Hyperbaric Oxygen Therapy Versus Intratympanic Steroid for Salvage Treatment of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

Abstract

The aim of this meta-analysis is to compare the efficacy of hyperbaric oxygen therapy (HBOT) and intratympanic steroids (ITS) as salvage treatment for patients with refractory sudden sensorineural hearing loss (SSNHL). Electronic search was performed in the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases to June 1, 2020. For each outcome measure, a forest plot was generated and a pooled relative risk (RR) or mean difference (MD) was calculated. Potential publication bias in the meta-analysis was assessed using funnel plot. The numbers of cases with hearing improvements and pure tone averages (PTA) changes after salvage treatment were entered into the R software to calculate the pooled effect of HBOT compared with ITS. When pooling the results of the studies reporting the proportion of patients with hearing improvement, a fixed-effects model was used. We calculated the RR and found no significant difference when HBOT compared with ITS (RR = 1.09, 95% confidence interval [CI]: 0.83-1.42, p = 0.55). With respect to the PTA changes, a fixed-effects model was used. The improvement in the PTA (in dB) was calculated in MD and no significant difference was found between the two groups (MD = 0.55, 95% CI: -1.76-2.86, p = 0.64). Both HBOT and ITS offer some benefits for refractory SSNHL patients, and there were no significant differences in hearing outcomes between the two modalities. Future RCTs that include large samples are needed to demonstrate superiority of one of the treatments.