Sudden sensorineural hearing loss

Objective The purpose of this study is to evaluate the effectiveness of oral, intratympanic steroid (IT) and Hyperbaric Oxygen therapy (HBOT) based treatments on hearing outcomes in patients with Sudden sensorineural hearing loss (SSNHL). Methods A systematic review of primary studies published in the English language between January 2000 to June 2018 identified by searching Medline, PubMed, Web of Science, and Embase databases was performed. Inclusion criteria were Primary articles on the treatment with (oral, IT steroid and HBOT) of patients diagnosed as having SSNHL. Patients with all other types of hearing loss were excluded. A retrospective chart review of patients presenting with SSNHL at Vancouver general hospital from 2015 to 2017 was also performed. The outcomes studied include; Averaged PTA threshold change between pre/posttreatment. Results 223 articles were identified of which 24 articles meet the study inclusion criteria. The quality of evidence was good in 20 articles, and poor in the remaining 4 articles. Overall, 90% of 687 patients in the 8 studies who received oral and IT steroids (combination therapy) and 86% 0f 494 patients in the 5 studies who received triple therapy with HBOT demonstrated hearing recovery compared to a 75% recovery rate in 548 patients who received oral steroids alone. Combination therapy had statistically significant hearing improvement compared with oral steroids alone (Chi squared, p < 0.05). The retrospective chart review of 37 SSNHL patients charts which fulfilled inclusion criteria were reviewed. Patients who received combination steroid therapy showed a significant hearing improvement based on their initial and final PTA readings. There is a significant difference in PTA average of the diseased ear between pre and post treatment (p15db) noticed in patient groups of prednisone alone and prednisone + IT and IT alone (p <0.05). Conclusions The systematic review and the retrospective charts review conclude that there is weak evidence of a beneficial effect of combination therapy (oral and IT steroids; or oral, IT steroids and HBOT) for patients with SSNHL over and above that achieved with mono-therapy with oral steroids (Chi squared, p < 0.05).Medicine, Faculty ofSurgery, Department ofGraduat