Usporedba ishoda nakon intratimpanalne aplikacije kortikosteroida i hiperbarične oksigenacijske terapije kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha

master's thesis

• Title: Usporedba ishoda nakon intratimpanalne aplikacije kortikosteroida i hiperbarične oksigenacijske terapije kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha : retrospektivna studija
• Title (english): Comparison of intratympanic steroid and hyperbaric oxygen salvage therapy hearing outcomes in idiopathic sudden sensorineural hearing loss : a retrospective study
• Author: Mirta Peček
• Mentor: Andro Košec (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Andro Košec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Sistemski kortikosteroidi (KKS) najčešće predstavljaju prvu liniju liječenja iznenadnog zamjedbenog gubitka sluha, sa značajnim poboljšanjem u ishodima sluha u preko 60 % bolesnika. Terapije spašavanja uključuju intratimpanalnu primjenu steroida (ITS) i hiperbaričnu oksigenacijsku terapiju (HBOT), a dosadašnji rezultati nisu konzistentni. Cilj je ove studije usporediti rezultate ITS i HBOT kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha koji prethodno nisu odgovorili na terapiju sistemskim KKS. U istraživanju je sudjelovalo 126 bolesnika s iznenadnim zamjedbenim gubitkom sluha. Od njih 126, 35 je primilo HBOT, 43 ITS, a 48 nije primilo nikakvu terapiju spašavanja (kontrolna skupina). Tonski audiogrami snimljeni su prije i poslije primjene terapije spašavanja, kao i u kontrolnoj skupini u istom vremenskom intervalu. Varijable koje su se pratile uključivale su dob, vrijeme do početka terapije, prisutnost tinitusa (šuma u uhu) i ishode sluha, s graničnim kriterijima za kumulativno poboljšanje od >30 dB na svim frekvencijama, što ukazuje na oporavak. ITS i HBOT povezane su sa statistički značajnim oporavkom sluha na svim frekvencijama, u usporedbi s primjenom sistemskih KKS. U usporedbi s kontrolnom skupinom, nakon primjene ITS, zabilježeno je prosječno poboljšanje sluha za 13,6 dB na svim frekvencijama (250-8000 Hz), a nakon HBOT poboljšanje za 7,4 dB. Značajno poboljšanje sluha pozitivno korelira s dobi, ITS i HBOT. Prisutnost tinitusa prije započinjanja terapije spašavanja negativno korelira s poboljšanjem sluha. Bolesnici koji su imali tinitus prije početka terapije spašavanja imali su za prosječno 4,67 dB manje poboljšanje sluha, u usporedbi s bolesnicima koji nisu imali tinitus prije početka terapije spašavanja. ITS značajno smanjuje tinitus, u usporedbi s druge dvije terapijske opcije. ITS i HBOT pokazuju bolje rezultate u oporavku sluha u osoba s iznenadnim zamjedbenim gubitkom sluha, u usporedbi s kontrolnom skupinom, nakon prethodno neuspješne primjene sistemskih KKS.

Abstract (english)

Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60 % of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation therapy (HBOT), with inconsistent results reported. This study aimed to compare the results of ITS and HBOT in patients with SSNHL that previously failed systemic steroid therapy. This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBOT, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Puretone audiograms were performed before and after the salvage therapy in the ITS and HBOT groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. ITS and HBOT were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13,6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7,4 dB in HBOT in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBOT. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4,67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. ITS and HBOT show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy.

• Keywords: hiperbarična oksigenacijska terapija; iznenadni zamjedbeni gubitak sluha; kortikosteroidi; intratimpanalno; ishodi sluha; terapija spašavanja
• Keywords (english): corticosteroids; hearing outcomes; hyperbaric oxygen therapy; intratympanic; salvage therapy; sudden sensorineural hearing loss
• Language: croatian
• URN:NBN: urn:nbn:hr:105:027164
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-27 10:49:55