Meta-Analysis Comparing Steroids and Diuretics in the Treatment of Acute Low-Tone Sensorineural Hearing Loss

Zhu, Yuanping; Li, Guangqi; Zhuang, Hongkai; Yang, Zhixu; Sun, Jincangjian; Xiong, Guangxia; Wang, Xianren

doi:10.1177/0145561319869610

Cited by 6 publications

(14 citation statements)

References 14 publications

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“…We found that ALHL patients who were responsive to lowdose steroids tended to have better recovery at 2 weeks after initial treatment, though this was marginally significant. In a meta-analysis, no significant difference in recovery was observed between steroid treatment and diuretic treatment, implying that both are equally effective [12].…”

Section: Discussionmentioning

confidence: 94%

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

et al. 2021

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Background and Objectives: We aimed to analyze treatment outcomes following different initial management approaches and confirm treatment regimens for acute low-tone sensorineural hearing loss (ALHL) that would yield the best results. Subjects and Methods: We retrospectively analyzed the medical records of 106 patients with ALHL who visited a university hospital's otology clinic from March 2013 to June 2019. Pure-tone averages at the initial visit and at 2 and 4 weeks after the initial visit were evaluated. Results: Forty-nine patients were enrolled in this study; of them, 41 (83.7%) exhibited complete recovery (CR) at 2 weeks and 43 (87.8%) exhibited CR at 1 month after the initial visit. Regression analysis revealed that CR at 2 weeks after the initial visit was associated with diuretic use [Exp(B): 10.309, 95% confidence interval (CI): 1.007-100]. An initial daily low-dose steroid use was marginally significant [Exp(B): 1.042, 95% CI: 0.997-1.092; p=0.066]. Isolated diuretic use [Exp(B): 25.641, 95% CI: 1.121-90.909; p=0.039] was an independent, good prognostic factor at 1 month after the initial visit. However, other treatment regimens did not affect the final results. Conclusions: A combination of initial daily administration of ≤30 mg prednisolone plus diuretics was sufficient as the first-line treatment for ALHL. High-dose steroids and salvage intratympanic steroid injections can be applied as a second choice; however, the predicted outcome would not be good in that case.

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Section: Discussionmentioning

confidence: 94%

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

et al. 2021

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“…At present, ALHL treatments often include steroids and diuretics. Previous studies have pointed out that there is no consensus regarding which treatment is more effective for ALHL [ 10 , 13 , 22 ]. A prior systematic review and meta-analysis of 3 RCTs assessed outcomes of hearing recovery by comparing the effectiveness of steroids and diuretics for the treatment of ALHL; the results did not show a significant difference between the recovery rate of patients treated with steroids and those treated with diuretics [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have pointed out that there is no consensus regarding which treatment is more effective for ALHL [ 10 , 13 , 22 ]. A prior systematic review and meta-analysis of 3 RCTs assessed outcomes of hearing recovery by comparing the effectiveness of steroids and diuretics for the treatment of ALHL; the results did not show a significant difference between the recovery rate of patients treated with steroids and those treated with diuretics [ 13 ]. Given that the trials included in the current article enrolled patients undergoing treatment with both steroids and diuretics, there may be some inconsistency in evaluating the efficacy of single-modality treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, diuretics have been reported to increase sodium transport in patients with endolymphatic hydrops [ 24 ] and effectively reduce symptoms. However, neither of the treatments showed superiority [ 9 , 13 , 26 ]. Studies have also proposed that it may be beneficial to administer both steroids and diuretics together to take advantage of their interaction, and aggressive combination treatment using steroids and diuretics should be considered for the treatment of ALHL [ 9 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…A previous study compared the effectiveness of steroids and diuretics for the treatment of ALHL and found no significant difference in the recovery rate of patients [ 13 ]. The current meta-analysis compared the efficacy of single-modality treatment (steroids or diuretics alone) and combination treatment (steroids and diuretics) among patients with ALHL and further validated the results using TSA.…”

Section: Introductionmentioning

confidence: 99%

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Combination Therapy and Single-Modality Treatment for Acute Low-Tone Hearing Loss: A Meta-Analysis with Trial Sequential Analysis

et al. 2022

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Acute low-tone hearing loss (ALHL) is a common clinical disease and was first proposed by Abe in 1981 as sensorineural hearing loss confined to low frequencies. The best strategy for initiating medication is still unclear, as the superiority of steroids and diuretics is still debated, and combination therapy might yield additional benefits. However, no study regarding combination therapy has been published. The objective of this study was to evaluate the efficacy of steroid therapy versus combination therapy of diuretics with steroids by conducting a systematic review with a meta-analysis and trial sequential analysis (TSA). Studies enrolling patients with a diagnosis of acute low-tone hearing loss were considered eligible. After searching the PubMed, Cochrane Library, Embase, Scopus and Web of Science databases from inception to 31 December 2021, five studies including 433 patients were enrolled. Overall, the comparison between combination therapy with steroids and diuretics and single-modality treatment with steroids (OR, 1.15; 95% CI, 0.51 to 2.59; p = 0.74; I2 = 34%) and the comparison between combination therapy and treatment with diuretics alone (OR, 1.73; 95% CI, 0.93 to 3.23; p = 0.09; I2 = 5%) showed that combination therapy did not confer significant benefits when compared to single-modality treatments. A trial sequential analysis (TSA) showed conclusive nonsignificant results of the comparison between the combination of steroids and diuretics and a single-modality treatment. In conclusion, we reported that the combination of steroids and diuretics did not yield significant benefits when compared to single-modality treatment with steroids or diuretics. We suggest that treatment should be initiated with steroids or diuretics alone to avoid potential adverse effects.

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Prognosis of Acute Low‐Tone Hearing Loss Without Vertigo: A Scoping Review

et al. 2023

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ObjectiveDespite its relatively high prevalence, our understanding of the natural clinical course of acute low‐tone hearing loss (ALHL) without vertigo remains incomplete. The purpose of this study is to summarize the findings of studies that evaluated recovery from hearing loss (HL), recurrence and/or fluctuation of HL, and progression to Meniere's Disease (MD) of patients presenting with ALHL without vertigo.MethodsA scoping review of the English literature was performed. On May 14, 2020 and July 6, 2022, MEDLINE, Embase, and Scopus were searched to identify articles related to the prognosis of ALHL. To be included, articles had to present outcomes that were clearly distinguishable for patients with ALHL without vertigo. Two reviewers evaluated articles for inclusion and extracted data. Disagreements were adjudicated by a third reviewer.ResultsForty‐one studies were included. There was extensive heterogeneity between studies in regard to defining ALHL, treatment methods, and time of follow‐up. Most of the cohorts (39 out of 40) reported partial or complete recovery of hearing in the majority (>50%) of patients, although reports of recurrence were relatively common. Progression to MD was infrequently reported. Shorter time from onset of symptoms to treatment predicted better hearing outcomes in 6 of 8 studies.ConclusionThe literature suggests that although the majority of patients with ALHL experience hearing improvement, recurrence and/or fluctuation are common, and progression to MD occurs in a minority of patients. Additional trials utilizing standardized inclusion and outcome criteria are needed to determine the ideal treatment for ALHL.Level of EvidenceNA Laryngoscope, 133:2457–2469, 2023

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Meta-Analysis Comparing Steroids and Diuretics in the Treatment of Acute Low-Tone Sensorineural Hearing Loss

Cited by 6 publications

References 14 publications

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

Combination Therapy and Single-Modality Treatment for Acute Low-Tone Hearing Loss: A Meta-Analysis with Trial Sequential Analysis

Prognosis of Acute Low‐Tone Hearing Loss Without Vertigo: A Scoping Review

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