Setting: Four tertiary academic rhinology practices: Oregon Health and Science University in Portland; Northwestern University in Chicago; Medical University of South Carolina in Charlestown; and the University of Pennsylvania in Philadelphia.
Explore this issue:March 2013
Synopsis: One-year follow up of three cohorts showed significantly better improvement in multiple disease-specific QOL measures in the surgical patients (n = 65) and medically managed patients who crossed over to the surgical arm during the study (n=17) than in medically managed patients (n = 33). Patients who were initially treated medically and switched to the surgical arm did so due to persistence or worsening of disease. This prospective study reports that, at a one-year follow-up, patients electing surgery for CRS showed greater improvement than patients electing medical therapy alone.
Bottom line: In patients who are candidates for ESS, the surgery results in greater disease-specific QOL improvements than medical therapy.
Citation: Smith TL, Kern R, Palmer JN, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2012;3:4-9.
—Reviewed by John M. DelGaudio, MD
First-Line Steroid Therapy Can Improve Outcomes for ISSHL
Is intratympanic steroid therapy an effective first-line therapy for patients with moderate idiopathic sudden sensorineural hearing loss (ISSNHL)?
Background: The causes of moderate ISSNHL are unknown, limiting the ability to find effective treatments. Steroids have become the most widely accepted treatment form; however, previous studies of their effectiveness have lacked a placebo control group, and have shown effectiveness of steroid therapy in treatments for ISSNHL patients in whom previous systemic therapy has failed.
Study design: Prospective, randomized, triple-blind, placebo-controlled trial.
Setting: Patients were referred from the Sapienza University of Rome and four private otolaryngology practitioners.
Synopsis: Fifty patients presenting with moderate ISSNHL with flat audiograms (250 Hz to 8,000 Hz) were enrolled in the study and randomized into two groups. Inclusion criteria were diagnosis within three days of onset of symptoms, no previous ISSNHL therapy and an age between 15 and 85 years. Twenty-five patients were given 0.3 ml of prednisolone (62.5 mg/mL once per day for three days); 25 control patients were given an IT injection of 0.3 mL of a saline solution once a day for three days. All patients underwent audiometric tests using standardized methods for pure-tone threshold audiometry at study entry, and seven days (T1), 17 days and 37 days after first treatment. Patients who did not show a complete recovery at T1 received oral prednisolone for eight days. Complete recovery, marked improvement, slight improvement and no recovery at T1 were recorded in 19 patients (76 percent), two patients (2 percent), three patients (12 percent) and one patient (4 percent), respectively, in the steroid group; in the control group, numbers were recorded at five patients (20 percent), no patients, no patients and 20 patients (80 percent), respectively. Results suggest that systemic steroid therapy cannot be considered a salvage therapy in case of IT steroid failure, and the lack of a speech discrimination audiometry was a study shortcoming.