Treatment of sudden hearing loss with corticosteroids applie | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Treatment of sudden hearing loss with corticosteroids applied into the middle ear

You can view up to 4 cases without signing up Sign up for unlimited access

We found 30 studies including 2133 people. The studies compared intratympanic treatment with corticosteroids with no treatment, with placebo and with corticosteroids that were taken by mouth or injection into the body (systemic corticosteroids). We took into account whether people were having their first treatment for sudden deafness or whether they had previously had some other kind of treatment (which had not worked).

For people having their first treatment for sudden deafness:

We did not find any studies that compared intratympanic corticosteroids to no treatment or placebo treatment.

Intratympanic corticosteroids might result in little or no difference in hearing when compared to people who receive systemic corticosteroids, and may make little to no difference in the number of people whose hearing improves. Side effects may be different with these two types of treatment. With intratympanic treatment, people may have an increased risk of dizziness or ear pain as compared to systemic corticosteroids, typically at the time of injection, and some may develop a small hole in the ear drum. However, systemic treatment may also increase risk of different side effects, such as problems with blood sugar levels.

Taking intratympanic corticosteroids as well as systemic corticosteroids may result in a small improvement in hearing compared to systemic corticosteroids alone, but it is uncertain how many people would notice improvement. Intratympanic treatment may cause some side effects, but we cannot be certain of the number of people who may experience these.

For people having additional treatment for sudden deafness (when their first treatment did not work):

When compared to no treatment or a placebo treatment, intratympanic corticosteroids may result in a much larger number of people having an improvement in their hearing but may only improve hearing slightly. Intratympanic injections might cause some side effects, such as pain or dizziness at the time of the injection, or development of a small hole in the ear drum. We are uncertain how often these side effects will happen.

We're very uncertain whether adding intratympanic treatment to systemic treatment will result in an improvement in hearing.

Most of the evidence we found was low or very low certainty. The conclusions of this review may change as new studies are published.

Read the Cochrane Review:

Comment

Sign up to add a comment

More about this case

ResolvedCommon presentation

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Benefits and risks of antibiotics taken orally or given as an injection to treat chronic suppurative otitis media (persistent or recurring ear infection with discharge)\ Why is this question important?\ Chronic suppurative otitis media (CSOM), also known as chronic otitis media (COM), is an inflammation and infection of the middle ear that lasts for two weeks or more. People with CSOM usually experience recurrent or persistent discharge – fluid that leaks out from a hole or tear in the eardrum – and hearing loss.\ CSOM can be treated with antibiotics (medicines that fight bacterial infections) taken orally or given as an injection (i.e. systemic treatment in which the whole body is treated). Systemic antibiotics can be used:\ ‐ alone;\ ‐ in combination with antibiotics in the form of drops, sprays, ointments or creams (topical, i.e. localised surface treatment); or\ ‐ in combination with other treatments such as steroids (anti‐inflammation medicines) or antiseptics (substances that stop or slow down the growth of micro‐organisms).\ To find out how effective systemic antibiotics are for treating CSOM, and whether they lead to side effects, we reviewed the evidence from research studies.\ How did we identify and evaluate the evidence?\ First, we searched the medical literature for studies that followed people with CSOM for at least one week and compared:\ ‐ a systemic antibiotic used alone against a placebo (dummy) treatment, no treatment or another systemic antibiotic;\ ‐ a systemic antibiotic combined with another treatment, against that treatment alone.\ We then compared the results, and summarised the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.\ What did we find?\ We found 18 studies that involved a total of 2135 people with CSOM. People were treated for between five days and 12 weeks, and were followed for up to one year. Four studies provided information about how they were funded or who supplied the medicines: two were publicly funded, and medicines were provided by pharmaceutical companies in the other two studies.\ Studies compared:\ ‐ systemic antibiotics against no treatment (one study);\ ‐ systemic antibiotics plus topical antibiotics against topical antibiotics alone (six studies);\ ‐ systemic antibiotics plus other treatments (other than topical antibiotics alone), against these same treatments without systemic antibiotics (four studies);\ ‐ different systemic antibiotics against one another (eight studies).\ Systemic antibiotics alone against no treatment\ We cannot determine from the only study we found whether systemic antibiotics alone are better or worse than no treatment. This is mainly because the study:\ ‐ was small;\ ‐ was conducted in ways that could have introduced error in the results; and\ ‐ reported limited information.\ Systemic antibiotics plus topical antibiotics against topical antibiotics alone\ Systemic antibiotics plus topical antibiotics may have little to no effect on whether discharge stops after one to two weeks, compared against topical antibiotics alone (five studies). We do not know if systemic antibiotics added to topical antibiotics have any other positive or negative effects, because:\ ‐ there are too few studies;\ ‐ available studies were small and may have been conducted in ways that introduce error in their results.\ Systemic antibiotics plus other treatments (other than topical antibiotics alone), against these same treatments without systemic antibiotics\ We cannot determine from the evidence available whether systemic antibiotics are effective or lead to adverse events when added to treatments other than topical antibiotics only. This is mainly because the few studies available reported limited information.\ Comparisons between different systemic antibiotics\ We do not know whether some systemic antibiotics are better than others. This is mainly because the way studies were conducted is likely to have introduced error in their results.\ What does this mean?\ There is insufficient robust evidence to determine whether systemic antibiotics are effective treatments for CSOM, and whether they lead to side effects. Evidence about side effects is particularly limited. When added to topical antibiotics, systemic antibiotics may make little to no difference to whether discharge resolves after one to two weeks. We do not know if some systemic antibiotics are better than others.\ How‐up‐to date is this review?\ The evidence in this Cochrane Review is current to March 2020.](https://app.figure1.com/case-detail/2a9fc52f-5f63-4054-bbac-2f00bea18998)

\ \ Local antibiotics or antibiotics that target the whole body: which works better to treat chronic suppurative otitis media (persistent or recurring ear infection with discharge)?\ Why is this question important?\ Chronic suppurative otitis media (CSOM), also known as chronic otitis media (COM), is an inflammation and infection of the middle ear that lasts for two weeks or more. People with CSOM usually experience recurrent or persistent discharge – fluid that leaks out from a hole or tear in the eardrum – and hearing loss.\ Antibiotics (medicines that fight bacterial infections) are the most common treatment for CSOM. Antibiotics can:\ ‐ be applied to part of the body (locally) in the form of drops, sprays, ointments or creams (topical antibiotics); or\ ‐ treat the whole body (systemic antibiotics) when injected, or taken orally (by mouth).\ To find out whether topical or systemic antibiotics are better for treating CSOM, and whether they have different adverse (unwanted) effects, we reviewed the evidence from research studies.\ How did we identify and evaluate the evidence?\ First, we searched the medical literature for studies that followed adults or children with CSOM for at least one week and compared:\ ‐ the topical and systemic forms of the same antibiotic; or\ ‐ a topical antibiotic against a different, systemic antibiotic.\ We then compared the results and summarised the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.\ What did we find?\ We found six studies that involved a total of 445 people. People were treated with antibiotics for between five days and two weeks, and were followed for up to 21 days. Studies were conducted in Spain (three studies), Italy (two studies) and Hong Kong (one study). Three studies provided information about how they were funded or who supplied medicines: one study received funding from a university, and medicines were provided by pharmaceutical companies in two studies.\ Studies compared:\ ‐ quinolone ear drops against oral quinolone (four studies);\ ‐ quinolone ear drops against injected aminoglycosides (one study);\ ‐ ofloxacin ear drops against oral amoxicillin‐clavulanic acid (one study).\ Quinolone ear drops compared to quinolone taken orally\ Compared to oral quinolone, quinolone ear drops may slightly increase the chances of ear discharge resolving after one to two weeks. We do not know if there is a difference between the two treatments for:\ ‐ hearing;\ ‐ ear pain;\ ‐ serious complications such as facial palsy (weakness of the muscles in the face);\ ‐ meningitis (an inflammation of fluid and membranes in the brain); or\ ‐ ototoxicity (when a person develops hearing or balance problems due to a medicine).\ This is because either no studies reported information about these effects, or we have too little confidence in the evidence available.\ Quinolone ear drops compared to injected aminoglycosides\ We do not know if quinolone ear drops are better or worse than injected aminoglycosides for treating CSOM. Only one study investigated this and it provided insufficient robust evidence.\ Ofloxacin ear drops against oral amoxicillin‐clavulanic acid\ We do not know if ofloxacin ear drops are better or worse than oral amoxicillin‐clavulanic acid for treating CSOM. Only one study investigated this and it provided insufficient robust evidence.\ No study reported information about the effects of different treatments on ear discharge after four weeks or health‐related quality of life.\ What does this mean?\ Topical antibiotics may be more effective than systemic antibiotics at resolving ear discharge. We do not know whether systemic or topical antibiotics are better for improving hearing. We need more evidence from robust studies to be able to compare the effects of topical and systemic antibiotics on aspects such as health‐related quality of life or ear pain. We also need more information about adverse effects.\ How up‐to‐date is this review?\ The evidence in this Cochrane Review is current to March 2020.](https://app.figure1.com/case-detail/95a2bd9a-9ef7-4561-859f-4dd5f1f1f73b)

\ \ What is the aim of this review?\ The aim of this review was to assess whether drugs to treat familial amyloid polyneuropathies (FAPs) reduce disability due to nerve damage, reduce the severity of nerve damage, and improve nutritional status, quality of life, and depression. We also reviewed evidence on side effects.\ Key messages\ Studies of drug treatments for people with FAP are so far limited to transthyretin‐FAP (also called TTR‐FAP). Four trials have compared a drug with a placebo (an inactive, dummy compound), but none have directly compared drugs with each other. The studies provided evidence that all four drugs studied (tafamidis, diflunisal, patisiran, and inotersen) are probably of benefit for people with TTR‐FAP, but it remains possible that their true effects are different from these results. As research comparing drugs with each other is limited by study size required to demonstrate the superiority of one drug and costs, studies monitoring their effects for longer are needed.\ What was studied in the review?\ FAPs are a group of hereditary progressive conditions in which insoluble protein deposits (fibrils) affect mainly peripheral nerves (nerves outside the brain and spinal cord). Fibrils are deposited because they are made up of genetically abnormal protein that does not fold properly. This process also occurs in many other organs including the heart, kidneys, and eyes, thus these disorders are complex. The type of protein fibril deposited and the exact genetic defect determine the type of FAP. TTR‐FAP is the most common FAP by far. Although liver transplantation was the only treatment, done in highly selected cases, drugs which may affect the disease course have recently become available for people with TTR‐FAP.\ What are the main results of the review?\ The review authors found four relevant studies, which involved 655 adults with TTR‐FAP.\ In one study, people with early‐stage TTR‐FAP received tafamidis or placebo for 18 months. Disability was not measured. The evidence suggested that tafamidis may reduce both the proportion of people with progression of peripheral neuropathy and the mean change (worsening) of nerve damage (based on a score of strength and sensation) compared to placebo. It is uncertain whether tafamidis has an effect on quality of life and the number of deaths, dropouts due to harmful effects or any severe side effects.\ Evidence from a 24‐month study in people with TTR‐FAP suggested that compared to placebo, diflunisal may slightly decrease disability due to FAP progression and lessen worsening of peripheral neuropathy. It is uncertain whether diflunisal has an effect on quality of life and number of deaths, dropouts due to side effects, and people who experience severe side effects.\ Results from an 18‐month study in people with TTR‐FAP suggested that compared to placebo, patisiran probably decreases disability due to FAP progression, and lessens worsening of peripheral neuropathy. Quality of life may decline slightly less with patisiran than placebo. Patisiran may lead to little or no difference in mortality, dropouts due to side effects or number of people experiencing severe side effects.\ In the fourth study, people with TTR‐FAP received inotersen or placebo for 66 weeks. Disability was not measured. This study indicated that inotersen probably reduces worsening of peripheral neuropathy, but may have little effect on the change in quality of life compared to placebo. Inotersen may be associated with numbers of adverse events above the placebo rate, illustrated by an increase in the number of dropouts due to side effects compared to placebo. There was little or no difference in mortality or number of people experiencing severe side effects.\ The review authors did not find any study addressing drug therapy for people with other types of FAP.\ Three of the four studies were funded by the manufacturer of the drug investigated.\ How up‐to‐date is this review?\ The evidence is current to November 2019.](https://app.figure1.com/case-detail/b52f3cea-9f48-4669-ab1c-d86c828de527)

\ \ Surgery or non‐surgical treatment: which works better for carpal tunnel syndrome?\ Key messages\ Surgery probably results in a higher rate of clinical improvement than splinting after a follow‐up of 6 to 12 months. The evidence on which of the two treatments may have less harmful effects is uncertain.\ The evidence is uncertain if clinical improvement or the rate of harmful effects differ between surgery and corticosteroid injection.\ What did we find?\ We found 14 studies randomising 1231 people.\ Key results\ Because surgery is often used for its long‐term effects, this summary focuses on long‐term follow‐up (6 to 12 months).\ Surgery compared to splinting\ Surgery probably results in a higher rate (twice) of clinical improvement compared with splinting. However, surgery may not be more beneficial than splinting for improving symptoms or hand function, or general health‐related quality of life.\ We are uncertain if the risk of harmful effects differs between surgery and splinting. Some people in the splinting group had surgery‐related harms because they had undergone surgery before the outcomes were measured. However, surgery probably reduces the need for further surgery.\ Surgery compared to corticosteroid injection\ We are uncertain if clinical improvement, symptom relief, risk of harmful effects and the need for further surgery differ between surgery and corticosteroid injection. Hand function or pain probably do not differ considerably.\ Other comparisons\ Surgery is probably slightly more beneficial than multimodal non‐operative treatment for improving symptoms, but may not provide benefits for other outcomes.\ Surgery probably results in a higher rate of clinical improvement than manual therapy (1.6 times) but may not provide benefits for other outcomes.\ We are uncertain if surgery provides more benefits compared with a combination of splint and corticosteroid injection.\ Limitations of the evidence\ The most important limitation is that there is no existing evidence to determine whether surgery is better than no treatment or if surgery is more effective than continuing non‐surgical treatments for people who have not improved with non‐surgical interventions. Additionally, it is unclear if surgery could provide more long‐lasting effects after several years' follow‐up.\ People in all the studies were aware of which treatment they received.](https://app.figure1.com/case-detail/b7b8d86f-b036-492d-8946-8cdd271630ba)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)