Evidence and recommendation. Is intratympanic corticosteroid treatment of sudden hearing loss effective?
Abstract Introduction and objective: It is considered that treatment with systemic corticosteroid (SC) orally is preferred in sudden deafness and intratympanic injection of corticosteroid (ITC) can be used as an alternative. PICO question: In an adult with no improvement sudden deafness or partial hearing improvement [patient], does treatment with intratympanic corticoid [intervention] compared with conventional treatment [compared] improve hearing? [result]. Material and Methods: Literature search in PubMed, Scopus and Cochrane meta-analysis of published data including descriptors: deafness, hearing loss, steroids, corticoids, intratympanic. Selected studies in adult humans, in Spanish or English that included meta-analysis. Results: Level of evidence: Evidence is high for the use of ITC as rescue therapy in patients undergoing SC without response or partial response. The evidence is moderate for the use of ITC as initial therapy given the poor quality of published studies. What is more, the evidence is high against the use of ITC as initial therapy. Conclusions: Recommendation: The recommendation is strongly in favor of ITC as rescue therapy in patients with little or no response to SC treatment. The recommendation is weak against ITC perform as first-line treatment.
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Vlastarakos PV, Papacharalampous G, Maragoudakis P, Kampessis G, Maroudias N, Candiloros D, et al. Are intra-tympanically administered steroids effective in patients with sudden deafness? Implications for current clinical practice. Eur Arch Otorhinolaryngol. 2012;269(2):363-80. http://dx.doi.org/10.1007/s00405-011-1738-0 -- PMid:21853324
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Garavello W, Galluzzi F, Gaini RM, Zanetti D. Intratympanic steroid treatment for sudden deafness: a meta-analysis of randomized controlled trials. Otol Neurotol. 2012;33(5):724-9. http://dx.doi.org/10.1097/MAO.0b013e318254ee04 -- PMid:22699982
Li H, Feng G, Wang H, Feng Y. Intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss after failure of conventional therapy: a meta-analysis of randomized, controlled trials. Clin. Ther. 2015;37(1):178-87. http://dx.doi.org/10.1016/j.clinthera.2014.11.009 -- PMid:25542075
Ng JH, Ho RCM, Cheong CSJ, Ng A, Yuen HW, Ngo RYS. Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis. Eur Arch Otorhinolaryngol. 2015 Oct;272(10):2777-82. http://dx.doi.org/10.1007/s00405-014-3288-8 -- PMid:25217083
Spear SA, Schwartz SR. Intratympanic steroids for sudden sensorineural hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2011 Oct;145(4):534-43. http://dx.doi.org/10.1177/0194599811419466 -- PMid:21873598
http://dx.doi.org/10.1016/j.otorri.2010.09.001 -- PMid:21112580
Weber PC. Sudden sensorineural hearing loss. Uptodate [Internet]. 2016. Disponible en: http://uptodate.publicaciones.saludcastillayleon.es/contents/sudden-sensorineural-hearing-loss?source=outline_link&view=text&anchor=H13 - H13. [citado 3 de mayo de 2016].
Vlastarakos PV, Papacharalampous G, Maragoudakis P, Kampessis G, Maroudias N, Candiloros D, et al. Are intra-tympanically administered steroids effective in patients with sudden deafness? Implications for current clinical practice. Eur Arch Otorhinolaryngol. 2012;269(2):363-80. http://dx.doi.org/10.1007/s00405-011-1738-0 -- PMid:21853324
Ochoa-Sangrador C. Evidencia y recomendación. Rev. ORL. 2016;7(2). En prensa. Disponible en: http://revistas.usal.es/cinco/index.php/2444-7986/article/view/14019. [citado 16 de mayo de 2016]. http://dx.doi.org/10.14201/orl201672.14019
Crane RA, Camilon M, Nguyen S, Meyer TA. Steroids for treatment of sudden sensorineural hearing loss: a meta-analysis of randomized controlled trials. Laryngoscope. 2015;125:209-17. http://dx.doi.org/10.1002/lary.24834 -- PMid:25045896
Garavello W, Galluzzi F, Gaini RM, Zanetti D. Intratympanic steroid treatment for sudden deafness: a meta-analysis of randomized controlled trials. Otol Neurotol. 2012;33(5):724-9. http://dx.doi.org/10.1097/MAO.0b013e318254ee04 -- PMid:22699982
Li H, Feng G, Wang H, Feng Y. Intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss after failure of conventional therapy: a meta-analysis of randomized, controlled trials. Clin. Ther. 2015;37(1):178-87. http://dx.doi.org/10.1016/j.clinthera.2014.11.009 -- PMid:25542075
Ng JH, Ho RCM, Cheong CSJ, Ng A, Yuen HW, Ngo RYS. Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis. Eur Arch Otorhinolaryngol. 2015 Oct;272(10):2777-82. http://dx.doi.org/10.1007/s00405-014-3288-8 -- PMid:25217083
Spear SA, Schwartz SR. Intratympanic steroids for sudden sensorineural hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2011 Oct;145(4):534-43. http://dx.doi.org/10.1177/0194599811419466 -- PMid:21873598
Pardal-Refoyo, J. L. (2016). Evidence and recommendation. Is intratympanic corticosteroid treatment of sudden hearing loss effective?. Revista ORL, 7(2), 91–95. https://doi.org/10.14201/orl.14575
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