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Abstract：
BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is a common disease in otology, and steroids play an important role in its treatment. Steroids can be administered systemically or locally, and the efficacies of different administration routes remain controversial.
METHODS: We searched the Cochrane, EMBASE, PubMed, Web of Science, CNKI, Wanfang and Weipu databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of topical and systemic steroid administration. The Review Manager 5.4 software was used for synthesis of data: the rate of reported hearing improvement and change in pure-tone audiometry (PTA).
RESULTS: In all the included studies, when intratympanic administration was compared to systemic therapies, the risk difference (RD) using reported hearing improvement as an outcome measure was 0.08 (95% CI: 0.01-0.14, I2 = 45%). Using PTA changes as an outcome measure in 4 studies, the mean difference (MD) was 10.43 dB (95% CI: 3.68-17.18, I2 = 81%). Hearing improvement RD was also compared among different types of steroid, recovery criteria, follow-up times and diagnostic criteria, and showed no significant differences exception for recovery criteria (>10 dB) (RD -0.06, 95% CI: 0.14-0.2, I2 = 0%).
CONCLUSIONS: As the initial treatment for SSNHL, topical steroids seem to be superior to systemic steroid administration, especially in patients with contraindications to systemic steroids usage. However, further verification based on high-quality research is needed.
METHODS: We searched the Cochrane, EMBASE, PubMed, Web of Science, CNKI, Wanfang and Weipu databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of topical and systemic steroid administration. The Review Manager 5.4 software was used for synthesis of data: the rate of reported hearing improvement and change in pure-tone audiometry (PTA).
RESULTS: In all the included studies, when intratympanic administration was compared to systemic therapies, the risk difference (RD) using reported hearing improvement as an outcome measure was 0.08 (95% CI: 0.01-0.14, I2 = 45%). Using PTA changes as an outcome measure in 4 studies, the mean difference (MD) was 10.43 dB (95% CI: 3.68-17.18, I2 = 81%). Hearing improvement RD was also compared among different types of steroid, recovery criteria, follow-up times and diagnostic criteria, and showed no significant differences exception for recovery criteria (>10 dB) (RD -0.06, 95% CI: 0.14-0.2, I2 = 0%).
CONCLUSIONS: As the initial treatment for SSNHL, topical steroids seem to be superior to systemic steroid administration, especially in patients with contraindications to systemic steroids usage. However, further verification based on high-quality research is needed.
摘要：
背景：突发性感音神经性耳聋（SSNHL）是耳科常见疾病，类固醇在其治疗中起着重要作用。类固醇可以全身或局部给药，不同给药途径的有效性仍存在争议。
方法：我们搜索了Cochrane，EMBASE,PubMed,WebofScience,CNKI,万方和维普数据库关于糖皮质激素治疗SSNHL的随机对照试验（RCT），以比较局部和全身类固醇给药的疗效。使用ReviewManager5.4软件合成数据：报告的听力改善率和纯音测听法（PTA）的变化。
结果：在所有纳入的研究中，当将鼓室内给药与全身治疗进行比较时，使用报告的听力改善作为结局指标的风险差异(RD)为0.08(95%CI:0.01~0.14,I2=45%).在4项研究中使用PTA变化作为结果指标，平均差（MD）为10.43dB（95％CI：3.68-17.18，I2=81％）。还比较了不同类型类固醇的听力改善RD，恢复标准，随访时间和诊断标准，除恢复标准（>10dB）外，没有显着差异（RD-0.06，95％CI：0.14-0.2，I2=0％）。
结论：作为SSNHL的初始治疗，局部类固醇似乎优于全身类固醇给药，尤其是有全身使用类固醇禁忌症的患者。然而,需要基于高质量研究的进一步验证。
方法：我们搜索了Cochrane，EMBASE,PubMed,WebofScience,CNKI,万方和维普数据库关于糖皮质激素治疗SSNHL的随机对照试验（RCT），以比较局部和全身类固醇给药的疗效。使用ReviewManager5.4软件合成数据：报告的听力改善率和纯音测听法（PTA）的变化。
结果：在所有纳入的研究中，当将鼓室内给药与全身治疗进行比较时，使用报告的听力改善作为结局指标的风险差异(RD)为0.08(95%CI:0.01~0.14,I2=45%).在4项研究中使用PTA变化作为结果指标，平均差（MD）为10.43dB（95％CI：3.68-17.18，I2=81％）。还比较了不同类型类固醇的听力改善RD，恢复标准，随访时间和诊断标准，除恢复标准（>10dB）外，没有显着差异（RD-0.06，95％CI：0.14-0.2，I2=0％）。
结论：作为SSNHL的初始治疗，局部类固醇似乎优于全身类固醇给药，尤其是有全身使用类固醇禁忌症的患者。然而,需要基于高质量研究的进一步验证。
