A systematic review and network meta-analysis of existing pharmacologic therapies in patients with idiopathic sudden sensorineural hearing loss

Abstract

BackgroundHearing loss is one of the leading causes of disability worldwide. Patients with hearing loss experience impaired quality of life, as well as emotional and financial consequences that affect both themselves and their families. Idiopathic sudden sensorineural hearing loss (ISSNHL) is a common but difficult to treat condition that has a sudden onset of ≤ 72 hour associated with various etiologies, with the majority of cases being idiopathic. There exists a wide range of therapeutic options, however, the uncertainty surrounding their comparative efficacy and safety makes selection of treatment difficult. This systematic review and network meta-analysis (NMA) assessed the relative effects of competing treatments for management of ISSNHL.MethodsA protocol for this review was registered with PROSPERO (CRD42017073756). A detailed search of MEDLINE, Embase and the Cochrane Library from inception to February 8th, 2018 was carried out by an experienced information specialist. Grey literature was also searched. Screening full-text records, and risk of bias assessment were carried out independently by two reviewers, and disagreements were resolved through consensus or third party adjudication, while data was collected by one reviewer and verified by a second reviewer. Bayesian network meta-analyses (NMA) were performed to inform comparisons between interventions for a priori specified outcomes that included pure tone average (PTA) improvement and hearing recovery.ResultsThe search identified a total of 1,138 citations, of which 613 remained for review after removal of duplicates. Of these, 23 publications describing 19 unique studies (total sample size of 1,527) met our a priori eligibility criteria, that were assessed to be at unclear or high risk of bias on several domains. We identified data on several interventions for ISSNHL therapy and were able to construct treatment networks consisting of six intervention groups that included placebo; intratympanic (IT) steroid; IT plus systemic steroid; per oral (PO) steroid; intravenous (IV) steroid; and IV plus PO steroid for our NMAs. IT plus systemic steroids demonstrated the largest difference in PTA improvement compared to placebo (25.85 dB, 95% CrI 7.18–40.58), followed by IV plus PO steroids (22.06 dB, 95% CrI 1.24–39.17), IT steroids (18.24 dB, 95% CrI 3.00–29.81). We observed that the difference of PTA improvement between each intervention and placebo diminished over time, attributed to spontaneous recovery. The binary outcomes of hearing recovery demonstrated similar relative ordering of interventions but were less sensitive than PTA improvement to capture the significant differences between interventions and placebo.ConclusionUnclear to high risk of bias trials rated IT plus systemic steroid treatment as the best among the six interventions compared, and all active treatments were better than placebo in improving PTA. However, it should be noted that certain comparisons were based on indirect evidence only or few studies of small sample size, and analyses were u...

Sudden sensorineural hearing loss: What factors influence the response to therapy?

“…In addition, Ahmadzai et al . 26 have shown, using treatment network based on the literature, that systemic plus IT steroids are associated with the largest differences in PTA change compared to other treatment options.…”

Perspectives on Human Hearing Loss, Cochlear Regeneration, and the Potential for Hearing Restoration Therapies

“…In the clinic, sudden sensorineural hearing loss is treated with anti-inflammatory glucocorticoids [ 30 ]. For some patients, this treatment correlates with hearing restoration [ 31 , 32 ]; however, there are also reports of individuals who recover spontaneously [ 33 ].…”

Imaging Parameters of the Ipsilateral Medial Geniculate Body May Predict Prognosis of Patients with Idiopathic Unilateral Sudden Sensorineural Hearing Loss on the Basis of Diffusion Spectrum Imaging

“…Idiopathic sudden sensorineural hearing loss (ISSHL) is an acute unexplained onset of hearing loss from a cochlear or retrocochlear origin. 1,2 Sudden sensorineural hearing loss affects approximately 5À27 per 100,000 people annually, and the incidence has increased across recent decades. 3,4 Viral infections, cochlear ischemia, autoimmune processes, and metabolic derangement have been proposed as potential etiologies.…”

“…However, selection of treatments may be difficult due to the variety of possible etiologies. 2 Additionally, the hearing prognosis in individual cases is quite uncertain.…”