성향점수매칭을 이용한 돌발성 난청환자에서 초기 고실 내 스테로이드 주입법 및구제치료 요법의 치료 성적 비교
Comparison of the Treatment Outcome Between Primary Intratympanic Steroid and Salvage Intratympanic Steroid Protocol in Sudden Sensorineural Hearing Loss: Propensity Score Matching Analysis
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Background and Objectives We aimed to compare the treatment outcomes of primary intratympanicsteroid (ITS) and the salvage ITS protocol. Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineuralhearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37patients received ITS only as a primary treatment while other patients received systemic steroid;of those remaining patients, 276 received systemic steroid as well as ITS as a salvagetreatment. We performed a 1:2 propensity score matching analysis for both groups using parameterssuch as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertensionand diabetes. The rate of hearing recovery was determinied by comparing thematching propensity score between the primary ITS and the control group according to theAmerican Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline andSiegel’s criteria. Results Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% ofpatients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%)were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did notrecover their hearing according to AAO-HNS guideline. The propensity score matchingshowed that the initial hearing level, age and onset of treatment were not significantly differentbetween the primary ITS and control group. Regarding the treatment outcome, completerecovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of theprimary ITS group, statistical significance was not identified. Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantlyaffect the clinical outcomes of ISSNHL differently.
Abstract
Background and Objectives We aimed to compare the treatment outcomes of primary intratympanicsteroid (ITS) and the salvage ITS protocol. Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineuralhearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37patients received ITS only as a primary treatment while other patients received systemic steroid;of those remaining patients, 276 received systemic steroid as well as ITS as a salvagetreatment. We performed a 1:2 propensity score matching analysis for both groups using parameterssuch as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertensionand diabetes. The rate of hearing recovery was determinied by comparing thematching propensity score between the primary ITS and the control group according to theAmerican Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline andSiegel’s criteria. Results Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% ofpatients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%)were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did notrecover their hearing according to AAO-HNS guideline. The propensity score matchingshowed that the initial hearing level, age and onset of treatment were not significantly differentbetween the primary ITS and control group. Regarding the treatment outcome, completerecovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of theprimary ITS group, statistical significance was not identified. Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantlyaffect the clinical outcomes of ISSNHL differently.
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