Steroids for idiopathic sudden sensorineural hearing loss.
Steroids for idiopathic sudden sensorineural hearing loss.
复制标题
类固醇治疗特发性突发感音神经性听力损失。
DOI：
10.1002/14651858.cd003998
复制
发表时间：
2006
期刊：
影响因子：
--
通讯作者：
M. Laopaiboon
中科院分区：
文献类型：
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作者：
Bpc Wei;S. O'Leary;N. Mansell;S. Thanaviratananich;M. Laopaiboon
背景
特发性突发性感音神经性耳聋(ISSHL)是一种临床诊断，其特征是在没有明确诱因的情况下，耳蜗性或蜗后性突发性耳聋。类固醇通常是用来治疗这种情况的。对于它们的有效性，目前还没有达成共识。
目标
目的：探讨激素治疗特发性突发性感音神经性聋的疗效和副作用。
搜索策略
我们检索了Cochrane耳鼻喉科疾病组专科登记册、Cochrane对照试验中央登记册(中央)(Cochrane图书馆2004年第4期)、MEDLINE(1966至2004年12月)和EMBASE(1974至2004年12月)。还手动搜索了所有试验的参考列表。
遴选标准
我们确定了所有随机对照试验(盲法或非盲法)，在这些试验中，类固醇与不治疗或安慰剂进行了比较。如果对照组也接受相同的其他治疗，则考虑包括使用类固醇与另一种治疗相结合的试验。两位作者审阅了所有检索到的可能相关试验的全文，并独立适用纳入标准。关于将哪些研究纳入审查的任何意见分歧都通过讨论解决。
数据收集和分析
使用Cochrane方法对试验进行方法学质量分级。数据提取由一位提交人以标准化方式进行，另一位提交人重新核对，必要时联系调查人员以获取缺失的信息。荟萃分析既不可能也不被认为是合适的，因为研究人群的异质性，类固醇配方、剂量和治疗持续时间的差异。每项研究的结果的质量都被单独分析和报告。给出了结果的叙述性概述。
主要成果
只有两项试验符合纳入标准，而且两项试验的方法学质量都较低。一项试验显示，与安慰剂对照组相比，口服类固醇在改善听力方面缺乏效果。另一项试验显示，服用口服类固醇的患者中有61%的患者听力有显著改善，而对照组(安慰剂治疗组和未治疗对照组的组合)中只有32%的患者听力有显著改善。在之前的研究中，没有明确的证据表明类固醇有任何有害的副作用。后一项研究宣布，没有患者受到类固醇治疗的不良影响。
作者的结论
类固醇在治疗特发性突发性感音神经性聋中的价值仍不清楚，因为从随机对照试验中获得的证据在结果上是相互矛盾的，部分原因是这些研究基于太少的患者数量。
BACKGROUND
Idiopathic sudden sensorineural hearing loss (ISSHL) is a clinical diagnosis characterised by a sudden deafness of cochlear or retrocochlear origin in the absence of a clear precipitating cause. Steroids are commonly prescribed to treat this condition. There is no consensus on their effectiveness.
OBJECTIVES
To determine the effectiveness and the side-effect profile of steroids in the treatment of idiopathic sudden sensorineural hearing loss.
SEARCH STRATEGY
We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to December 2004) and EMBASE (1974 to December 2004). Reference lists of all trials were also manually searched.
SELECTION CRITERIA
We identified all randomised controlled trials (with or without blinding) in which steroids were evaluated in comparison with either no treatment or a placebo. Trials including the use of steroids in combination with another treatment were considered if the comparison control group also received the same other treatment. The full text articles of all the retrieved trials of possible relevance were reviewed by the two authors and the inclusion criteria applied independently. Any differences in opinion about which studies to include in the reviews were resolved by discussion.
DATA COLLECTION AND ANALYSIS
Trials were graded for methodological quality using the Cochrane approach. The data extraction was performed in a standardised manner by one author and rechecked by the other author, and where necessary investigators were contacted to obtain the missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the populations studied, the differences in steroid formulations, dosages and duration of the treatment. The quality of the result of each study was analysed and reported individually. A narrative overview of the result is presented.
MAIN RESULTS
Only two trials satisfied the inclusion criteria and both were of low methodological quality. One trial showed a lack of effect of oral steroids in hearing improvement compared with the placebo control group. The other trial showed a significant improvement of hearing in 61% of the patients receiving oral steroid and in only 32% of the patients from the control group (combination of placebo treated group and untreated control group). There was no clear evidence presented in the former study about any harmful side effects of the steroids. The latter study declared that no patients suffered from adverse effects from the steroid treatment.
AUTHORS' CONCLUSIONS
The value of steroids in the treatment of idiopathic sudden sensorineural hearing loss remains unclear since the evidence obtained from randomised controlled trials are contradictory in outcome, in part because the studies are based upon too small a number of patients.