Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network...

Area of Science:

• Otolaryngology
• Audiology
• Regenerative Medicine

Background:

• Sudden sensorineural hearing loss (SSNHL) affects 30-50% of patients who do not respond to systemic steroids.
• The optimal treatment for refractory SSNHL (RSSNHL) remains undetermined.
• Investigating salvage therapies is crucial for improving hearing outcomes in non-responders.

Purpose of the Study:

• To compare the efficacy of various salvage treatment regimens for RSSNHL.
• To identify the most effective treatment for patients with SSNHL refractory to initial therapy.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Comparison of five salvage strategies: intratympanic steroid injection (ITS), hyperbaric oxygen (HBO) therapy, post-auricular steroid injection (PSI), combined ITS and HBO, and continued systemic steroids.
• Inclusion of randomized controlled trials and cohort studies identified through extensive database searches.

Main Results:

• Both PSI and ITS demonstrated significant hearing improvement compared to no additional treatment.
• PSI yielded a greater mean hearing gain (11.1 dB) than ITS (7.7 dB).
• Intratympanic steroid injection combined with hyperbaric oxygen therapy (ITS + HBO) showed the largest improvement (14.5 dB) for pure tone average under a restricted RSSNHL definition.

Conclusions:

• Post-auricular steroid injection (PSI) and intratympanic steroid injection (ITS) are the most effective salvage treatments for RSSNHL.
• Further research is needed to establish a consensus definition for RSSNHL to refine treatment comparisons.