糖皮质激素经鼓膜与经口途径治疗突发性聋疗效分析

Meta analysis of intratympanic steroids versus oral steroids for sudden sensorineural hearing loss

目的通过对现有文献的系统性回顾,比较经鼓膜糖皮质激素疗法（intratympanic steroid,ITS）与经口糖皮质激素疗法在治疗突发性聋（sudden sensorineural hearing loss,SSHL）的差异。数据来源于在线数据库包括Medline、EMBASE和Cochrane Review。方法纳入符合标准的治疗突发性聋的随机对照试验,对纳入研究的质量进行系统性回顾。结果作者筛选69篇文献,其中符合标准的文献7篇。在限定两种疗法的剂量、疗程、频次后,Meta分析示ITS组受试者平均纯音听阈（pure tone audiometry,PTA）改善较经口糖皮质激素组高11.13dB（95%可信区间[CI]=9.16-13.11,P〈0.00001;Chi2=2.44,df=2,P=0.30,I2=18%）。结论虽然评估ITS治疗SSHL的高质量研究有限,但其作为第一线治疗组在PTA改善和恢复率上优于受限制的条件下口服类固醇组（口服类固醇给药时间≤10 d,类固醇浓度60 mg/kg·d,和注射的次数是4-5倍之间在ITS）。

OBJECTIVE To compare the effcacy of intratympanic steroid（ITS）versus oral steroid treatment for sudden sensorineural hearing loss（SSHL）through a systematic review of the existing literatures.Data Sources：Online databases consisting of Medline,EMBASE,Cochrane Review,and collected additional publications cited in bibliographies.METHODS Literature search by both authors with structured criteria to select studies which was systematically reviewed.RESULTS The authors identified 69 articles,of which 7 represented studies of ITS versus oral steroids treatment for sudden hearing loss.Despite the paucity of well-executed trials,the vast majority of studies demonstrated a benefit of ITS better than oral steroid treatment.A meta-analysis of the limited studies revealed a mean difference in PTA improvement of 11.13 dB（95% confidence interval[CI]=9.16-13.11,P 0.00001;Chi2=2.44,df =2,P =0.30,I2=18%）.CONCLUSION Although very few high-quality studies exist that evaluate the benefit of intratympanic steroids for treating SSHL,limited high-quality studies selected in this review showed that the ITS as a frst-line therapy is superior to the oral steroid in the PTA improvement and the recovery rate under some restricted conditions（oral steroid administration time≤10 days and steroid concentration is about 60mg/kg·d,and the number of injections was between 4 to 5 times in ITS）.