鼓室内类固醇注射对突发性感音神经性听力损失听力阈值改善的有效性：一项Meta分析。

文献信息

中文摘要

背景与目的： 突发性感音神经性听力损失（SSNHL）是一种需要早期干预以防止永久性听力损害的耳科急症。尽管近期研究报告了鼓室内类固醇注射（ITSI）的有效性，但支持其在不同临床情境中一致性的证据仍然有限。评估ITSI在改善诊断为SSNHL患者听力阈值方面的有效性，并探讨治疗结果是否因基线听力损失严重程度、临床表型和治疗作用而异。
材料与方法： 对16项符合条件的研究进行了定量Meta分析。使用随机效应模型计算合并效应量，治疗效果以Hedges' g表示，并使用Egger回归检验评估发表偏倚。根据初始听力损失的严重程度、是否存在临床合并症以及治疗策略（主要治疗与挽救治疗）进行亚组分析。p≤0.05的差异被认为具有统计学意义。
结果： ITSI显著改善了听力阈值，具有较大的合并效应量（Hedges' g=-1.05；p<0.05）。Egger检验表明无显著发表偏倚（p=0.07）。亚组分析显示，中度至重度和重度基线听力损失之间的治疗效果无显著差异（p=0.20），各种临床表型之间也无显著差异（p=0.63）。然而，ITSI作为主要治疗时显示出更大的有效性（Hedges' g=-1.24），相比之下作为挽救治疗时（Hedges' g=-0.59）。
结论： ITSI是改善SSNHL患者听力阈值的有效干预措施。治疗结果不受基线听力损失严重程度或临床表型的显著影响，但受治疗作用的影响。早期使用ITSI作为一线治疗可获得最佳的听力恢复，同时仍是一种有价值的挽救选择。

英文摘要

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is an otological emergency requiring early intervention to prevent permanent hearing impairment. Although recent studies have reported the effectiveness of intratympanic steroid injection (ITSI), evidence supporting its consistency across different clinical contexts remains limited. To evaluate the effectiveness of ITSI in improving hearing threshold(s) in patients diagnosed with SSNHL, and to examine whether treatment outcomes differ according to baseline hearing loss severity, clinical phenotype, and therapeutic role.
MATERIALS AND METHODS: A quantitative meta-analysis of 16 eligible studies was performed. Pooled effect sizes were calculated using a random-effects model, with treatment effects expressed as Hedges' g, and publication bias was assessed using Egger's regression test. Subgroup analyses were performed based on the severity of initial hearing loss, presence of clinical comorbidities, and therapeutic strategy (primary versus salvage therapy). Differences with p≤0.05 were considered to be statistically significant.
RESULTS: ITSI significantly improved hearing thresholds, with a large pooled effect size (Hedges' g=-1.05; p<0.05). Egger's test indicated no significant publication bias (p=0.07). Subgroup analyses revealed no significant differences in treatment effectiveness between moderate-to-severe and severe baseline hearing loss (p=0.20), or among the various clinical phenotypes (p=0.63). However, ITSI demonstrated greater effectiveness when used as primary therapy (Hedges' g= -1.24) compared with salvage therapy (Hedges' g=-0.59).
CONCLUSIONS: ITSI was an effective intervention to improve hearing thresholds in patients with SSNHL. Treatment outcomes were not significantly influenced by baseline hearing loss severity or clinical phenotype, but were affected by the therapeutic role. Early use of ITSI as first-line therapy yielded the most optimal hearing recovery while remaining a valuable salvage option.