[J]. Chin J Otol, 2016, 14(6): 764-768. doi: 10.3969/j.issn.1672-2922.2016.06.013.
[18] 李和清, 任基浩, 卢永德. 突聋血清病毒特异性IgM抗体及NO检测的初步研究[J]. 中国耳鼻咽喉颅底外科杂志, 2002, 6(2): 133-134. doi: 10.3969/j.issn.1007-1520.2002.02.023.
[19] 刘瑶, 管国芳, 孙开, 等. 突发性耳聋与巨细胞病毒感染关系初探[J]. 吉林医学, 2011,32(13): 2513-2514. doi: 10.3969/j.issn.1004-0412.2011.13.006. LIU Yao, GUAN Guofang, SUN Kai, et al. Preliminary research on relationship between sudden deafness and Cytomegalovirus infection[J]. Jilin Med J, 2011, 32(13): 2513-2514. doi: 10.3969/j.issn.1004-0412.2011.13.006.
[20] 原晶晶,鲍诗平,张帆,等.慢性乙型肝炎病毒感染与听力相关性初步研究[J]. 中国听力语言康复科学杂志,2016, 14(6):428-431. doi:10.3969/j.issn.1672-4933.2016.06.008. YUN Jingjing, BAO Shiping, ZHANG Fan, et al. A preliminary study on the correction between chronic hepatitis B virus infection and hearing status [J]. Chinese Scientific Journal of Hearing and Speech Rehabilitation, 2016, 14(6):428-431. doi:10.3969/j.issn.1672-4933.2016.06.008.
[21] Rossini BAA, Penido NO, Munhoz MSL, et al. Sudden sensorioneural hearing loss and autoimmune systemic diseases[J]. Int Arch Otorhinolaryngol, 2017, 21(3): 213-223. doi:10.1055/s-0036-1586162.
[22] 衡伟伟, 后婕, 魏先梅, 等. TNF-α和IL-8在突发性聋患者血清及外周血单个核细胞中的表达及其意义[J]. 山东大学耳鼻喉眼学报, 2016,30(2): 40-45. doi: 10.6040/j.issn.1673-3770.0.2015.473. HENG Weiwei, HOU Jie, WEI Xianmei, et al. Expressions and significance of TNF-α and IL-8 in serum and peripheral blood mononuclear cells from patients with sudden sensorineural hearing loss[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(2): 40-45. doi: 10.6040/j.issn.1673-3770.0.2015.473.
[23] 梁敏, 吴悔, 陈建勇, 等. 前庭诱发肌源性电位预测突聋患者疗效的临床价值[J]. 山东大学耳鼻喉眼学报, 2020,34(5): 27-32. doi: 10.6040/j.issn.1673-3770.1.2020.063. LIANG Min, WU Hui, CHEN Jianyong, et al. Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(5): 27-32. doi: 10.6040/j.issn.1673-3770.1.2020.063.
[24] Silverstein H, Thompson J, Rosenberg SI, et al. Silverstein MicroWick[J]. Otolaryngol Clin N Am, 2004, 37(5): 1019-1034. doi:10.1016/j.otc.2004.04.002.
[25] 孙爱华, LorneS.Parnes, DavidJ. Freeman, 等. 不同用药途径地塞米松在内耳液中的分布[J]. 中华耳鼻咽喉科杂志, 2001, 36(1): 62-63. doi: 10.3760/j.issn:1673-0860.2001.01.021.
[26] Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application[J]. Laryngoscope, 1999, 109(7 pt 2): 1-17. doi:10.1097/00005537-199907001-00001.
[27] 李穗, 龚树生, 陈建国, 等. 3种糖皮质激素经圆窗膜给药在内耳的药代动力学研究[J]. 临床耳鼻咽喉科杂志, 2005, 19(1): 24-26. doi: 10.3969/j.issn.1001-1781.2005.01.010. LI Sui, GONG Shusheng, CHEN Jianguo, et al. Pharmacokinetics of the methylprednisolone,dexamethasone and hydrocortisone in the inner ear after administered via round window[J]. Journal of Clinical Otorhinolaryngology, 2005, 19(1): 24-26. doi: 10.3969/j.issn.1001-1781.2005.01.010.
[28] Plontke SK, Biegner T, Kammerer B, et al. Dexamethasone concentration gradients along Scala tympani after application to the round window membrane[J]. Otol Neurotol, 2008, 29: 401-406. doi: 10.1097/MAO.0b013e318161aaae.
[29] 严小玲, 毛敏, 翟锦明, 等. 鼓室内注射治疗难治性突发性耳聋52例[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 23-26. doi: 10.6040/j.issn.1673-3770.0.2014.045. YAN Xiaoling, MAO Min, ZHAI Jinming, et al. Intratympanic steroids to treat refractory sudden sensorineural hearing loss(52 cases report)[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(5): 23-26. doi: 10.6040/j.issn.1673-3770.0.2014.045.
[30] Marx M, Younes E, Chandrasekhar SS, et al. International consensus(ICON)on treatment of sudden sensorineural hearing loss[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(1s): S23-S28. doi:10.1016/j.anorl.2017.12.011.
[1] XU Jia, LI Xin, CHEN Wenjing, GAO Juanjuan, LU Xingxing, YI Haijin. Short-term and long-term outcomes of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 17-21.
[2] LIN Manqing, ZHOU Min, CHEN Tengyu, LI-Dan, FANG Caishan, WANG Ruizhi, ZHU Jinxiang, RUAN-Yan, XU Huixian, WANG Peiyuan. Meta-analysis of the efficacy and safety of traditional Chinese medicine for nasal irrigation in the treatment of chronic rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 209-225.
[3] JIANG Xuelian, ZHANG Jingyue, WEI Xudong. Evaluation of the efficacy and potential mechanism of biyuan tongqiao granules in chronic sinusitis treatment based on Meta-analysis bridging network pharmacology [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 226-236.
[4] HUANG Kaiyue, LI Xueqing, HAN Gouxin, ZHANG Qinxiu. Meta-analysis of acupoint catgut embedding in the treatment of allergic rhinitis based on the theory of “lung and spleen” [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 266-274.
[5] LIU Shanshan, HAN Shujing, WANG Xiaoxu, LI Yanhong, NI Xin, ZHANG Jie. Hearing loss in children after bacterial meningitis: a systematic review and meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 48-54.
[6] LIU Yi, YU Mingkun, SUN Wei, SHAO Zhen, HU Yuanyuan, BI Hongsheng. The effectiveness and safety of orthokeratology on controlling myopia of children: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 92-100.
[7] LIN Xiaoyan, LI Jing, MA Zhiqi, LI Yilin, GAO Xinyi, LI Yong. Therapeutic and anti-allergic effects of probiotics on allergic rhinitis: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 70-80.
[8] ZHOU En, XIAO Yu, XIAO Xuping. Application progress of radiofrequency ablation technology in the treatment of early glottic carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 9-15.
[9] TAN Fengwu, DENG Yaping, LI Kehua. The therapeutic effects of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic carcinoma: a Meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 63-71.
[10] Obstructive sleep apnea(OSA)is a common sleep-related respiratory disorder. If left untreated, it can lead to cardiovascular and nervous system damage. In addition to continuous positive airway pressure(CPAP), most OSA patients have surgical treatment based on the anatomical obstruction. Uvulopalatopharyngoplasty(UPPP)is the most common procedure performed. This paper reviews the current research on the preoperative evaluation of UPPP, summarizes possible predictors, and screens out more specific predictive factors. The aim is to construct a more efficient predictive system, specify the indications and contraindications of UPPP surgery.. Analysis of the preoperative predictive factors of Uvulopalatopharyngoplasty [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 145-151.
[11] ObjectiveTo compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). MethodsWe searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May , . We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. ResultsWe identified seven studies including CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: ., % confidence interval .-., P=.). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: ., % confidence interval .-., P<.). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. ConclusionAlthough intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.. Intra-arterial thrombolysis for central retinal artery occlusion: a Meta-analysisCHEN Xi, LI Shanshan, ZHAO Lu, YOU Ran, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 28-34.
[12] ZONG Xiaofang, HU Guohua, ZHONG Shixun, LEI Yan, JIANG Lizhu, KANG Houyong. Analysis of the factors affecting the prognosis of low-frequency descending sudden hearing loss without vertigo [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 33-37.
[13] ZHANG Junjun, LIU Haili, LIU Jiafu, QIN Xiaofeng, DU Hongming, WANG Houhui. Clinical efficacy and safety of different methods of administration of glucocorticoids in the treatment of sudden deafness [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 52-55.
[14] JI Di, CHEN Xiang, YU Lin. Soft palate surgeries with hyoid bone suspension for obstructive sleep apnea hypopnea syndrome with glossoptosis: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 124-130.
[15] LIU Lin, ZHENG Hua, CHEN Shaolin, DUAN Xuanchu. Neuroprotective effects and safety of stem cell transplantation in rats with experimental glaucoma: a systematic review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 138-144.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] YANG Changliang,HUANG Zhiwu,YAO Hangqi,ZHU Yong,SNU Yi . Study on auditory brainstem response[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 9 -13 .
[2] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 89 -89 .
[3] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 90 -91 .
[4] LIU Da-yu,PAN Xin-liang,LEI Da-peng,ZHANG Li-qiang,LUAN Xin-yong . Surgical treatment for medial wall pyriform sinus cancer[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(1): 8 -11 .
[5] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 188 -188 .
[6] LIU Yan,LIU Xin-yi,WANG Jin-ping,LI Da-jian . Measurement of the posterior tympanum and its clinical significance [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 218 -221 .
[7] ZHAO Min,WANG Shou-sen,ZHEN Ze-nian,CHEN Xian-ming,WANG Mao-xin . Sphenoid sinus and trans-sphenoid surgery under nasal endoscopy and microscopy [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 244 -245 .
[8] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 252 -252 .
[9] WANG Hong-xia,WANG Peng-cheng . Expression of NSE,S100 and GFAP in retinoblastoma and its clinical significance[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 263 -264 .
[10] HUANG Fang,HUANG Hai-qiong,HUANG Jian-qiang,HE He-fan . Bronchoscopic video supervision system in infant bronchial foreign bodies[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 276 -277 .
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd