For were investigated for relevant studies. These searches were

For this review, the MEDLINE, EMBASE and
Cochrane databases were investigated for relevant studies. These searches were
conducted in order to identify clinical trials on the treatment of sudden
sensorineural hearing loss. The PICOS structure was utilised in order to define
the research strategy. It was mandatory for the published studies to be written
in the English, Dutch or German language. Also, the date of issue had to be between
2002 and 2017 (timespan of 15 years). The following search terms were
emphasized while conducting the research: sudden
sensorineural hearing loss, sudden
deafness and idiopathic sudden
hearing loss. Restrictive search terms were hyperbaric therapy, oxygen therapy, corticosteroids and dexamethasone. In order to specify on
subject matters, a differentiation was established based upon oral, intratympanic and intravenous
treatments. Supplemental information was gathered by utilising the snowball method, a technique which exploits
references within articles.


for inclusion

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articles were identified by conducting a comprehensive search through various
databases. In order to be integrated in the review, the articles had to meet
certain criteria. Each study had to be a clinical trial that compared the
treatment of sudden sensorineural hearing loss with a control group. Intravenous,
oral and intratympanic corticosteroid treatment combinations with/without
hyperbaric oxygen therapy were included. Patients with a hearing loss
equivalent to at least 30 dB fit inclusion.   


for exclusion

Several criteria for exclusion had to be
contained in order to keep unwanted data out of prospect. Several criteria for
exclusion were applied: 1) Patients who had an etiological cause for their
sudden sensorineural hearing loss such as noise, infections or medicines. 2)
conductive forms of hearing impairment. 3) case reports, comments on articles
and reviews were excluded 4) Only the English, Dutch or German language were
assessed as viable. Reports were not excluded on behalf of the qualitative or
quantitative definitions of idiopathic sudden sensorineural hearing loss. Patients
who received therapy after 30 days of the onset of symptoms were excluded from
the study




screening on title, abstract and full text, the remaining articles were
critically appraised for risk of bias. The primary outcome measure was the
pure-tone average (PTA) score. Pure-tone average (PTA) is an average hearing
sensitivity test on frequencies as 500, 1000 and 2000. Additional outcome
measures of interest included objective measures, such as speech reception
thresholds and speech discrimination scores, and subjective measures, such as
perceived hearing improvement. Outcome data of the included studies were
extracted and analyzed by two independent authors


Quality assessment

The results
of all studies were reviewed systematically. The following data were collected
for all patients: age, sex, maximum diving depth, diving time, diving gas, extent
of hearing loss, presence of vestibular symptoms, time between dive and symptom
onset, time between symptom onset and hyperbaric oxygen therapy, hyperbaric
oxygen treatment table, number of hyperbaric oxygen therapy sessions,
additional corticosteroid treatment, follow up, diagnosis, and outcome.


1) evaluation of the study
population, (2) the intervention, (3) the control treatment, and (4) the
reported out- comes. Assessment of the validity included (1) baseline criteria,
(2) standardization of intervention and control groups, (3) standardiza- tion
of the outcome, (4) randomization, (5) blinding for intervention, (6) intention
to treat analysis, (7) missing data, (8) handling of missing data, (9) loss to
follow-up, and (10) cross-over.




critical appraisal, we extracted study characteristics and descriptive data on
hearing loss and otologic manifestations from the included studies. If the
prevalence was not given in the article, it was calculated by dividing the
number of affected patients by the total number of assessed patients.



The initial
search resulted in 18 articles of which 5 didn’t meet the inclusion criteria.

The remaining 13 articles are represented in this review. With the use of
reference searching I was able to find a few extra articles which gave some
more insight in the illness itself. The total numbers that met the inclusion
criteria was brought to 17.