鼓室与全身应用激素治疗突发性耳聋的系统评价与Meta分析

目的 利用Meta分析的方法评价及分析鼓室注射与全身应用激素初始治疗突发性耳聋的有效性,痊愈率及安全性.方法 计算机搜索Web of science、Pubmed、Embase、Cochrane library、中国知网、万方医学网、维普信息资源系统,系统收集2020年7月之前的随机对照研究,经筛选后对符合纳入标准的文...

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

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.