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Steroids for idiopathic sudden sensorineural hearing loss

  1. Benjamin PC Wei1,2,
  2. Dimitra Stathopoulos1,
  3. Stephen O'Leary1,*

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 2 JUL 2013

Assessed as up-to-date: 22 APR 2013

DOI: 10.1002/14651858.CD003998.pub3


How to Cite

Wei BPC, Stathopoulos D, O'Leary S. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003998. DOI: 10.1002/14651858.CD003998.pub3.

Author Information

  1. 1

    Royal Victorian Eye and Ear Hospital/University of Melbourne, Department of Otolaryngology, Melbourne, Victoria 3002, Australia

  2. 2

    Royal Victorian Eye and Ear Hospital/University of Melbourne, Department of Surgery, Melbourne, Australia

*Stephen O'Leary, Department of Otolaryngology, Royal Victorian Eye and Ear Hospital/University of Melbourne, 32 Gisborne Street, Melbourne, Victoria 3002, Australia. sjoleary@unimelb.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 2 JUL 2013

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Characteristics of included studies [ordered by study ID]
Cinamon 2001

MethodsRandomised, double-blinded


ParticipantsSetting: general community patients suffering from unilateral ISSHL who were referred to Chaim Sheba Medical Center
Country: Israel
Total number: 41
Mean age: 36
Male to female ratio: 19/22
Tinnitus (no. of patients): 23
Vertigo (no. patients): 13
Duration of treatment: 5 days


InterventionsGroup 1: prednisone tablet 1 mg/kg once a day
Group 2: placebo tablets (similar to prednisolone tablets)
Group 3: carbogen (5% CO2 + 95% oxygen) inhalation for 30 minutes, 6 times per day
Group 4: room air inhalation for 30 minutes, 6 times per day


OutcomesOutcome measures: objective audiometry performed on admission, on day 6 and at follow-up (range 14 to 90 days, average 33 days). The authors evaluated and compared the average hearing level at 6 frequencies (250 to 8000 Hz), the pure-tone average of speech frequencies (500, 1000, 2000 Hz) and the high-tone average (4000, 8000 Hz). An "improvement" was considered to be a minimum 15 dB change between the average hearing level evaluated at the different times mentioned.


NotesQuality score: C


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskThe randomisation was made on a rotation basis. This method of randomisation did not provide adequate concealment as the investigators would know which patient entered which group.

Allocation concealment (selection bias)High riskInadequate. Based on sequential allocation of the participants to each treatment group. The investigators would know which patient entered which group.

Blinding (performance bias and detection bias)
All outcomes
Low riskBoth the steroid and placebo tablets looked the same and were marked as "Prednisone A" or "Prednisone B". Only the pharmacist and the study controller (who did not participate in the decision making) knew the real composition of the medications.

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no loss to follow-up or drop-out from the study and intention-to-treat analysis was performed by the authors

Selective reporting (reporting bias)Low riskThere was no evidence of selective reporting

Other biasLow risk

Nosrati-Zarenoe 2012

MethodsRandomised, triple-blind study


ParticipantsSetting: 14 public otorhinolaryngological centres in Sweden

Total number: 103 (10 participants were excluded after random allocation to either control or prednisolone group)

Mean age: 55

Male to female ratio: 53:40

Tinnitus (number of patients): 68

Vertigo (number of patients): 25

Duration of treatment: all participants were asked to complete 8 days of the medication. If the hearing recovery was not complete, the participants would take medication to a total of 30 days.


InterventionsPrednisolone versus placebo

Prednisolone as 10 mg capsules, or placebo was given as a single dose of 60 mg daily for 3 days; the dose was then reduced by 10 mg per day, with a total treatment period of 8 days. If recovery was complete (complete recovery = difference between the initial audiogram and audiogram at the follow-up < 10 dB) treatment stopped, otherwise medication was continued at 10 mg daily to a total of 30 days.


OutcomesThe outcome assessment was based on objective hearing audiometry taken within 24 hours of hearing loss, 8 days after treatment, 1 month and 3 months after the onset of ISSHL. However, 1-month audiometric assessment was not performed and subsequently not reported in the result section. A complete recovery was defined as the difference between initial audiogram and audiogram at the follow-up < 10 dB. Partial recovery was defined as the difference ≥ 10 dB and the improvement ≥ 10 dB.


NotesQuality score: C


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskThe participants appeared to be equally distributed between the prednisolone and placebo groups

Allocation concealment (selection bias)Unclear riskThere was no clear mention of allocation concealment of the study. After the participants were assigned to the treatment groups, 10 participants were excluded as they did not fit the study's inclusion criteria.

Blinding (performance bias and detection bias)
All outcomes
Low riskNeither the participant, the person administrating the treatment nor the person evaluating the response to treatment knew which treatment a particular participant was receiving

Incomplete outcome data (attrition bias)
All outcomes
High riskFinal audiometric examinations were missing in 4 participants; 20 participants did not complete the treatment protocol

Selective reporting (reporting bias)High riskToo many participants were excluded from the study after randomisation. Many participants did not complete the study protocol. 1-month audiometric examination was either not carried out or not reported.

Other biasUnclear riskThe trial was not carried out in strict compliance with the proposed methodology of the initial trial design

Wilson 1980

MethodsDouble-blinded
It is unclear whether randomisation took place in this study and if so the methodological process has not been described


ParticipantsSetting: 2 different centres, conducted by 2 different investigators (Kaiser-Permanente (K-P), Oakland and Massachusetts Eye and Ear Infirmary (MEEI), Boston)
Country: USA
Total number: 123 (however only 119 were included in the analysis and 4 were excluded after the study (K-P: 27 MEEI: 92))
Mean age: not known
Male to female ratio: not mentioned
Tinnitus (no. of patients): not mentioned
Vertigo: K-P 61% and MEEI 33%
Duration of treatment: K-P 10 days; MEEI 12 days


InterventionsK-P
Treatment group: oral methylprednisolone 12 days
Control group: placebo

MEEI
Treatment group: oral dexamethasone 10 days
Control group 1: placebo
Control group 2: no treatment


OutcomesOutcome measures: objective audiometry performed on admission, at 4 weeks and 3 months after the onset of hearing loss. A "complete recovery" was defined as recovery of hearing to within 10 dB of the unaffected ear speech reception score or averaged pure-tone score (if loss was primarily in the high frequency range). A "partial recovery" was defined as recovery of hearing to within 50% or more of the unaffected ear's speech reception score or averaged pure-tone score. A "no recovery" was defined as less than 50% recovery of hearing.


NotesQuality score: C


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskThere is evidence that the randomisation was inadequate and that this resulted in a selection bias. This is supported by the uneven distribution of the age, symptom of vertigo, audiogram types and number of the participants between the different treatment groups and between the 2 centres.

Allocation concealment (selection bias)High riskAllocation concealment was not mentioned and was assessed to be inadequate as 52 patients elected not to have treatment during the allocation process

Blinding (performance bias and detection bias)
All outcomes
High riskThe control group that received no treatment was not blinded in this study as they knew they did not receive any tablets. There was no mention of the use of independent blinded assessors in this study. The study authors did not respond to our request for information relating to the degree of blinding.

Incomplete outcome data (attrition bias)
All outcomes
High riskThe intention-to-treat analysis was not achieved as 4 patients were excluded from the study and 14 patients were reallocated to the control group after the initial allocation

Selective reporting (reporting bias)High riskThe study authors then excluded the 34 patients with hearing loss of greater than 90 dB and 14 patients with mid-frequency loss to perform a subgroup analysis of the remaining 74 patients

Other biasHigh riskThere were problems with the study population. As the study was carried out in 2 different independent centres, there was heterogeneity of the population between the 2 centres. Furthermore, the types of steroids, dosage and duration of the steroid treatment were different between the 2 centres.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ahn 2006ALLOCATION
Randomised, placebo-controlled but not double-blinded

PARTICIPANTS
270 patients with SSHL

INTERVENTION
Patients were assigned to lipo-prostaglandin infusion over 5 days or saline (placebo group); all patients studied were treated with 48 mg methylprednisolone for 5 days
Note: impossible to determine the true effects of steroid when both groups received steroid

Ahn 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Ai 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Alexiou 1999ALLOCATION
Not randomised, not double-blinded

Alimoglu 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Angeli 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Aoki 2006ALLOCATION
Not randomised, double-blinded or placebo-controlled

Arellano 1997ALLOCATION
Not randomised, double-blinded or placebo-controlled

Arslan 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Asada 1998ALLOCATION
Not randomised, double-blinded or placebo-controlled

Bae 2013ALLOCATION
Not randomised, double-blinded or placebo-controlled

Barriat 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled 

Battaglia 2008ALLOCATION
Randomised, double-blinded, placebo-controlled, multicentre study

PARTICIPANTS
51 patients with ISSHL

INTERVENTION
Intratympanic dexamethasone with placebo taper, high-dose prednisone taper with placebo intratympanic injections, intratympanic dexamethasone with high-dose prednisone taper

Note: impossible to determine the true effects of steroid when there was no double placebo control (placebo intratympanic injections with placebo taper). This study compared the hearing recovery rate between different routes of steroid administration.

Baysal 2013ALLOCATION
Not randomised, double-blinded or placebo-controlled

Behnoud 2009ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
71 patients with SSHL

INTERVENTION

Steroid and hydration therapy with and without phlebotomy
Note: impossible to determine the true effects of steroid when there was no placebo control

Bianchin 2010ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
132 patients with SSHL and high plasmatic levels of low-density lipoprotein cholesterol and/or fibrinogen

INTERVENTION

A standard treatment (glycerol and dexamethasone) with and without a single selective plasmapheresis

Note: impossible to determine the true effects of steroid when there was no placebo control. Furthermore this study focused on a subgroup of patients who had high serum cholesterol and fibrinogen.  

Bittar 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Byl 1984ALLOCATION
Not randomised, double-blinded or placebo-controlled

Cekin 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Chan 2009ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
19 patients with SSHL

INTERVENTION

Oral steroid versus intratympanic steroid

Note: impossible to determine the true effects of steroid when there was no placebo control

Chandrasekhar 2001ALLOCATION
Not randomised, double-blinded or placebo-controlled

Chen 2003ALLOCATION
Not randomised, double-blinded or placebo-controlled

Chen 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled 

Chen 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Choi 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Choung 2005ALLOCATION
Not randomised, double-blinded or placebo-controlled 

Clary 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Dallan 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Dallan 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Dauman 1985ALLOCATION
Not randomised, double-blinded or placebo-controlled

Dispenza 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
46 patients with SSHL

INTERVENTION

Oral versus intratympanic steroid treatment

Note: impossible to determine the true effects of steroid when there was no placebo control

Echarri 2000ALLOCATION
Not randomised, double-blinded or placebo-controlled

Edamatsu 1985ALLOCATION
Not randomised, not double-blinded

Filipo 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Filipo 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Fu 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Fujimura 2007ALLOCATION
Not randomised, double-blinded or placebo-controlled

Fuse 2002ALLOCATION
Not randomised, double-blinded or placebo-controlled

Gianoli 2001ALLOCATION
Not randomised, double-blinded or placebo-controlled

Gouveris 2005ALLOCATION
Not randomised, double-blinded or placebo-controlled

Gouveris 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Grandis 1993ALLOCATION
Not randomised, double-blinded or placebo-controlled

Han 2008ALLOCATION
Not randomised, double-blinded or placebo-controlled

Han 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Herr 2005ALLOCATION
Not randomised, double-blinded or placebo-controlled

Hong 2009ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
63 patients with ISSHL

INTERVENTION
Oral prednisolone versus intratympanic dexamethasone

Note: impossible to determine the true effects of steroid when there was no placebo control 

Huang 1989ALLOCATION
Not randomised, not double-blinded

Hultcrantz 2012ALLOCATION

Meta-analysis of data from a randomised controlled trial and a Swedish national database for ISSHL

Hunchaisri 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Joong 2005ALLOCATION
Not randomised, double-blinded or placebo-controlled

Jun 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kanzaki 1988ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kanzaki 2003ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kara 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kasapoglu 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kawamata 2007ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kim 2011aALLOCATION
Not randomised, double-blinded or placebo-controlled

Kim 2011bALLOCATION
Not randomised, double-blinded or placebo-controlled

Kitajiri 2002ALLOCATION
Not randomised, not double-blinded

Kitamura 1996ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kopke 2001ALLOCATION
Not randomised, double-blinded or placebo-controlled

Kubo 1988ALLOCATION
Randomised, no placebo control, paired double-blinded

PARTICIPANTS
169 people with unilateral ISSHL from 5 medical schools and their affiliated hospitals in Japan

INTERVENTION
Combined intravenous and oral betamethasone versus intravenous batroxobin with oral placebo tablet

Note: impossible to determine the true effects of steroid when there was no control

Lee 2008ALLOCATION
Not randomised, double-blinded or placebo-controlled

Lee 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Leong 1991ALLOCATION
Retrospective, not randomised, double-blinded or placebo-controlled

Li 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Li 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
65 patients with SSHL

INTERVENTION
After the patients did not respond to intravenous treatment with prednisolone, they were randomised into 3 groups: treatment with intratympanic methylprednisolone, treatment with methylprednisolone in ear drops and a blank control

Note: impossible to determine the true effects of steroid when there was no placebo control

Lim 2013ALLOCATION
Randomised but not double-blinded or placebo-controlled

Liu 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Mattox 1977ALLOCATION
Not randomised or placebo-controlled

Min 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Minoda 2000ALLOCATION
Not randomised, double-blinded or placebo-controlled

Moon 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Mosges 2009ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
240 patients with SSHL

INTERVENTION
Rheopheresis treatment versus intravenous corticosteroids versus intravenous haemodilution

Note: impossible to determine the true effects of steroid when there was no placebo control

Moskowitz 1984ALLOCATION
Not randomised, not double-blinded

Nakagawa 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Nickisch 1987ALLOCATION
Not randomised, double-blinded or placebo-controlled

Nosrati-Zarenoe 2007ALLOCATION
Not randomised, double-blinded or placebo-controlled

Nosrati-Zarenoe 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Ogawa 2002ALLOCATION
Randomised, double-blinded and placebo-controlled

PARTICIPANTS
57 patients with ISSHL

INTERVENTION
Intravenous prostaglandin E1 and hydrocortisone versus intravenous placebo and hydrocortisone

Note: impossible to determine the true effects of steroid when there was no placebo control and both intervention groups received systemic steroid. This study was designed to examine the effect of prostaglandin E1 on ISSHL.

Orchi 1998ALLOCATION
Not randomised, double-blinded or placebo-controlled

Panda 2008ALLOCATION
Not randomised, double-blinded or placebo-controlled

Park 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Park 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
88 patients with SSHL

INTERVENTION
1) Intratympanic dexamethasone was given simultaneously initially with systemic steroid

2) Intratympanic dexamethasone was given 7 days after systemic steroid treatment

Note: impossible to determine the true effects of steroid when there was no placebo control

Peng 2008ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
84 patients with ISSHL

INTERVENTION
Oral dexamethasone plus conventional methods (n = 21), intravenous dexamethasone plus conventional methods (n = 21), and intratympanic dexamethasone plus conventional methods (n = 21), intratympanic dexamethasone injection by the way of pharyngotympanic tube combined with conventional methods (n = 21)

Note: impossible to determine the true effects of steroid when there was no placebo control. Furthermore, the total amount of steroid received was different by each route of administration.

Penido 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Plontke 2009ALLOCATION
Randomised, double-blinded and placebo-controlled

PARTICIPANTS
23 patients with ISSHL

INTERVENTION
Systemic high-dose glucocorticoid therapy followed by either dexamethasone or placebo (saline 0.9%) continuously applied for 14 days into the round window niche via a temporarily implanted catheter

Note: impossible to determine the true effects of steroid when there was no placebo control (participants without any systemic and local steroid treatment)

Pyykkö 1997ALLOCATION
Not randomised, double-blinded or placebo-controlled

Rauch 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
250 patients with ISSHL

INTERVENTION
Intravenous methylprednisolone versus oral prednisone

Note: impossible to determine the true effects of steroid when there was no placebo control

Roebuck 2006ALLOCATION
Not randomised, double-blinded or placebo-controlled

Sakata 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

She 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Shin 2007ALLOCATION
Randomised but not double-blinded or placebo-controlled 

PARTICIPANTS
44 participants with ISSHL who did not respond to 1 cycle of oral prednisolone with intravenous acyclovir and volume expander (intravenous pentastarch)

INTERVENTION
Second cycle of oral prednisolone therapy versus no treatment

Shiraishi 1991ALLOCATION
Paired double-blinded, unclear randomisation and no placebo control

PARTICIPANTS
168 people with unilateral ISSHL from 5 multi-institutions in Japan

INTERVENTION
Combined intravenous and oral betamethasone versus intravenous batroxobin with oral placebo tablet

Note: impossible to determine the true effects of steroid when there was no control

Slattery 2005aALLOCATION
Not randomised, double-blinded or placebo-controlled

Slattery 2005bALLOCATION
Not randomised, double-blinded or placebo-controlled

Suoqiang 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Suzuki 2003ALLOCATION
Not randomised, double-blinded or placebo-controlled

Suzuki 2008ALLOCATION
Not randomised, double-blinded or placebo-controlled

Suzuki 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Tsai 2011ALLOCATION
Not randomised, double-blinded or placebo-controlled

Wang 2012ALLOCATION
Not randomised, double-blinded or placebo-controlled

Wilkins 1987ALLOCATION
Not randomised, double-blinded or placebo-controlled

Wu 2011ALLOCATION
Randomised, double-blinded and placebo-controlled

PARTICIPANTS
60 patients with ISSHL who did not respond to an initial round of steroid treatment

INTERVENTION
After failure of systemic steroid treatment, patients were given either intratympanic steroid or saline

Note: impossible to determine the true effects of steroid when there was no double placebo control of patients who received neither systemic nor intratympanic steroid

Xenellis 2006ALLOCATION
Not randomised, double-blinded or placebo-controlled

Yang 2010ALLOCATION
Not randomised, double-blinded or placebo-controlled

Yang 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
66 patients with SSHL

INTERVENTION

Oral corticosteroid treatment with and without oral zinc gluconate

Note: impossible to determine the true effects of steroid when there was no placebo control

Zadeh 2003ALLOCATION
Not randomised, double-blinded or placebo-controlled

Zernotti 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Zhao 2009ALLOCATION
Not randomised, double-blinded or placebo-controlled

Zhou 2011ALLOCATION
Randomised; not double-blinded or placebo-controlled

PARTICIPANTS
76 patients with ISSHL

INTERVENTION
Intratympanic steroid versus no treatment in patients who did not respond to the initial systemic steroid therapy

Note: impossible to determine the true effects of steroid when there was no placebo control

 
Comparison 1. Oral steroid versus oral placebo immediately post-treatment

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hearing recovery: average speech frequencies (500, 1000, 2000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)1.1 [0.52, 2.30]

 2 Hearing improvement: average hearing level at six frequencies (250 to 8000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)0.94 [0.48, 1.85]

 3 Hearing improvement: high-tone hearing level average (4000, 8000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.32, 2.39]

 
Comparison 2. Oral steroid versus oral placebo at follow-up (14 to 90 days, average 33 days)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hearing improvement: average speech frequencies (500, 1000, 2000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)0.96 [0.56, 1.66]

 2 Hearing improvement: average hearing level at six frequencies (250 to 8000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)0.98 [0.64, 1.48]

 3 Hearing improvement: high-tone hearing level average (4000, 8000 Hz)121Risk Ratio (M-H, Fixed, 95% CI)1.1 [0.52, 2.30]

 
Comparison 3. Oral steroid versus oral placebo (4 weeks and 3 months follow-up)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hearing recovery (see 'Description of studies' for definition)1119Risk Ratio (M-H, Fixed, 95% CI)1.40 [0.99, 1.97]

    1.1 Massachusetts Eye and Ear Infirmary (MEEI) group
192Risk Ratio (M-H, Fixed, 95% CI)1.45 [1.03, 2.06]

    1.2 Kaiser-Permanente (K-P) group
127Risk Ratio (M-H, Fixed, 95% CI)1.16 [0.40, 3.38]

 
Comparison 4. Recovery by group for steroid-effective zone patients only (see 'Results' section)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hearing recovery (see 'Description of studies' for definition)174Risk Ratio (M-H, Fixed, 95% CI)1.84 [1.27, 2.68]

    1.1 Massachusetts Eye and Ear Infirmary (MEEI) group
156Risk Ratio (M-H, Fixed, 95% CI)1.95 [1.35, 2.80]

    1.2 Kaiser-Permanente (K-P) group
118Risk Ratio (M-H, Fixed, 95% CI)1.57 [0.57, 4.32]

 
Comparison 5. Prednisolone versus placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hearing improvement 8 days after treatment193Mean Difference (IV, Fixed, 95% CI)-0.90 [-11.73, 9.93]

 2 Hearing improvement 3 months after diagnosis of SSHL193Mean Difference (IV, Fixed, 95% CI)3.90 [-8.57, 16.37]