Evidence Supporting the Hypothesis That Inflammation-Induced Vasospasm Is Involved in the Pathogenesis of Acquired Sensorineural Hearing Loss

Table 3

Meta-analyses of randomised controlled trials in humans to treat SNHL with steroids.

Design	Number of participants/number of randomised controlled trials	Age of participants	Intervention	Outcome	Critical appraisal	Reference
Systematic review with meta-analysis of randomised controlled trials	1394/14	Unknown	Combined intratympanic and systemic use of steroids as a first-line treatment for sudden SNHL	The proportion of patients with hearing improvement as the outcome measure was observed in 13 studies, which resulted in an odds ratio (OR) of 2.50 (95% confidence interval (CI): 1.95–2.1)	The differences in treatment regimes or unclear treatment invalidate the pooling of results	[83]
Systematic review and meta-analysis of randomised controlled trials	416/8	Mean age 47 to 60 years	Isolated intratympanic dexamethasone for sudden SNHL	Pure-tone audiogram improvement criterion did not reach statistical significance (OR 5 0.39, CrI 5 0.11–1.27)	Large heterogeneity was noted among these studies	[84]
Systematic review and meta-analysis of randomised, controlled trials	203 /5	Unknown overall age distribution	Intratympanic steroid therapy as a salvage treatment for sudden SNHL after failure of conventional therapy	The meta-analysis data were derived from 5RCTs of 102 patients in the ITS group and 101 control subjects; the mean difference and 95% CI of the PTA improvement (indB) were 7.43 and 4.25–10.60, respectively	The authors suspected that the small number of trials (5) available for their meta-analysis was due to publication bias with studies reporting nonsignificant results under represented	[85]
Systematic review and meta-analysis of randomised, controlled trials	1166/15	Unknown	Treatment of sudden SNHL	Three articles (181 subjects), steroid versus placebo analysis: OR = 1.52 (95% confidence interval (CI): 0.83–2.77); six articles (702 subjects) in systemic versus intratympanic steroids analysis (OR 1.14 (95% CI: 0.82–1.59)); six articles (283 subjects): salvage treatment analysis (OR: 6.04 (95% CI: 3.26–11.2))	Numbers are small in the subgroup analyses shown; a clinically significant effect may have been missed	[86]