الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
SHL remains one of the more interesting and disputed topics in otolaryngology. It is a topic of seemingly boundless discussion and active research.
Idiopathic sudden sensorineural hearing loss (ISSNHL) occurs over a short period of time and may vary from mild to profound hearing impairment in otherwise normal hearing individuals, incidence is 5-20 cases per 100,000 a year.
Most patients with sudden sensorineural hearing loss cannot be given a cause for their diagnosis. The most popular theories as to cause ISSNHL include viral infection, vascular insufficiency, and immune mediated reaction.
Patients with sudden hearing loss presenting to general practice should be assessed with a minimum of pure tone audiometry (with air and bone conduction thresholds), and those with sensorineural hearing loss should be urgently referred to a specialist.
Timing is an important factor in the prognosis of ISSNHL, previous studies have found that patients seen within 2 weeks of onset of hearing loss show more improvement than those patients seen at a later time.
A careful assessment is necessary to exclude life threatening or treatable causes such as vascular events and malignant disease. About half of patients show complete recovery, usually in about 2 weeks.
It is recommended that patients with sudden sensorineural hearing loss with no clear underlying cause after investigation are treated with a short course of oral prednisolone started within 2 weeks after onset.Much needs to be learnt about pathogenesis, and more clinical trials are necessary to establish evidence-based treatment.
The use of more than one agent in the treatment is common, and the choice of agents used varies among clinicians. Steroids (systemic or intratympanic) are the most widely used treatment and less common antiviral drugs.
Mechanism of action of steroids is through counteracting the inflammatory cascade sparing the cochlea from continued damage, recently inner ear glucocorticoid and mineralocorticoid receptors were discovered. Type of steroids used is: Methylprednisolone, Dexamethasone and hydrocortisone.
The use of other treatments has been well described and should be carefully considered. Ongoing large-scale research projects may soon provide a greater understanding of how to more optimally manage SHL.
This meta-analytic study was performed to evaluate the efficacy of different systemic therapies in patients with ISSNHL.
This was done through the following steps:
• Target: Does patients with ISSNHL get hearing benefits from different types of systemic therapy..
• Identification and location of articles: By searching Pubmed, 542 articles where found 23 out of them were relevant to our study.
• Screening and evaluation: According to the inclusion criteria, included articles were classified by type of intervention.
• Data collection: Through fourteen out of 23 included articles.
• Data analysis:
Data analysis was performed utilizing Meta-analytic Review Manger (Rev-Man 5) software. The results of the data collected from the chosen articles were fed into the above mentioned (Rev-Man 5) software.
• Reporting and Interpretation of results:
This study analyzing 2 articles studying corticosterois, two studying HBO and three on plasmapheresis, results shows improvement in hearing and was statistically significant.
In this study analyzing antiviral and prostaglandin treatments, results were insignificant and it can’t be concluded that they add in improving ISSNHL.