Research Needs section from Sudden Hearing Loss (Update) CPG
This guideline was developed based on the current body of evidence regarding the diagnosis, treatment, and ongoing management of patients with SHL. As determined by the GUG’s review of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:
- Determine a standardized and evidence-based definition of SSNHL.
- Determine the actual incidence of SSNHL in the United States.
- Investigate the impact of ethnicity and socioeconomic status on timeliness of diagnosis and treatment, treatment outcome, and rehabilitation.
- Investigate the effectiveness of systemic corticosteroid treatment versus a placebo. The panel believes that such a clinical trial should be conducted due to the equipoise of existing data.
- Investigate the benefit of HBOT. Current evidence regarding this treatment option is equivocal. Additionally, there is a bias among US physicians and payers not to offer this therapy. Standardized treatment protocols and outcomes assessments are needed for HBOT for ISSNHL.
- Development of standardized outcome criteria to aid the comparison of clinical studies.
- The use of IT steroids, as primary and salvage therapy, needs to be further studied. Particularly, the optimal medications, dosage, concentrations, timing, and administration schedules for IT therapy need investigation. The panel believes that differing concentrations of steroid in injected solutions, ranging from 4 mg/mL to 24 mg/mL of dexamethasone, for example, contribute to the inhomogeneity of study outcomes.
- Develop criteria to determine at what level of hearing-recovery IT steroids would be offered as salvage.
- Determine the percentage of patients who gain serviceable hearing as a result of treatment. Here we emphasize the importance of WRS percentages, acknowledging that even a severe pure tone loss but with good or better word recognition ability is a good outcome.
- Investigate the use of ‘‘combined therapy’’ (ie, oral and IT steroids) in patients with SSNHL.
- Develop long-term follow-up protocols for patients with SSNHL.
- Evaluate therapies with standardized definitions and treatment protocols across studies.
- Develop a protocol with stacked ABR to better detect small retrocochlear lesions, which is usable in the routine clinical audiologic setting.
- Investigate the effectiveness of targeted laboratory assessment in determining the etiology of SSNHL.
- Investigate association of SHL with other risk factors, such as stroke and coagulopathies.
- Investigate new agents for the treatment of SSNHL.