Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study.

{"article_title":"Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study.","author":"Witsell DL, Mulder H, Rauch S, Schulz KA, Tucci DL","journal_title":"Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery","issn":"1097-6817","isbn":"","publication_date":"2018 Nov","volume":"159","issue":"5","first_page":"895","page_count":"","accession_number":"30084293","doi":"10.1177\/0194599818785142","publisher":"Wiley","doctype":"Journal Article","subjects":"Glucocorticoids administration & dosage; Hearing Loss, Sensorineural diagnosis; Hearing Loss, Sensorineural drug therapy; Hearing Loss, Sudden diagnosis; Hearing Loss, Sudden drug therapy; Academic Medical Centers; Administration, Oral; Administration, Topical; Adult; Audiometry, Pure-Tone methods; Community Health Services methods; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Treatment Outcome; Tympanic Membrane drug effects","interest_area":["ENT"," Emergency Medicine"],"abstract":"Objective: The objective of this study was to describe patterns of corticosteroid treatment for sudden sensorineural hearing loss and to evaluate effectiveness based on delivery mode (oral vs intratympanic vs both). Study Design: Cross-sectional repeated measures. Setting: Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) Network. CHEER is a National Institutes of Health-funded nationwide network of 30 community and academic otolaryngology practice sites. Subjects and Methods: A subset of 117 patients who had been treated with steroids for sudden sensorineural hearing loss were recruited from within a larger initial CHEER Network study on clinical practice guideline compliance. Outcomes included audiometric and speech scores and patient-perceived improvement. Descriptive analyses, Wilcoxon rank-sum tests, and Fisher exact tests were run. Results: Two categories (oral and simultaneous oral + intratympanic) had adequate sample sizes to support statistical comparison of treatment results. Improvements were seen in both audiometry and speech testing scores; 57% of patients self-reported improvement perceived as either minor or major. There were no significant differences in degree of improvement between these treatment groups. Conclusions: We observed that a majority of steroid-treated patients demonstrated hearing improvement, but this improvement did not meet criteria for statistical significance. As in other studies on this topic, the relatively small sample size may have prevented differentiation of effectiveness among steroid treatments. We propose that the use of alternative approaches, such as pragmatic clinical trials and multidisciplinary electronic health record systems and megadatabases, may hold the most promise for an approach to best practice development.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=30084293&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Witsell DL, Mulder H, Rauch S, Schulz KA, Tucci DL","Journal_Info":"Publisher: Wiley Country of Publication: England NLM ID: 8508176 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6817 (Electronic) Linking ISSN: 01945998 NLM ISO Abbreviation: Otolaryngol Head Neck Surg Subsets: MEDLINE","Publication_Type":"Journal Article; Multicenter Study; Research Support, N.I.H., Extramural","Published_Date":"2018-11-01","Source":"Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2018 Nov; Vol. 159 (5), pp. 895-899. Date of Electronic Publication: 2018 Aug 07.","Languages":"English","Electronic_ISSN":"1097-6817","MeSH_Terms":"Glucocorticoids\/*administration & dosage , Hearing Loss, Sensorineural\/*diagnosis , Hearing Loss, Sensorineural\/*drug therapy , Hearing Loss, Sudden\/*diagnosis , Hearing Loss, Sudden\/*drug therapy, Academic Medical Centers ; Administration, Oral ; Administration, Topical ; Adult ; Audiometry, Pure-Tone\/methods ; Community Health Services\/methods ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; Tympanic Membrane\/drug effects","Subjects":"Academic Medical Centers, Administration, Oral, Administration, Topical, Adult, Audiometry, Pure-Tone methods, Community Health Services methods, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Assessment, Treatment Outcome, Tympanic Membrane drug effects, Glucocorticoids administration & dosage, Hearing Loss, Sensorineural diagnosis, Hearing Loss, Sensorineural drug therapy, Hearing Loss, Sudden diagnosis, Hearing Loss, Sudden drug therapy","Title_Abbreviations":"Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery","Volume":"159"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"30084293","RelevancyScore":"821","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"821.262145996094"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30084293&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30084293&authtype=shib&custid=ns346513&group=main&profile=eds"}