title: Intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss after failure of conventional therapy: a meta-analysis of randomized, controlled trials.
abstract: OBJECTIVE
  Systemic steroid therapy (SST) for sudden sensorineural hearing loss (SSNHL) is considered the only effective treatment, but the results are not satisfactory in clinical practice. Intratympanic steroid (ITS) treatment has been adopted as a salvage treatment for patients in whom previous SST failed. However, the uncertain results of ITS treatment as a salvage treatment present patients with the dilemma of accepting or refusing ITS treatment. The goal of this study was to review relevant studies and analyze the pooled data to determine whether ITS treatment is effective for SSNHL after the failure of SST.
  
  
  METHODS
  A literature search of the PubMed, Embase, and Cochrane databases to May 2014 was performed without restrictions regarding the language of publication. The studies were screened after reading the abstract and full text. Only prospective, randomized, controlled trials that evaluated the effect of ITS therapy on SSNHL adult patients after SST failed were included in the meta-analysis. Improvements in pure tone averages and the number of patients with no improvement were extracted and entered into RevMan software to meta-analyze the overall effect of ITS on SSNHL after SST failed.
  
  
  RESULTS
  A total of 543 studies were identified, and 41 of these studies were found to be eligible and related to ITS therapy after SST failed. Ultimately, 5 randomized, controlled trials containing data from 102 patients in the ITS group and 101 control subject were included. The pooled results revealed that ITS therapy was able to improve the hearing levels of SSNHL patients who had responded poorly to SST.
  
  
  CONCLUSIONS
  ITS therapy might be an effective approach to the treatment of SSNHL after SST fails.
authors.affiliation: Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Feng
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: wangh2014@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: yanmeifeng2008@gmail.com.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Feng
mesh_terms: D000328:Adult; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000188:drug therapy*; D006801:Humans; D000069555:Injection, Intratympanic; D011446:Prospective Studies; D019233:Retreatment; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: failure; meta-analysis; steroid; sudden sensorineural hearing loss