Prognosis of acute acoustic trauma: a retrospective study using multiple logistic regression analysis

Hearing Outcomes of Treatment for Acute Noise-induced Hearing Loss: A Systematic Review and Meta-analysis

OBJECTIVE

To determine the efficacy of various treatment modalities used for acute noise-induced hearing loss (aNIHL) from acute acoustic trauma (AAT) via a systematic review and meta-analysis.

DATA SOURCES

PubMed, Cochrane, and Scopus databases.

STUDY SELECTION

The scientific literature was searched up to October 2018 for articles evaluating hearing outcomes after treatment of aNIHL.

DATA EXTRACTION

The following were extracted: Oxford level of evidence, number of patients, mean age, time to presentation, source of noise exposure, method of treatment/intervention, baseline hearing threshold, posttreatment hearing threshold, hearing gain, proportion of patients with no recovery, partial recovery, or complete recovery, and treatment complications.

DATA SYNTHESIS

Sixteen studies with 932 patients met inclusion criteria for systematic review and four studies with 187 patients were included in the meta-analysis.

CONCLUSIONS

Treatment modalities identified were steroids, vascular agents, nootropics, antioxidants, vitamins, cell apoptosis inhibitors, and hyperbaric oxygen therapy. Meta-analysis demonstrated significant improvement in mean hearing threshold for patients with high-frequency hearing loss, those treated within 48 hours, and those receiving treatment with a nootropic agent. Significant heterogeneity was present in experimental design among included studies and many were of lower levels of evidence. More prospective, large scale, randomized, double-blinded, placebo-controlled clinical trials are required to determine optimal treatment regimens for patients suffering from aNIHL caused by AAT.

Comparison of oral steroid regimens for acute acoustic trauma caused by gunshot noise exposure

Background

There are no definite guidelines regarding the most adequate steroid regimens for acute acoustic trauma.

Objective

To elucidate the dose-dependent differing benefits of oral steroids on hearing improvement following acute acoustic trauma.

Methods

Twenty-nine patients treated with oral steroids following a diagnosis of unilateral acute acoustic trauma were retrospectively reviewed. Patients were sorted into two groups with an oral steroid regimen. Group 1 received a 14-day course of treatment: 60 mg prednisolone daily for 10 days, tapering off over days 11–14. Group 2 received prednisolone for a total of 10 days: 60 mg for 5 days, tapering down each day for the remainder. Multivariable linear regression analysis was performed to evaluate the factors associated with the hearing gain.

Results

In the multivariable regression (R2 = 0.51, p < 0.001), patients in group 1 showed more significant improvement in the degree of hearing gain compared to group 2 (p = 0.03).

Conclusion

After comparing the differing benefits of oral steroids on hearing improvement by dosage, we recommend a high dose of prednisolone (60 mg per day) for 10 days, tapering over the remaining 4 days, for better hearing recovery following acute acoustic trauma.

Differences between acoustic trauma and other types of acute noise-induced hearing loss in terms of treatment and hearing prognosis

OBJECTIVES

To evaluate the differences between acoustic trauma (AT) and other types of acute noise-induced hearing loss (ANIHL), we performed a literature search and case reviews.

METHODS

The literature search based on online databases was completed in September 2016. Articles on ANIHL and steroid treatment for human subjects were reviewed. The source sounds and treatment sequelae of our accumulated cases were also reviewed. Hearing loss caused by gun-shots and explosions was categorized into the AT group, while hearing loss caused by concerts and other noises was categorized into the ANIHL group.

RESULTS

Systemic steroid treatment did not appear to be effective, at least in the AT group, based on both the literature and our case reviews. However, effective recovery after treatment including steroids was observed in the ANIHL group. The difference in hearing recovery between the AT and ANIHL groups was statistically significant (p = .030), although differences in age, days from the onset to treatment and pretreatment hearing levels were not significant.

CONCLUSIONS

Hearing recovery from AT is very poor, whereas, ANIHL is recoverable to some extent. Therefore, it is essential to differentiate between these two groups for accurate prediction of the hearing prognosis and evaluation of treatment effects.

Potential efficacy of early treatment of acute acoustic trauma with steroids and piracetam after gunshot noise

The purpose of this randomized study was to evaluate the early effect of the treatment of acute acoustic trauma (AAT) with steroids and piracetam in a sample of 52 young soldiers who were exposed to intense gunfire noise (G3 rifle). These patients were divided into three groups: (1) group A (20 patients) in which the treatment began within the first hour after the AAT, (2) group B (17 patients) in which the treatment started more than 1 h later and less than 16 h after the AAT and (3) group C (15 patients) in which the treatment began after 24 h or more. One month after the treatment onset, 36 (69%) patients of all the groups showed hearing improvement (complete-partial recovery) in the pure tone audiometry. The greater number of patients who showed complete recovery after AAT was noted in group A (65%) compared to group B (23.5%) and C (13.3%). Moreover, in group A, in the final audiogram, the averaged hearing threshold was statistically better (P < 0.001) than that of groups B and C. In spite of the lack of control group, our data demonstrated the possible effectiveness of the immediate onset of treatment of AAT.