Postauricular versus systemic use of steroids for sudden hearing loss: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) can be debilitating and is one of the most common otological diseases. Steroids play an important role in its treatment. There are many ways to administer steroids, and the efficacy and safety of different administration routes remain unclear. This meta-analysis aimed to investigate the effect and safety of different types of steroid delivery administration for the treatment of SSNHL. METHODS AND ANALYSIS: We searched the Weipu, Wanfang, Chinese Biomedical Literature, National Knowledge Infrastructure, Web of Science, Embase and PubMed databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of postauricular injection and systemic steroid administration. Review Manager 5.4 software was used for data synthesis, which included the recovery rate (RR) of reported hearing improvement and change level in pure-tone audiometry (PTA). Subgroup analyses were performed based on different drugs, basic treatment, initial PTA, drug administration methods, onset time, and treatment course. Stata 15.1 software was used for analyses of publication bias and sensitivity. RESULTS: Our meta-analysis included 38 studies involving 3609 patients with SSNHL. In all included studies, the risk difference (RD) using reported improvement as an outcome measure was 0.12 for postauricular injection administration compared with systemic therapy (95% confidence interval [CI] = 0.008, 0.16, P < .00001, I2 = 59%). When examining PTA changes as an outcome measure (19 studies), the mean difference was 6.06 (95% CI = 3.96, 8.16, P < .00001, I2 = 70%). The RD for hearing improvement was compared among different factors, and the results showed that postauricular injection is superior to systemic steroid administration. CONCLUSION: Postauricular injection may be safer and more effective treatment than systemic therapy as a treatment for SSNHL.

[Application of restricted mean survival time in clinical follow-up study].

In clinical follow-up studies, hazard ratio (HR) is routinely used to quantify the differences between-groups, however, it is being estimated by the Cox procedure. HR, the ratio of two hazard functions has abstract meaning only and is in lack of the context to give an intuitive explanation of the survival of patients and the assumption of proportional hazards (PH) must be satisfied. Under this context, the restricted mean survival time (RMST) can be used as a relatively effective measure or index of statistics. This paper introduces the RMST-based statistical analysis methods, including estimation of RMST and its difference, hypothesis testing and regression analysis. The application of RMST in data analysis is also introduced. All the evidence demonstrates that RMST can be used as an effective analytical tool with straightforward interpretation. RMST is also more effective than HR in comparing differences between groups, when non-PH is observed. Therefore, RMST is suggested to be stated along with HR in the process of disease efficacy evaluation and prognosis analysis. Cooperation and complement of the two, a precise reflection on the characteristics of data can be expected.

Birth-weight prediction using three-dimensional sonographic fractional thigh volume at term in a Chinese population.

OBJECTIVES: To develop and validate new birth-weight prediction models in Chinese pregnant women using fractional thigh volume. METHODS: Healthy late third-trimester fetuses within 5 days of delivery were prospectively examined using two- (2D) and three- (3D) dimensional ultrasonography. Measurements were performed using 2D ultrasound for standard fetal biometry and 3D ultrasound for fractional thigh volume (TVol) and middle thigh circumference. The intraclass correlation coefficient (ICC) was used to analyze the inter- and intraobserver reliability of the 3D ultrasound measurements of 40 fetuses. Five birth-weight prediction models were developed using linear regression analysis, and these were compared with previously published models in a validation group. RESULTS: Of the 290 fetuses studied, 100 were used in the development of prediction models and 190 in the validation of prediction models. The inter- and intraobserver variability for TVol and middle thigh circumference measurements was small (all ICCs ≥ 0.95). The prediction model using TVol, femur length (FL), abdominal circumference (AC) and biparietal diameter (BPD) provided the most precise birth-weight estimation, with a random error of 4.68% and R(2) of 0.825. It correctly predicted 69.5 and 95.3% of birth weights to within 5 and 10% of actual birth weight. By comparison, the Hadlock model with standard fetal biometry (BPD, head circumference, AC and FL) gave a random error of 6.41%. The percentage of birth-weight prediction within 5 and 10% of actual birth weight was 46.3 and 82.6%, respectively. CONCLUSION: Consistent with studies on Caucasian populations, a new birth-weight prediction model based on fractional thigh volume, BPD, AC and FL, is reliable during the late third trimester in a Chinese population, and allows better prediction than does the Hadlock model.