Awad Z, Huins C, Pothier DD, et al.
The Cochrane database of systematic reviews. Date of publication 2012 Aug 15;volume (8):CD006987.
1. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD006987. doi:
10.1002/14651858.CD006987.pub2.
Antivirals for idiopathic sudden sensorineural hearing loss.
Awad Z(1), Huins C, Pothier DD.
Author information:
(1)Department of Otolaryngology, Head and Neck Surgery, University College
London Hospital, London, UK. z.awad@doctors.org.uk.
BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSHL) is
characterised by sudden loss of hearing of cochlear or retro-cochlear origin
without an identifiable cause. Antivirals are commonly prescribed, but there is
no consensus on the treatment regimen or their effectiveness.
OBJECTIVES: To determine the effectiveness and side effect profile of antivirals
in the treatment of ISSHL.
SEARCH METHODS: We systematically searched the Cochrane Ear, Nose and Throat
Disorders Group Trials Register, the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), PubMed, EMBASE, CINAHL
and other databases to 12 June 2012. We also scanned the reference lists of
identified studies for further trials.
SELECTION CRITERIA: Randomised controlled trials comparing different antivirals
versus placebo (both with or without other treatment).
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data, met to
resolve disagreements and contacted study authors for further information. We
assessed study risk of bias independently. We considered meta-analysis
inappropriate and ultimately not possible due to differing treatment protocols
of varying dose and duration, together with differing inclusion criteria and
outcome measures between studies. The results of each study are reported
individually.
MAIN RESULTS: We included four randomised trials (257 participants). The overall
risk of bias in the included studies was low. Two trials compared the addition
of intravenous acyclovir to a steroid (prednisolone). One included 43
participants, the other 70 patients. Neither demonstrated any hearing
improvement with ISSHL. Another (84 patients) did not show any statistically
significant difference between groups with the addition of valacyclovir to
prednisolone (compared to steroid plus placebo) with respect to change in
pure-tone audiogram. Comparing the addition of intravenous acyclovir to
hydrocortisone with hydrocortisone alone, the final trial did not show any
statistically significant difference between groups (60 patients). No trial
documented any serious adverse effects related to the use of antiviral
treatment. One study reported slight to moderate nausea equally in the acyclovir
and placebo groups (one patient in each). Another reported insomnia, nervousness
and weight gain with valacyclovir (number not specified). Even though no
meta-analysis was possible, evidence from the four RCTs has demonstrated no
statistically significant advantage in the use of antivirals in the treatment of
ISSHL.
AUTHORS' CONCLUSIONS: There is currently no evidence to support the use of
antiviral drugs in the treatment of ISSHL. The four trials included in this
review were, however, small and with a low risk of bias. Further randomised
controlled trials with larger patient populations, using standardised inclusion
criteria, antiviral regimes and outcome measures, are needed in order for
adequate meta-analysis to be performed to reach definitive conclusions. A
uniform definition of ISSHL should also be established, together with what
constitutes adequate recovery.
DOI: 10.1002/14651858.CD006987.pub2
PMID: 22895957 [Indexed for MEDLINE]
