Cochrane · systematic review · CD008080
Intratympanic corticosteroids for sudden sensorineural hearing loss
Plontke, SK, Meisner, C, Agrawal, S, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
ENTAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
22
No studies
14
Included studies
NR
No studies 14 · 38.9%Ungraded 0 · 0%Very low 12 · 33.3%Low 8 · 22.2%Moderate 2 · 5.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Intratympanic corticosteroids versus systemic corticosteroids as primary therapy
Population: sudden sensorineural hearing loss
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in hearing threshold determined by PTA Range 0 dB to 140 dB Negative values represent lowering and positive values represent raising of the hearing threshold. A lower hearing threshold represents hearing improvement). Â Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | 10 studies · 701 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of patients whose hearing is improved Intratympanic corticosteroids vs systemic corticosteroids | RR 1.04 [0.97, 1.12] | 14 studies · 972 participants | Moderate |
Final hearing threshold determined by PTA (a lower value represents better hearing) Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | 7 studies · 516 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse eventsb Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | NR | No studies |
Tympanic membrane perforation Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | 4 studies · 463 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vertigo/dizziness: timing not reportedd Intratympanic corticosteroids vs systemic corticosteroids | RR 2.53 [1.41, 4.54] | 1 study · 250 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vertigo/dizziness: at the time of injection Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | 4 studies · 301 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Ear pain: timing not reportedf Intratympanic corticosteroids vs systemic corticosteroids | RR 15.68 [6.22, 39.49] | 2 studies · 289 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Ear pain: at the time of injectionf Intratympanic corticosteroids vs systemic corticosteroids | no estimate extracted | 3 studies · 393 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as primary therapy
Population: sudden sensorineural hearing loss
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in hearing threshold determined by PTA Range 0 dB to 140 dB Negative values represent lowering and positive values represent raising of the hearing threshold. A lower hearing threshold represents hearing improvement. Â Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 6 studies · 435 participants | Low Downgraded: risk of bias, imprecision |
Proportion of patients whose hearing is improved Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | RR 1.27 [1.15, 1.41] | 10 studies · 788 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Final hearing threshold determined by PTA A lower value represents better hearing Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 3 studies · 194 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse eventsb Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Persistent tympanic membrane perforation Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 5 studies · 474 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vertigo/dizziness: timing not reported Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Vertigo/dizziness: at the time of injection Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 4 studies · 341 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Ear pain: timing not reported Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Ear pain: at the time of injection Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 1 study · 73 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Intratympanic corticosteroids versus no treatment or versus placebo as secondary therapy
Population: sudden sensorineural hearing loss
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in hearing threshold determined by PTA Range 0 dB to 140 dB Negative values represent lowering and positive values represent raising of the hearing threshold. A lower hearing threshold represents hearing improvement. Â Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | 7 studies · 280 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Proportion of patients whose hearing is improved Intratympanic corticosteroids vs no treatment or versus placebo | RR 5.55 [2.89, 10.68] | 6 studies · 232 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Final hearing threshold determined by PTA (a lower value represents better hearing) Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | 5 studies · 203 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Adverse eventsb Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | NR | No studies |
Persistent tympanic membrane perforation Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | 5 studies · 185 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Vertigo/dizziness: timing not reported Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | NR | No studies |
Vertigo/dizziness at the time of intratympanic injection Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | 3 studies · 128 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Ear pain: timing not reported Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | NR | No studies |
Ear pain at the time of intratympanic injection Intratympanic corticosteroids vs no treatment or versus placebo | no estimate extracted | 44 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as secondary therapy
Population: sudden sensorineural hearing loss
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in hearing threshold determined by PTA Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Proportion of patients whose hearing is improved Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | RR 2.24 [1.1, 4.55] | 1 study · 76 participants | Very low Downgraded: risk of bias, imprecision |
Final hearing threshold determined by PTA Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Adverse eventsb Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Persistent tympanic membrane perforation Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | 1 study · 76 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Vertigo/dizziness: timing not reported Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Vertigo/dizziness: at the time of injection Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Ear pain: timing not reported Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |
Ear pain: at the time of injection Intratympanic plus systemic corticosteroids (combined therapy) vs systemic corticosteroids alone | no estimate extracted | NR | No studies |