- 期刊
突發性感音神經性聽力受損病人接受高壓氧治療是否能改善聽力表現？
Can hyperbaric oxygen therapy improve hearing performance in patients with sudden sensorineural hearing loss?
摘要
形成臨床提問：臨床上，越來越多突發性感音神經性聽力損失（Sudden Sensorineural Hearing Loss, SSNHL）的患者，在接受傳統類固醇治療的同時，選擇結合高壓氧療法進行綜合治療。然而，不同患者的治療方案差異主要在於是否採用高壓氧療法。基於此情況，筆者期望以實證為依據，通過嚴謹的文獻篩選與評讀，深入探討高壓氧療法是否能有效改善SSNHL患者的聽力表現。文獻搜尋的方法與分析：設定關鍵字：族群（Participants, P）：突發性感音神經性聽力損失患者；介入措施（Intervention, I）：高壓氧治療；對照組（Comparison, C）：類固醇治療；結果（Outcome, O）：聽力表現（純音聽力檢查）。運用布林邏輯（OR和AND）在PubMed、Cochrane和華藝中文電子期刊等資料庫中搜尋過去五年內的系統性文獻回顧及隨機對照試驗。經篩選後共獲得31篇相關文獻，刪除重複及與研究主題不符的文獻後，最終納入一篇系統性文獻回顧和一篇隨機對照試驗進行評析。文獻的品質評讀：評讀工具以CASP（2024）RCT checklist及CASP（2018）SR checklist分別進行有效性、重要性及應用性三大面向的評讀。證據等級以牛津實證醫學中心證據2011年版本等級表進行評析；本文SR文獻證據等級為Level 1，RCT文獻證據等級為Level 2。結果、結論與建議：本文評讀Lei等人（2021）之系統性文獻回顧（SR），該研究共納入2篇隨機對照試驗（RCT）及4篇非RCT研究，主探討鼓室內注射類固醇及高壓氧治療對突發性感音神經性聽力損失患者聽力恢復率及純音聽力檢查結果的影響。經整合分析發現，高壓氧治療在聽力恢復率（RR=1.09，95% CI=0.831.42，P=0.55）及純音聽力檢查結果變化（MD=0.55，95% CI=1.7612.86，P=0.64）未顯示顯著差異。此外，Cavaliere等人（2022）的一篇RCT則比較了高壓氧治療、口服類固醇以及兩者聯合治療於不同時間點開始介入的效果。結果顯示，不論治療是早期或晚期開始，高壓氧加類固醇的聯合治療皆為突發性感音神經性聽力損失患者的有效治療選項。總體而言，目前的證據顯示高壓氧治療對於突發性感音神經性聽力損失患者純音聽力檢查結果的影響尚不確定，需進一步研究以明確其療效。建議未來研究應採用更嚴謹設計，包括更大樣本量及更長期的追蹤，以評估高壓氧治療對純音聽力檢查結果的持久性及臨床重要性。
並列摘要
Ask an answerable question (PICO): In clinical practice, an increasing number of patients with sudden sensorineural hearing loss (SSNHL) opt for a combination of hyperbaric oxygen therapy (HBOT) alongside traditional steroid treatment. However, the primary distinction in treatment plans among patients lies in whether HBOT is incorporated. In light of this, the author aims to investigate the efficacy of HBOT in improving hearing performance in SSNHL patients by conducting a rigorous review and analysis of evidence-based literature. The Method and Analysis of Literature Review: The keywords were defined as follows: Participants (P): patients with sudden sensorineural hearing loss (SSNHL); Intervention (I): hyperbaric oxygen therapy (HBOT); Comparison (C): steroid therapy; Outcome (O): hearing performance (pure tone audiometry). Boolean logic (OR and AND) was applied to search PubMed, Cochrane, and Airiti Library databases for systematic reviews and randomized controlled trials (RCTs) published in the past five years. A total of 31 relevant articles were identified. After removing duplicates and excluding studies that did not align with the research topic, one systematic review and one RCT were selected for in-depth analysis. Critical Appraisal: Evaluate the effectiveness, importance, and applicability of the tools using the CASP (2024) RCT checklist and the CASP (2018) SR checklist. Evidence levels are assessed according to the Oxford Centre for Evidence- Based Medicine 2011 Levels of Evidence. The evidence level for this SR literature is Level 1, while the evidence level for RCT literature is Level 2. Results, Conclusions and Recommendations: This review evaluates the study by Lei et al. (2021), which included two randomized controlled trials (RCTs) and four non-RCTs, focusing on the effects of hyperbaric oxygen therapy (HBOT) and intratympanic steroids (ITS) as treatments for patients with sudden sensorineural hearing loss (SSNHL). The analysis revealed that HBOT demonstrated no significant improvement in hearing recovery rates (RR = 1.09, 95% CI = 0.83-1.42, P = 0.55) or changes in pure tone audiometry (PTA) (MD = 0.55, 95% CI = 1.76-12.86, P = 0.64) for SSNHL patients. Additionally, Cavaliere et al. (2022) conducted an RCT comparing HBOT, oral steroids (OS), and a combination of both therapies for SSNHL. The findings indicated that the combination of HBOT and OS was an effective treatment for SSNHL, regardless of whether treatment was initiated early or late. Notably, this combined therapy yielded the best results when treatment commenced more than 14 days after symptom onset. Overall, the efficacy of HBOT on pure tone audiometry outcomes in SSNHL patients remains inconclusive, warranting further research. Future studies should adopt more rigorous methodologies, including larger sample sizes and extended follow-up periods, to clarify the long-term effectiveness and clinical significance of HBOT in treating SSNHL.