Meta-analysis Of Glucocorticoid Injection Into The Ventral Tympanum And Retro Auricular For Treatment Of Sudden Deafness

Objective:The effectiveness and safety of Intratympanic Injection(II)and Postauricular Injection(PI)as initial treatment and remedial treatment for sudden sensorineural hearing loss(SSNHL)were analyzed by Meta-analysis.Methods:A randomized controlled study of Ⅱ and PI glucocorticoid as an initial and remedial treatment for SSNHL related articles published inside and outside the country like CNKI,Wanfang,PubMed,Vip,Cochrane from 2005 to 2020 was collected for the data.Revman5.4 and Stata software package were used to analyze the studies that meet the quality standards.Before the selection,all words are blindly processed(excluding title,author,journal name and publication year),and marked with a random number table,and the selection is done independently by two authors.In accordance with the PICOS principle,any differences are resolved through discussion by the third person.The following information was extracted from each article:initial treatment or remedial therapy,sample size of each study group,age range of the study group,types and methods of glucocorticoids used,treatment time in the treatment group,and basic treatment drugs.The quality of the included literature was evaluated by CochraneHandbook6.0,which was shown by a summary of bias risk.According to the test level of a=0.05,the two calculated 95%CI,and the difference was statistically significant(P<0.05).The total effective rate,cure rate,improvement rate of concomitant symptoms and incidence of adverse reactions were evaluated respectively.Results:1.In terms of initial treatment,A total of 1072 articles were retrieved,and 15 articles were finally included,all Chinese documents.The funnel chart was basically symmetrical,and there was no source of publication bias after analysis by Egger’s weighted regression method and Begg’s rank correlation method(P>0.05),so the possibility of publication bias was small.Meta-analysis showed that the total effective rate of the PI group was significantly higher than that of the Ⅱ group(RR=1.10,95%CI:1.04～1.15,P=0.0005),the recovery rate of the PI group was higher than that of the Ⅱ group(RR=1.18,95%CI:1.02～1.36,P=0.03),and the adverse reactions of the PI group were significantly lower than the Ⅱ group(RR=0.47,95%CI:0.31～0.69,P=0.0001).2.In terms of salvage treatment,a total of 517 articles were retrieved,and 5 articles were finally included,all Chinese articles.The funnel chart was basically symmetrical,and there was no source of publication bias after analysis by Egger’s weighted regression method and Begg’s rank correlation method(P>0.05),so the possibility of publication bias was small.Meta-analysis showed that in the treatment of refractory sudden deafness,the total effective rate of the Ⅱ group was significantly higher than that of the PI group(RR=0.87,95%CI:0.78～0.97,P=0.01);there was no statistical difference in the cure rate between the two approaches(RR=0.71,95%:CI 0.50～1.02,P=0.07).Conclusion:1.In terms of initial treatment,PI glucocorticoid has better efficacy and less adverse reactions compared with Ⅱ,so PI can be tried to be promoted as the initial treatment of SSNHL;2.In terms of remedial treatment,glucocorticoid Ⅱ has a better overall response rate than PI and is an ideal treatment method for refractory SSNHL,but larger sample size,more rigorous statistical methods and more detailed clinical trials are needed to confirm this.