Systematic Review and Meta-Analysis Medicine ®

Postauricular versus systemic use of steroids for

sudden hearing loss
A systematic review and meta-analysis of randomized
controlled trials
H.S. Deng, BDa, Y.W. Hou, BDa, J.N. Zhang, BDa, T. Yang, MDb,c,d,*

Abstract
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.
Abbreviations: CI = confidence interval, DEX = dexamethasone, MP = methylprednisolone, PTA = pure-tone audiometry, RCTs
= randomized controlled trials, RD = risk difference, RR = recovery rate, SSNHL = sudden sensorineural hearing loss, WHO =
World Health Organization.
Keywords: meta-analysis, postauricular injection, sudden sensorineural hearing loss, systematic review, systemic therapy

1. Introduction or 430 million people, required rehabilitation to address their

In 1944, Kleyn first described and defined sudden sensori-
neural hearing loss (SSNHL) as hearing loss of at least 30
dB HL at 3 or more consecutive frequencies on a pure-tone
audiogram in 3 days or fewer.[1] If it cannot be treated in a
timely manner, SSNHL can lead to persistent and disabling
hearing loss, which significantly compromises the quality of
life of patients. In 2021, it was reported by the World Health
Organization (WHO) that over 5% of the world population,
disabling hearing loss (432 million adults and 34 million
children). Moreover, it is estimated that by 2050, over 700
million people or 1 in every ten people will have disabling
hearing loss.[2] Therefore, studies relating to SSNHL permit
no delay.
In 1980, the efficacy of corticosteroid therapy was first
confirmed by Wilson.[3] Since then, steroids have been
consistently tested in all kinds of clinical and basic trials.

All the contributing authors have agreed to the publication of this manuscript. *Correspondence: T. Yang, Chongqing Medical University, Chongqing, 400016,
The authors have no funding and conflicts of interest to disclose. China (e-mail: yangting118@126.com).

All data generated or analyzed during this study are included in this published Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
article [and its supplementary information files]. The datasets generated during This is an open access article distributed under the Creative Commons
and/or analyzed during the current study are available from the corresponding Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and
author on reasonable request. reproduction in any medium, provided the original work is properly cited.

Ethical approval was not necessary because this study is a review and
meta-analysis.
a
Department of Otolaryngology Head and Neck Surgery, Hanzhong People’s
Hospital, Hanzhong, Shaanxi, China, b Chongqing Medical University, Chongqing,
China, c Chongqing Institute of Green and Intelligent Technology, Chinese Academy
of Science, Chongqing, China, d Chongqing School, University of Chinese Academy
of Sciences, Chongqing, China, e Chongqing People Hospital, Chongqing, China.
How to cite this article: Deng HS, Hou YW, Zhang JN, Yang T. Postauricular
versus systemic use of steroids for sudden hearing loss: A systematic
review and meta-analysis of randomized controlled trials. Medicine
2023;102:32(e34494).
Received: 12 October 2022 / Received in final form: 29 June 2023 / Accepted: 5
July 2023
http://dx.doi.org/10.1097/MD.0000000000034494

1
Deng et al. • Medicine (2023) 102:32Medicine
Steroids, which serve as the first recommended drug in
SSNHL guidelines worldwide, have been widely used for
many years. However, their therapeutic efficacy can be
greatly affected by the drug administration route, dosage,
administration duration time, frequency of application and
so on.
In terms of the best drug delivery administration, there
has been no agreement to date. Currently, there are 2 main
methods for steroid administration in SSNHL therapy: sys-
temic steroid therapy and local steroid therapy.[4] The sys-
temic drug delivery method, which is the traditional method
of steroid administration for SSNHL, is commonly used
and accepted in the clinic. However, the drug delivery effi-
cacy of this method is not ideal and may lead to some side
effects, including increased blood pressure, hyperglycemia,
electrolyte disturbances, and infections. Therefore, it is more
important to identify some local drug delivery methods that
can increase targeted drug delivery efficacy and reduce the
side effects of steroid application. At present, there are many
local drug delivery methods, such as intratympanic steroid
therapy, postauricular drug injection (Fig. 1), and intraco-
chlear administration.
The efficacy and safety of postauricular administration
have been proven in some clinical trials, and this approach
is also more convenient. We aimed to determine whether
postauricular administration can be used as an ideal and
widely applied therapy for SSNHL. The purpose of this
meta-analysis was to evaluate the efficacy and safety of
postauricular drug injection for SSNHL treatment by exam-
ining published studies in the Chinese and English litera-
ture. Postauricular steroid administration may be a more
promising method of SSNHL therapy than systemic steroid
treatment.
Figure 1. Schematic of postauricular injection.
2
2. Materials and methods
2.1. Literature retrieval
This study was designed based on the Preferred Reporting
Items for Systematic Review and Meta-analysis Protocols
statement, and the protocol was reviewed and registered in
PROSPERO (ID: CRD42022343333). Two investigators (YT
and DHS) independently searched the Weipu, Wanfang, Chinese
Biomedical Literature, National Knowledge Infrastructure,
Web of Science, Embase and PubMed databases up to May 1,
2022. The search was limited to English and Chinese articles.
Free search terms and Medical Subject Headings terms were
both used in the literature search. The following search terms
were used: “sudden hearing loss,” “sudden deafness,” “sudden
sensorineural hearing loss,” “idiopathic sensorineural hearing
loss,” “idiopathic deafness,” “postauricular,” “postauricular
injection administration,” “opisthotic injection,” “systemic,”
“systemic administration,” “intravenous injection,” “intrave-
nous drip,” “hormone, hormones,” “hormone therapy, phyto-
hormone,” “glucocorticoid,” “glucocorticoid hormone,” and
“glucocorticoids.” The flow chart of the study selection process
is shown in Figure 2.
2.2. Study selection
Two investigators (YT and HYW) independently screened the
identified abstracts and selected studies for full review. Full-text
review, which included intensive reading of the appropriate arti-
cles, was performed by the same investigators. All disagreements
were resolved by group consensus.
2.3. Inclusion and exclusion criteria
2.3.1. Research categories. All the included studies were
randomized controlled trials (RCTs) published in English or
Chinese, and only human studies were included.
2.3.2. Research subjects. All patients with SSNHL who had
normal behavior and the ability to communicate were included.
There were no limitations on race, age, sex or disease course.
Patients who had some basic diseases, including hypertension,
diabetes and blood diseases, that were well controlled were
all included. However, patients diagnosed with stroke,
nasopharyngeal carcinoma, acoustic neuroma, otitis media,
inner ear malformation, active peptic ulcer, tuberculosis, or a
psychological disorder were excluded.
2.3.3. Interventions. All the included experimental groups
were administered steroids via a retroauricular subperiosteal
injection in the periosteum of the posterior plain mastoid region
or a cribriform area injection. Oral or intravenous steroid
therapy was used in the control group.
2.3.4. Outcome assessment criteria. Pure-tone audiometry
(PTA) was performed before and after treatment. The categories
of the outcome[5] were as follows: recovery: hearing threshold
improved to a normal level after the treatment; obvious
effectiveness: an improvement in the hearing threshold of
more than 30 dB HL; effectiveness: an improvement in the
hearing threshold of 15 to 30 dB HL; and ineffectiveness: an
improvement in the hearing threshold of <15 dB HL.
2.3.5. Exclusion criteria. The exclusion criteria were as follows:
articles that were not published in English or Chinese; articles
that had no key information, such as the lack of a suitable
comparator and the main quantitative outcomes; animal
experimental investigations, case reports, meeting abstracts and
comments, meta-analyses and review articles; duplicate articles;
and studies that were not RCTs.
Deng et al. • Medicine (2023) 102:32www.md-journal.com
Figure 2. PRISMA flowchart of the review search. PRISMA = Preferred Reporting Items for Systematic Review and Meta-analysis Protocols.
2.3.6. Data extraction and outcome definitions. Two
investigators (YT and ZJN) independently extracted the
data, and any disagreements were resolved by discussion and
consensus with the third investigator (DHS). For each selected
publication, the following baseline and study characteristics
were extracted: sample size, mean age, time to onset, affected
ear, initial PTA, country, treatment information (e.g., SSNHL
definition, drug condition, mode of administration, duration of
treatment, dose), and treatment efficacy (e.g., criteria for hearing
recovery, recovery rate (RR), PTA differences and follow-up
period).
3
2.3.7. Risk-of-bias assessment. The Cochrane Collaboration
tool was used to assess the risk of bias in the selected studies
using the Cochrane Hand Book 5.4 software.[6] The following
aspects were assessed independently by 2 reviewers (YT and
DHS): random sequence generation, allocation concealment,
blinding of participants and personnel, blinding of outcome
assessment, incomplete outcome data, selective reporting, and
other bias. Disagreements between the 2 reviewers were resolved
through either discussion or adjudication by a third reviewer
(ZJN). We judged each study as having a low, unclear, or high
risk of bias in each domain. In the review of randomization,
Deng et al. • Medicine (2023) 102:32Medicine
studies that described their exact randomization method were
scored as having a low risk of bias; however, when the study
did not report the exact randomization method but indicated
that they had randomized, controlled designs, we scored them
as “unclear.” Similar criteria were applied for the scoring of
allocation concealment, blinding, incomplete outcome data, and
selective reporting.
2.3.8. Statistical methods. RevMan 15.4 and Stata 15.1
software were used for the data analyses. We pooled the
data and used the mean difference with the 95% confidence
interval (CI) to assess the continuous variables, for example,
PTA changes in dB HL; the risk difference (RD) with the 95%
CI was used to assess dichotomous variables, for example,
hearing recovery. Heterogeneity was evaluated using the chi-
square test.
Heterogeneity between studies was also assessed using the
I2 value, which indicated the likelihood that the variability
between difference effect estimates exceeded expectations. The
I2 values were categorized as follows using the Nordic Cochrane
Centre reference:
I2 = 0% to 40%, no important heterogeneity; I2 = 30% to
60%, moderate heterogeneity; I2 = 50% to 90%, substantial
heterogeneity; I2 = 75% to 100%, considerable heterogeneity.
An I2 statistic ≥ 50% and a Cochrane Q statistic with
a value of P < .1 indicated the presence of heterogeneity,
and in such cases, the random effects model was used. If no
considerable heterogeneity among studies was apparent (P ≤
.1, I 2 ≥ 50%), the fixed effects model was used. Funnel plots
and Egger linear regression test were used to investigate
potential publication bias (n ≥ 10). All statistical analyses
were carried out with Review Manager 5.4 (The Cochrane
Collaboration).
3. Results
3.1. Search results and study characteristics
A total of 481 citations were identified from the Weipu,
Wanfang, China National Knowledge Infrastructure, Cochrane
Library, Web of Science, PubMed and Embase databases. The
number of citations decreased to 412 after duplicates were
removed. By screening titles and abstracts, we excluded an
additional 154 articles for different reasons, including animal
experiments, case reports, meeting abstracts and comments,
review articles and irrelevant studies. Of the 258 potentially
eligible studies, 220 articles were excluded for the following
reasons: the study was not an RCT and/or the lack of a suit-
able comparator. Ultimately, 38 studies[7–44] with 3609 partici-
pants were included. All the studies were published in Chinese
from 2013 to 2021. The search strategy is shown in Figure 2,
and descriptions of the studies are summarized in Table 1. The
treatment and outcome details of the selected studies are shown
in Tables 2 and 3.
3.2. Risk-of-bias assessment
Figure 3A and B illustrate the methodological quality of the
included studies. All the included studies mentioned ran-
dom sequence generation. Only 17 studies provided detailed
methods of randomization. None of the studies described the
concealment of allocation. Regarding the blinding of partici-
pants and personnel, only 1 study had an explicit double-blind
design,[32] and 3 studies had a single-blind design.[10,13,31] In
terms of incomplete outcome data, 16 studies completely
described the treatment efficacy and side effect condi-
tions.[7,9,13,16,17,22,24–26,32,33,35,37–39,42] In the domain of selective
reporting and other bias, all the studies were judged as having
a “low” risk of bias (Fig. 3A and B).
4
3.3. Meta-analysis
3.3.1. RR among patients with SSNHL after steroid
treatment. All the studies, with a total of 3609 participants,
compared the RR of postauricular injection and systemic
therapy for SSNHL, which was available for analysis using a
random-effects model, with moderate heterogeneity among
studies (I2 = 59%, P < .00001). The results showed statistically
significant differences between the postauricular injection group
and the systemic therapy group (RD = 0.12; 95% CI = 0.008,
0.16; P < .00001), as shown in Figure 4A.
3.3.2. Variation in PTA in patients with sudden hearing
loss after steroid treatment. When comparing the
PTA variation level between postauricular injection and
systemic therapy in SSNHL, a random effects model was
used because of the substantial heterogeneity (I2 = 70%, P
< .00001). The pooled mean difference was 6.06 (95% CI =
3.96, 8.16; P < .00001) (Fig. 4B), indicating a statistically
significant difference in the change in the PTA level between
the 2 groups.
3.4. Subgroup analyses
To address the high heterogeneity, we conducted subgroup
analyses and categorized patients by age, type of drug, basic
treatment, initial PTA, treatment timing, drug administration
methods, time of onset, and course of treatment.
3.4.1. Age. We conducted the first subgroup analysis according
to the latest definition for the age groups reported by the WHO
(youth, <44; middle age, 45–59; and old age, >60).[45] The
heterogeneity decreased in these subgroups, indicating that this
factor may have been a source of some of the heterogeneity. The
postauricular injection vs systemic therapy hearing recovery RD
was 0.12, 0.08, and 0.18 in the youth, middle-age and old-age
groups, respectively, which demonstrated that the therapeutic
effect of the postauricular injection method may be higher in
elderly people (Fig. 4C).
3.4.2. Drug. As shown in Figure 4D, subgroup analysis was
stratified by different types of drugs, that is, methylprednisolone
(MP)(T) vs dexamethasone (DEX)(C) or MP(T) vs MP(C)
or MP(T) vs P(C) or DEX(T) vs DEX(C). The RD of the
therapeutic effect was 0.09 (I2 = 66%, 95% CI = 0.02, 0.17,
P = .01) for MP(T) vs DEX(C), 0.13 (I2 = 57%, 95% CI =
0.06, 0.20, P = .0006) for MP(T) vs MP(C), 0.18 (I2 = 72%,
95% CI = −0.03, 0.38, P0.10) for MP(T) vs P(C), and 0.08
(I2 = 0%, RD=, 95% CI = 0.02, 0.15, P = .02) for DEX(T) vs
DEX(C), which may indicate that MP is more effective when
administered via postauricular injection and that different
types of drug administration methods may be a source of
heterogeneity.
3.4.3. Foundation treatment. This subgroup was defined
based on whether foundational treatment was provided. Thirty-
three studies with 3309 participants reported hearing recovery
conditions after steroid treatment. In addition, some additional
foundation therapies were included in this group (Fig. 4E). The
pooled analysis demonstrated a statistically significant difference
in the RR in the group that received foundational treatment (I2
= 56%, RD = 0.11, 95% CI = 0.06, 0.15). To compare the RR
between postauricular injection and systemic therapy without
foundational treatment, we included 3 studies with a total of
300 participants. The significant result of this comparison also
indicated that postauricular injection may be more effective than
systemic therapy (I2 = 0%, RD = 0.26, 95% CI = 0.17, 0.34).
However, the RD increased in the subgroup without foundation
treatment, which demonstrated that additional foundation
therapy may not be helpful for postauricular steroid therapy.
 Table 1
Characteristics of the eligible studies.
With With With Diabetic
Sample tinnitus vertigo hypertension population
size (n) Mean age Time to onset (d) Affected ear Sex (n) (n) Initial PTA (dB) (n) (n)
Study
(publication yr) Country T C T C T C T C T C T C T C T C T C T C

[7]
Pan 2013-1 China 15 15 17.00~75.00 NA NA 6 (L)/9 (R) 6 (L)/9 (R) 6 (M)/9 (F) 8 (M)/7 (F) 12 13 3 6 73.5 ± 23.19 72.27 ± 20.08 NA NA
Pan 2013-2[7] China 15 15 17.00~75.00 NA NA 6 (L)/9 (R) 8 (L)/7 (R) 6 (M)/9 (F) 8 (M)/7 (F) 12 13 3 5 73.5 ± 23.19 72.49 ± 21.50 NA NA
Chen 2014[8] China 35 37 18~68 18~63 1~30 (AVG:6.20) 1~30 (AVG:6.40) NA 14 (M)/21 (F) 15 (M)/22 (F) NA NA NA 0 0
(AVG:40.26) (AVG:38.14)
Wang 2014[9] China 218 220 44.50 ± 25.20 46.60 ± 23.40 8.50 ± 6.70 10.30 ± 6.70
112 (L)/106 (R) 109 (L)/111 (R) 117 (M)/101 (F) 124 (M)/96 (F) NA NA NA 63 61 NA
Cao 2015[10] China 27 31 51.70 ± 22.40 49.20 ± 21.60 6.40 ± 4.50 5.80 ± 4.5013 (L)/14 (R) 18 (L)/13 (R) 15 (M)/12 (F) 17 (M)/14 (F) NA NA 75.30 ± 24.60 70.70 ± 23.8 NA NA
Dong 2015-1[11] China 31 30 46.16 ± 12.15 47.23 ± 12.76 NA 14 (L)/17 (R) 15 (L)/15 (R) 15 (M)/16 (F) 15 (M)/15 (F) NA NA NA NA NA
Dong 2015-2[11] China 25 22 46.80 ± 11.36 46.77 ± 12.87 NA 11 (L)/14 (R) 9 (L)/13 (R) 11 (M)/14 (F) 13 (M)/9 (F) NA NA NA NA NA
Qu 2015[12] China 62 69 18.00~65.00 Within 14 days NA 30 (M)/3 2 (F) 36 (M)/33 (F) 29 33 14 13 NA 13 11 9 8
Qin 2015[13] China 30 32 45.87 ± 15.00 47.16 ± 14.92 NA NA 15 (M)/15 (F) 16 (M)/16 (F) NA NA 61.77 ± 19.70 63.72 ± 19.95 0 0
Wu 2015[14] China 42 38 42.43 ± 15.18 Within 14 days 40 (L)/35 (R)/5 (D) 3 1 (M)/49 (F) 56 23 67.29 ± 22.47 70.52 ± 22.76 38 0
Cai 2016[15] China 41 44 60.10 ± 5.30 59.40 ± 6.10 NA NA 19 (M)/22 (F) 21 (M)/23 (F) NA NA 67.93 ± 10.43 68.34 ± 11.36 NA 41 44
Fang 2016[16] China 43 44 39.50 ± 8.60 41.30 ± 9.40 7.70 ± 2.40 7.40 ± 1.90 NA 18 (M)/25 (F) 23 (M)/21 (F) NA NA 71.90 ± 9.20 69.80 ± 10.70 NA NA
Jia 2016[17] China 30 30 50.32 ± 11.68 51.28 ± 10.35 4.21 ± 1.52 4.87 ± 1.98 15 (L)/15 (R) 13 (L)/18 (R) 14 (M)/16 (F) 14 (M)/16 (F) NA NA 71.19 ± 20.57 69.83 ± 23.17 20 17 12 11
Li 2016[18] China 39 39 49.69 ± 9.04 47.68 ± 8.65 NA NA 28 (M)/11 (F) 29 (M)/10 (F) 12 23 NA NA NA
Lu 2016[19] China 35 35 46.02 ± 6.29 46.11 ± 6.35 NA NA 18 (M)/17 (F) 19 (M)/16 (F) NA NA 61.25 ± 8.29 61.33 ± 8.31 NA NA
Zhang 2016[20] China 35 43 42.6 ± 18.0 40.23 ± 16.70 17.6 ± 5.30 16.02 ± 7.80 20 (L)/15 (R) 19 (L)/24 (R) 19 (M)/16 (F) 22 (M)/21 (F) NA NA 73.90 ± 2.20 78.50 ± 2.85 9 3
Zhou 2016[21] China 32 32 48.40 ± 0.60 53.40 ± 3.80 7.00 ± 0.20 8.20 ± 1.00 NA 18 (M)/14 (F) 15 (M)/17 (F) NA NA 74.20 ± 11.80 70.80 ± 18.40 NA NA
Chen 2017[22] China 54 48 41.50 ± 23.40 42.60 ± 20.20 8.70 ± 5.70 10.30 ± 6.70 NA 23 (M)/31 (F) 20 (M)/28 (F) NA NA 26.17 ± 6.76 28.03 ± 5.83 11 8 9 4
Wei 2017[23] China 40 40 58.80 ± 7.70 58. 00 ± 7.90 0.50~14.00 1.00~13.00 32 (L)/48 (R) NA NA NA 56.80 ± 8.70 54.20 ± 9.30 0 0

5
Zhao 2017[24] China 47 47 50.20 ± 10.70 49.50 ± 11.30 1.59 ± 0.51 1.63 ± 0.56 NA 15 (M)/32 (F) 15 (M)/32 (F) NA NA 50.50 ± 13.10 52.30 ± 11.20 NA NA
Zhu 2017[25] China 35 31 39.09 ± 11.50 40.32 ± 12.87 6.74 ± 6.67 5.58 ± 5.07 18 (L)/17 (R) 19 (L)/12 (R) 22 (M)/13 (F) 18 (M)/13 (F) 31 29 6 6 75.52 ± 22.22 74.63 ± 20.07 0 0
Li 2018[26] China 35 35 45.67 ± 5.23 45.28 ± 5.51 10.91 ± 4.02 10.53 ± 3.74 NA 19 (M)/16 (F) 20 (M)/15 (F) NA NA 70.63 ± 8.43 70.15 ± 8.61 0 0
Wang 2018[27] China 40 40 16.64 ± 1.63 16.78 ± 1.55 Within 14 d 19 (L)/21 (R) 20 (L)/20 (R) 20 (M)/20 (F) 21 (M)/19 (F) NA NA NA 0 0
Zhan 2018[28] China 84 83 54.30 ± 5.80 55.80 ± 4.70 2.00~30.00 3.00~35.00 NA 47 (M)/37 (F) 43 (M)/40 (F) NA NA NA NA NA
Zhang-1 2018[29] China 15 15 46.30 ± 7.00 45.90 ± 7.20 NA NA 8 (M)/7 (F) 8 (M)/7 (F) NA NA 61.28 ± 8.30 61.25 ± 8.31 NA NA
Zhang-2 2018[30] China 37 30 44.00 ± 12.24 44.70 ± 10.85 NA 20 (L)/17 (R) 16 (L)/14 (R) 19 (M)/18 (F) 13 (M)/17 (F) NA none 96.03 ± 10.59 96.37 ± 11.52 0 0
Chen 2019[31] China 58 58 NA 4.50 ± 1.10 4.30 ± 1.00 NA 30 (M)/28 (F) 32 (M)/26 (F) NA NA 68.80 ± 25.10 68.10 ± 26.50 19 16 11 12
Huang 2019[32] China 31 31 45.98 ± 7.07 43.25 ± 9.86 NA NA 13 (M)/18 (F) 16 (M)/15 (F) NA NA NA NA NA
Luo 2019[33] China 40 40 65.00 ± 7.00 66.00 ± 7.30 NA NA 22 (M)/18 (F) 20 (M)/20 (F) NA NA NA NA NA
Zhang 2019[34] China 50 50 55.38 ± 9.18 55.82 ± 9.49 2503.90 ± 861.40 2423.60 ± 817.60 25 (L)/25 (R) 23 (L)/27 (R) 25 (M)/25 (F) 29 (M)/21 (F) 47 46 5 7 NA NA NA
Zhuang 2019[35] China 40 40 45.38 ± 4.65 45.21 ± 4.83 7.12 ± 4.85 7.69 ± 3.12 NA 20 (M)/20 (F) 21 (M)/19 (F) NA NA 63.25 ± 2.51 63.33 ± 2.47 0 0
Jiang 2020[36] China 39 39 46.80 ± 11.50 45.60 ± 11.80 3.20 ± 1.20 3.70 ± 1.80 NA 19 (M)/23 (F) 18 (M)/21 (F) NA NA 56.81 ± 12.91 54.95 ± 11.63 0 0
Li-1 2020[37] China 28 28 42.80 ± 4. 12 43.10 ± 3.65 NA NA 16 (M)/12 (F) 15 (M)/13 (F) NA NA NA NA NA
Li-2 2020[38] China 128 112 43.50 ± 2.50 NA 137 (L)/103 (R) 65 (M)/63 (F) 52 (M)/60 (F) 105 99 5 7 NA 0 0
Li-3 2020[39] China 65 65 42.38 ± 7.51 43.46 ± 8.22 8.24 ± 2.81 8.07 ± 2.64 37 (L)/28 (R) 33 (L)/32 (R) 36 (M)/29 (F) 34 (M)/31 (F) 36 35 24 26 68.16 ± 9.88 67.44 ± 10.28 NA 0
Lu-1 2020[40] China 32 32 49.80 ± 2.50 50.60 ± 2.20 NA NA 18 (M)/14 (F) 12 (M)/20 (F) NA NA 61.74 ± 17.41 61.58 ± 17.63 NA NA
Lu-2 2020[41] China 25 25 63.42 ± 7.09 63.28 ± 6.93 3.03 ± 0.68 3.84 ± 0.71 NA 16 (M)/9 (F) 15 (M)/10 (F) NA NA NA NA NA
Yang 2021[42] China 60 60 43.81 ± 3.48 43.27 ± 3.76 5.62 ± 1.12 5.16 ± 1.01 25 (L)/35 (R) 27 (L)/33 (R) 34 (M)/26 (F) 29 (M)/31 (F) NA NA NA 0 0
Zhang 2021[43] China 40 40 53.90 ± 6.90 53.20 ± 6.10 NA 19 (L)/21 (R) 20 (L)/20 (R) 20 (M)/20 (F) 21 (M)/19 (F) NA NA 74.73 ± 21.24 72.90 ± 22.92 NA NA
Zhu 2021[44] China 33 33 43.00 ± 12.00 41.00 ± 15.00 5.10 ± 1.40 5.30 ± 2.70 NA 17 (M)/16 (F) 19 (M)/14 (F) NA NA NA NA NA

C = control group, NA = not available, PTA = pure tone average, T = treatment group.
Deng et al. • Medicine (2023) 102:32www.md-journal.com
 Table 2
Details of the treatment conditions.
Study Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
(publication
yr) SSNHL definition T C T C T C T C T C T C
[7]
Pan 2013-1 At least 20 dB hearing loss MP P postaurieal oral first-line first-line 10 d 10 d 1 mL/d every 3 d 3 times 50 mg/d for the first 3 d, 105 mg ginaton for intravenous
in 2 CFs occurring within injection 10 mg less a d until the infusion, 100 mg vitamin B1
3d 7th d and 0.5 mg mecobalamin
administered orally
Pan 2013-2[7] At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 10 d 10 d 1 mL/d every 3 d 3 times 40 mg/d for the first 3 d, 8 mg 105 mg ginaton for intravenous
in 2 CFs occurring within injection less a d until the 7th d infusion, 100 mg vitamin B1
3d and 0.5 mg mecobalamin
administered orally
Chen 2014[8] At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line 10~14 d 10~14 d 0.5 mL, 40 mg/mL supple- 10 mg/d for the first 3 d, 70 mg ginaton added with
in 2 CFs occurring within injection mented with 0.2 mL, 2% 5 mg/d for the following 3 d 10 μg alprostadil for
3d lidocaine every 3 d intravenous infusion,
0.5 mg mecobalamin via
intramuscular injection
Wang 2014[9] At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line within 15 d within 15 d 40 mg/d every 3 d until healed 10 mg/d for the first 3 d, ginaton, mecobalamin and
in 2 CFs occurring within injection or at most 5 times 5 mg/d for the following 4 d batroxobin administered
3d within 2 wk
Cao 2015[10] At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line within 15 d within 15 d 40 mg/d every 3 d until healed 10 mg/d for the first 3 d, reducing fibrinogen, promoting
in 2 CFs occurring within injection or at most 5 times 5 mg/d for the following 4 d the microcirculation
3d and neurotrophic drugs

6
administered within 15 d
Dong At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line within 15 d within 15 d 40 mg supplemented with 10 mg/d for the first 3 d, 87.5 mg ginaton once per d;
2015-1[11] in 2 CFs occurring within injection 0.2 mL lidocaine every 3 d 5 mg/d for the following 3 d, 1 mg batroxobin one time
3d 5 times 2.5 mg/d for the last 3 d on the first d, then 0.5 mg
every other d for following
d; 500 mg mecobalamin
once a d
Dong At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line within 15 d within 15d 40 mg supplemented with 10 mg/d for the first 3 d, 87.5 mg ginaton once per d;
2015-2[11] in 2 CFs occurring within injection 0.2 mL lidocaine every 3 d 5 mg/d for the following 3 d, 1 mg batroxobin one time
3d 5 times 2.5 mg/d for the last 3 d on the first day, then 0.5 mg
every other d for following
d; 500 mg mecobalamin
once a d
Qu 2015[12] At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 7d 10 d 40 mg/d every other D for 10 d 85 mg/d for the first 4 d, then blood vessel enlarging,
in 2 CFs occurring within injection 40 mg/d for the following neurotrophic, activating
3d 3d and stasis removing drugs
administered for 10 d
Qin 2015[13] At least 20 dB hearing loss MP DEX postaurieal IV/oral NA NA 15 d 15 d 40 mg supplemented with 10 mg/d intravenous infusion 25 mg ginaton and neurotrophic
in 2 CFs occurring within injection 1 mL lidocaine every 3 d for the first 5 d, 30 mg drugs administered via
3d 5 times prednisone taken orally for intravenous infusion for 15 d
the following 3 d, 10 mg/d
for the other 3 d, 5 mg/d for
the last 3 d
(Continued )
Deng et al. • Medicine (2023) 102:32Medicine
 Table 2
(Continued )
Study Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
(publication
yr) SSNHL definition T C T C T C T C T C T C
[14]
Wu 2015 At least 15 dB hearing loss MP P postaurieal oral first-line first-line 14 d 5d 40 mg/d every 2 d 7 times 1 mg/kg once a d for 3 or 5 d
20 mL ginkgo-damole
in 2 CFs occurring within injection supplemented with 10 μg
3d alprostadil administered via
injection once a d for 14 d
Cai 2016[15] At least 30 dB hearing loss MP DEX/P postaurieal IV/oral first-line first-line 40 d 40 d 40 mg/d every 3 d for 40 d 10 mg/d dexamethasone for 25 mg ginaton and neurotrophic
in 3 CFs occurring within injection the first 5 d, oral prednisone drugs administered via
3d for the following d intravenous infusion for 40 d
Fang 2016[16] At least 20 dB hearing loss MP P postaurieal oral first-line first-line 5d 5d 40 mg/d every other d 3 times 30 mg/d for 5 d 5 mg sibelium, 25000 u vitamin
in 2 CFs occurring within injection A, 0.1 g vitamin E taken
3d orally every d for 14 d
Jia 2016[17] At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line 5d 5d 40 mg/d for 5 d 10 mg/d for 5 d 140 mg ginaton and 10 μg
in 2 CFs occurring within injection alprostadil supplemented
3d with 0.5 mg cobamamide
administered via intravenous
infusion once a day for 10 d,
10 μg batroxobin once a d
for the first day, then 5 μg/d
every other d 3 times
Li 2016[18] At least 20 dB hearing loss MP MP postaurieal IV NA NA 10 d 10 d 40 mg supplemented with 40 mg/d for the first 3 d, then 5 mL ginkgo-damole

7
in 2 CFs occurring within injection 0.5 mL 2% lidocaine once a half less every 3 d until the supplemented with 0.5 mg
3d d for 10 d 10th d mecobalamine once a d
for 10 d
Lu 2016[19] At least 20 dB hearing loss MP DEX/P postaurieal IV/oral NA NA 15 d 14 d 40 mg supplemented with 10 mg/d dexamethasone ad- 25 mg ginaton administered
in 2 CFs occurring within injection 1 ml 2% lidocaine every 3 ministered via intravenous via intravenous infusion, oral
3d d for 15 d infusion for the first 5 d, 0.5 mg mecobalamine thrice
oral prednisone for the a d for 15 d
following d
Zhang At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line 5d 9d 20 mg/d every other d 3 times 10 mg/d for the first 3 d, vinpocetine administered
2016[20] in 2 CFs occurring within injection 8 mg/d for the following 3 d, via intravenous infusion,
3d 5 mg/d for the last 3 d mecobalamine and ginaton
taken orally
Zhou 2016[21] At least 20 dB hearing loss DEX DEX postaurieal IV first-line first-line 10~14 d 10~14 d 0.5 mg supplemented with 10 mg/d for 6 d alprostadil administered
in 2 CFs occurring within injection 0.2 mL lidocaine every 3 d via intravenous infusion,
3d 4 times neurotrophic and vitamin
drugs taken orally
Chen At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line within 15 d within 15 d 40 mg/d every 2 d 5 times 10 mg/d for the first 3 d, 105 mg/d ginaton, 500 μg/d
2017[22] in 2 CFs occurring within injection 5 mg/d for the following 4 d neurotrophic drugs and
2 wk defibrase administered via
intravenous infusion
(Continued )
Deng et al. • Medicine (2023) 102:32www.md-journal.com
 Table 2
(Continued )

Study Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
(publication
yr) SSNHL definition T C T C T C T C T C T C
[23]
Wei 2017 At least 20 dB hearing loss DEX DEX postaurieal IV first-line first-line 10 d 10 d 5 mg/d every other d for 10 d 5 mg/d every other d for 10 d mouse nerve growth factor,
in 2 CFs occurring within injection blood vessel enlarging drugs,
3d vitamins and coenzymes
administered via intravenous
infusion
Zhao 2017[24] At least 20 dB hearing loss DEX DEX postaurieal IV NA NA 10 d 10 d 5 mg/d every 2 d 5 times 10 mg/d for the first 3 d, blood vessel enlarging,
in 2 CFs occurring within injection 5 mg/d for the following 3 d neurotrophic, activating and
3d microcirculation improving
drugs for 10 d
Zhu 2017[25] At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 10 d 10 d 40 mg/d for 5 d 40 mg/d for 5 d 105 mg/d ginaton for 10 d,
in 2 CFs occurring within injection 5~10 BU/d batroxobin every
3d other d 5 times
Li 2018[26] At least 20 dB hearing loss DEX DEX/P postaurieal IV/oral NA NA 10 d 30 d 0.5 mL/d every 2 d for 10 d 10 mg/d dexamethasone for none
in 2 CFs occurring within injection the first 7 d, oral prednisone
3d for the following d
Wang At least 20 dB hearing loss MP MP postaurieal IV NA NA 1 0d 10 d 40 mg/d every 2 d 5 times 80 mg/d for the first 4 d, blood vessel enlarging,
2018[27] in 2 CFs occurring within injection 40 mg/d for the following neurotrophic, activating
3d 3d and stasis removing drugs
administered for 10 d

8
Zhan 2018[28] At least 20 dB hearing loss MP MP postaurieal IV NA NA NA NA 10~160 mg per time for 12 10~160 mg per time for 12 ginaton administered via
in 2 CFs occurring within injection times times intravenous infusion
3d
Zhang-1 At least 20 dB hearing loss MP DEX/P postaurieal IV/oral NA NA 15 d 15 d 40 mg supplemented with 10 mg/d administered via none
2018[29] in 2 CFs occurring within injection 1 mL 2% lidocaine every 3 intravenous infusion for a
3d d for 15 d wk, oral prednisone for the
following d
Zhang-2 At least 20 dB hearing loss DEX DEX postaurieal IV first-line first-line NA 5d 5 mg per time 10 mg/d administered via anticoagulation and
2018[30] in 2 CFs occurring within injection intravenous infusion for 5 d microcirculation improving
3d drugs administered via
intravenous infusion
Chen At least 20 dB hearing loss DEX DEX postaurieal IV second-line second-line 14 d 14 d 40 mg/d every other d 5 times 10 mg/d for the first 3 d, neurotrophic and
2019[31] in 2 CFs occurring within injection 5 mg/d for the following 2 d microcirculation improving
3d drugs administered for 14 d
Huang At least 20 dB hearing loss NA MP postaurieal IV NA NA 6d NA 20 mg/d every other day 3 0.8 mg/kg·d administered via 0.5 mg mecobalamine
2019[32] in 2 CFs occurring within injection times intravenous infusion supplemented with 4 mL
3d gastrodin once per d via
intravenous infusion
Luo 2019[33] At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 10 d 10 d 0.5 mL/d every other d for 80 mg/d for the first d, then none
in 2 CFs occurring within injection 10 d 20 mg less 3 d until the
3d 10th day
Zhang At least 20 dB hearing loss MP MP postaurieal IV NA NA 5d 10 d 20 mg/d every other d 3 times 0.8 mg/kg·d for the first 5 d, 0.5 mg mecobalamine
2019[34] in 2 CFs occurring within injection then 8 mg less a d until supplemented with 4 mL
3d the 9th d gastrodin once per d via
intravenous infusion
Deng et al. • Medicine (2023) 102:32Medicine

(Continued )
 Table 2
(Continued )
Study Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
(publication
yr) SSNHL definition T C T C T C T C T C T C
Zhuang At least 20 dB hearing loss MP DEX/ postaurieal IV/oral first-line first-line 14 d 14 d 20 mg supplemented with 10 mg/d dexamethasone for 10 μg alprostadil supplemented
2019[35] in 2 CFs occurring within MP injection 0.2 mL 2% lidocaine once a the first 5 d, oral prednisone with 0.5 mg mecobalamine
3d d every 3 d 5 times for the following d once a d for 2 wk
Jiang At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 14 d 14 d 40 mg/d every other d 7 times 80 mg/d for the first 3 d, ginaton, mecobalamine and
2020[36] in 2 CFs occurring within injection 40 mg/d for the following batroxobin once a d for 2 wk
3d 4d
Li-1 2020[37] NA MP DEX postaurieal IV first-line first-line 15 d 15 d 40 mg/d every other d for 15 d 10 mg/d for the first 3 d, none
injection 5 mg/d for the following 4 d
Li-2 2020[38] At least 20 dB hearing loss MP DEX postaurieal IV NA NA 10 d 10 d 40 mg/d every other d 5 times 10 mg/d for the first 3 d, 105 mg/d ginaton for 10 d
in 2 CFs occurring within injection 5 mg/d for the following 3 d
7d
Li-3 2020[39] At least 20 dB hearing loss MP DEX postaurieal IV first-line first-line 10 d 10 d 20 mg/d every other d 5 times 10 mg/d for the first 3 d, ginaton administered via
in 2 CFs occurring within injection 5 mg/d for the following 7 d intravenous infusion and oral
7d mecobalamine for 10 d
Lu-1 2020[40] NA MP DEX postaurieal IV NA NA 14 d 6d 40 mg supplemented with 2% 10 mg/d for the first 3 d, none
injection lidocaine every 3 d for 2 wk 6 mg/d for the following 3 d
Lu-2 2020[41] At least 20 dB hearing loss MP MP postaurieal IV NA NA 10 d 10 d 40 mg/d every other d for 10 d 40 mg/d for the first 5 d, neurotrophic and
in 2 CFs occurring within injection 8 mg less a day until to the microcirculation improving
3d 10th day drugs

9
Yang 2021[42] NA DEX DEX postaurieal IV NA NA 14 d 14 d 5 mg/d every 3 d 10 mg/d for the first 3 d, 20~40 mg/d ginaton and
injection 5 mg/d for the following 4 d 10 AU/d defibrase
supplemented with 0.5 mg/d
mecobalamine once a d
for 14 d
Zhang At least 20 dB hearing loss MP MP postaurieal IV first-line first-line 10 d 10 d 40 mg/mL once a d for 5 d 40 mg/d for 5 d 30 mL/d ginkgo-damole for
2021[43] in 2 CFs occurring within injection 10 d
3d
Zhu 2021[44] At least 20 dB hearing loss MP MP postaurieal IV second-line second-line 15 d 15 d 0.5 mL supplemented with NA ginaton administered via
in 2 CFs occurring within injection 0.3 mL 2% lidocaine once a intravenous infusion and oral
3d d every 3 d 5 times mecobalamine for 2 wk
C = control group, CF = continuous frequency, d = day, DEX = dexamethasone, M = moth, MP = methylprednisolone, NA = not available, P = prednisone, PTA = pure tone average, SSNHL = sudden sensorineural hearing loss, T = treatment group.
Deng et al. • Medicine (2023) 102:32www.md-journal.com
 Table 3
Summary of the treatment outcomes.
Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
Study
(publication yr) SSNHL definition T C T C T C T C T C T C

Pan 2013-1[7] At least 20 dB hearing MP P postaurieal injection oral first-line first-line 10 d 10 d 1 mL/d every 3 d 3 times 50 mg/d for the first 3 d, 105 mg ginaton for intravenous
loss in 2 CFs occurring 10 mg less a day until infusion, 100 mg vitamin B1
within 3 d the 7th day and 0.5 mg mecobalamin
administered orally
Pan 2013-2[7] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 10 d 10 d 1 mL/d every 3 d 3 times 40 mg/d for the first 3 d, 105 mg ginaton for
loss in 2 CFs occurring 8 mg less a day until the intravenous infusion,
within 3 d 7th day 100 mg vitamin B1 and
0.5 mg mecobalamin
administered orally
Chen 2014[8] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line 10~14 d 10~14 d 0.5 mL, 40 mg/mL supple- 10 mg/d for the first 3 d, 70 mg ginaton added with
loss in 2 CFs occurring mented with 0.2 mL, 2% 5 mg/d for the following 10 μg alprostadil for
within 3 d lidocaine every 3 d 3d intravenous infusion,
0.5 mg mecobalamin via
intramuscular injection
Wang 2014[9] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line within 15 d within 15 d 40 mg/d every 3 d 10 mg/d for the first 3 d, ginaton, mecobalamin and
loss in 2 CFs occurring until healed or at most 5 mg/d for the following batroxobin administered
within 3 d 5 times 4d within 2 wk
Cao 2015[10] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line within 15 d within 15 d 40 mg/d every 3 d 10 mg/d for the first 3 d, reducing fibrinogen,
loss in 2 CFs occurring until healed or at most 5 mg/d for the following promoting the
within 3 d 5 times 4d microcirculation and

10
neurotrophic drugs
administered within 15 d
Dong At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line within 15 d within 15 d 40 mg supplemented with 10 mg/d for the first 3 d, 87.5 mg ginaton once per
2015-1[11] loss in 2 CFs occurring 0.2 mL lidocaine every 3 5 mg/d for the following day; 1 mg batroxobin one
within 3 d d 5 times 3 d, 2.5 mg/d for the time on the first day, then
last 3 d 0.5 mg every other day
for following d; 500 mg
mecobalamin once a day
Dong At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line within 15 d within 15d 40 mg supplemented with 10 mg/d for the first 3 d, 87.5 mg ginaton once per
2015-2[11] loss in 2 CFs occurring 0.2 mL lidocaine every 3 5 mg/d for the following day; 1 mg batroxobin one
within 3 d d 5 times 3 d, 2.5 mg/d for the time on the first day, then
last 3 d 0.5 mg every other day
for following d; 500 mg
mecobalamin once a day
Qu 2015[12] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 7d 10 d 40 mg/d every other day 85 mg/d for the first 4 d, blood vessel enlarging,
loss in 2 CFs occurring for 10 d then 40 mg/d for the neurotrophic, activating
within 3 d following 3 d and stasis removing drugs
administered for 10 d
Qin 2015[13] At least 20 dB hearing MP DEX postaurieal injection IV/oral NA NA 15 d 15 d 40 mg supplemented with 10 mg/d intravenous infusion 25 mg ginaton and
loss in 2 CFs occurring 1 mL lidocaine every 3 for the first 5 d, 30 mg neurotrophic drugs
within 3 d d 5 times prednisone taken orally administered via
for the following 3 d, intravenous infusion for
10 mg/d for the other 3 15 d
d,5 mg/d for the last 3 d
Deng et al. • Medicine (2023) 102:32Medicine

(Continued )
 Table 3
(Continued )
Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
Study
(publication yr) SSNHL definition T C T C T C T C T C T C
[14]
Wu 2015 At least 15 dB hearing MP P postaurieal injection oral first-line first-line 14 d 5d 40 mg/d every 2 d 7 times 1 mg/kg once a day for 3 20 mL ginkgo-damole
loss in 2 CFs occurring or 5 d supplemented with 10 μg
within 3 d alprostadil administered
via injection once a day
for 14 d
Cai 2016[15] At least 30 dB hearing MP DEX/P postaurieal injection IV/oral first-line first-line 40 d 40 d 40 mg/d every 3 d for 40 d 10 mg/d dexamethasone 25 mg ginaton and
loss in 3 CFs occurring for the first 5 d, oral neurotrophic drugs
within 3 d prednisone for the administered via intravenous
following d infusion for 40 d
Fang 2016[16] At least 20 dB hearing MP P postaurieal injection oral first-line first-line 5d 5d 40 mg/d every other day 30 mg/d for 5 d 5 mg sibelium, 25000 u
loss in 2 CFs occurring 3 times vitamin A, 0.1 g vitamin
within 3 d E taken orally every day
for 14 d
Jia 2016[17] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line 5d 5d 40 mg/d for 5 d 10 mg/d for 5 d 140 mg ginaton and 10 μg
loss in 2 CFs occurring alprostadil supplemented
within 3 d with 0.5 mg cobamamide
administered via
intravenous infusion once
a day for 10 d, 10 μg
batroxobin once a day for

11
the first day, then 5 μg/d
every other day 3 times
Li 2016[18] At least 20 dB hearing MP MP postaurieal injection IV NA NA 10 d 10 d 40 mg supplemented with 40 mg/d for the first 3 d, 5 mL ginkgo-damole
loss in 2 CFs occurring 0.5 mL 2% lidocaine then half less every 3 d supplemented with
within 3 d once a day for 10 d until the 10th day 0.5 mg mecobalamine
once a day for 10 d
Lu 2016[19] At least 20 dB hearing MP DEX/P postaurieal injection IV/oral NA NA 15 d 14 d 40 mg supplemented with 10 mg/d dexamethasone 25 mg ginaton administered
loss in 2 CFs occurring 1 mL 2% lidocaine every administered via intra- via intravenous
within 3 d 3 d for 15 d venous infusion for the infusion, oral 0.5 mg
first 5 d, oral prednisone mecobalamine thrice a
for the following d day for 15 d
Zhang 2016[20] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line 5d 9d 20 mg/d every other day 10 mg/d for the first 3 d, vinpocetine administered
loss in 2 CFs occurring 3 times 8 mg/d for the following via intravenous infusion,
within 3 d 3 d, 5 mg/d for the mecobalamine and
last 3 d ginaton taken orally
Zhou 2016[21] At least 20 dB hearing DEX DEX postaurieal injection IV first-line first-line 10~14 d 10~14 d 0.5 mg supplemented with 10 mg/d for 6 d alprostadil administered
loss in 2 CFs occurring 0.2 mL lidocaine every 3 via intravenous infusion,
within 3 d d 4 times neurotrophic and vitamin
drugs taken orally
Chen 2017[22] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line within 15 d within 15 d 40 mg/d every 2 d 5 times 10 mg/d for the first 3 d, 105 mg/d ginaton, 500 μg/d
loss in 2 CFs occurring 5 mg/d for the following neurotrophic drugs and
within 2 wk 4d defibrase administered
via intravenous infusion
(Continued )
Deng et al. • Medicine (2023) 102:32www.md-journal.com
 Table 3
(Continued )
Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
Study
(publication yr) SSNHL definition T C T C T C T C T C T C
Wei 2017[23] At least 20 dB hearing DEX DEX postaurieal injection IV first-line first-line 10 d 10 d 5 mg/d every other day 5 mg/d every other day mouse nerve growth factor,
loss in 2 CFs occurring for 10 d for 10 d blood vessel enlarging
within 3 d drugs, vitamins and
coenzymes administered
via intravenous infusion
Zhao 2017[24] At least 20 dB hearing DEX DEX postaurieal injection IV NA NA 10 d 10 d 5 mg/d every 2 d 5 times 10 mg/d for the first 3 d, blood vessel enlarging,
loss in 2 CFs occurring 5 mg/d for the following neurotrophic, activating
within 3 d 3d and microcirculation
improving drugs for 10 d
Zhu 2017[25] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 10 d 10 d 40 mg/d for 5 d 40 mg/d for 5 d 105 mg/d ginaton for 10 d,
loss in 2 CFs occurring 5~10 BU/d batroxobin
within 3 d every other day 5 times
Li 2018[26] At least 20 dB hearing DEX DEX/P postaurieal injection IV/oral NA NA 10 d 30 d 0.5 mL/d every 2 d for 10 d 10 mg/d dexamethasone none
loss in 2 CFs occurring for the first 7 d, oral
within 3 d prednisone for the
following d
Wang 2018[27] At least 20 dB hearing MP MP postaurieal injection IV NA NA 1 0d 10 d 40 mg/d every 2 d 5 times 80 mg/d for the first 4 blood vessel enlarging,
loss in 2 CFs occurring d, 40 mg/d for the neurotrophic, activating
within 3 d following 3 d and stasis removing
drugs administered for

12
10 d
Zhan 2018[28] At least 20 dB hearing MP MP postaurieal injection IV NA NA NA NA 10~160 mg per time for 10~160 mg per time for ginaton administered via
loss in 2 CFs occurring 12 times 12 times intravenous infusion
within 3 d
Zhang-1 At least 20 dB hearing MP DEX/P postaurieal injection IV/oral NA NA 15 d 15 d
40 mg supplemented with 10 mg/d administered via none
2018[29] loss in 2 CFs occurring 1 mL 2% lidocaine every intravenous infusion for
within 3 d 3 d for 15 d a wk, oral prednisone for
the following d
Zhang-2 At least 20 dB hearing DEX DEX postaurieal injection IV first-line first-line NA 5d 5 mg per time 10 mg/d administered via anticoagulation and
2018[30] loss in 2 CFs occurring intravenous infusion microcirculation improving
within 3 d for 5 d drugs administered via
intravenous infusion
Chen 2019[31] At least 20 dB hearing DEX DEX postaurieal injection IV second-line second-line 14 d 14 d 40 mg/d every other day 10 mg/d for the first 3 d, neurotrophic and
loss in 2 CFs occurring 5 times 5 mg/d for the following microcirculation
within 3 d 2d improving drugs
administered for 14 d
Huang 2019[32] At least 20 dB hearing NA MP postaurieal injection IV NA NA 6d NA 20 mg/d every other day 0.8 mg/kg·d administered 0.5 mg mecobalamine
loss in 2 CFs occurring 3 times via intravenous infusion supplemented with 4 mL
within 3 d gastrodin once per day
via intravenous infusion
Luo 2019[33] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 10 d 10 d 0.5 mL/d every other day 80 mg/d for the first day, none
loss in 2 CFs occurring for 10 d then 20 mg less 3 d
within 3 d until the 10th day
(Continued )
Deng et al. • Medicine (2023) 102:32Medicine
 Table 3
(Continued )
Drug Mode of administration Treatment timing Duration of treatment Dose and frequency Foundation treatment
Study
(publication yr) SSNHL definition T C T C T C T C T C T C
[34]
Zhang 2019 At least 20 dB hearing MP MP postaurieal injection IV NA NA 5d 10 d 20 mg/d every other day 0.8 mg/kg·d for the first 5 0.5 mg mecobalamine
loss in 2 CFs occurring 3 times d, then 8 mg less a day supplemented with 4 mL
within 3 d until the 9th day gastrodin once per day
via intravenous infusion
Zhuang At least 20 dB hearing MP DEX/ postaurieal injection IV/oral first-line first-line 14 d 14 d 20 mg supplemented with 10 mg/d dexamethasone 10 μg alprostadil
2019[35] loss in 2 CFs occurring MP 0.2 mL 2% lidocaine for the first 5 d, oral supplemented with
within 3 d once a day every 3 d prednisone for the 0.5 mg mecobalamine
5 times following d once a day for 2 wk
Jiang 2020[36] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 14 d 14 d 40 mg/d every other day 80 mg/d for the first 3 ginaton, mecobalamine and
loss in 2 CFs occurring 7 times d, 40 mg/d for the batroxobin once a day
within 3 d following 4 d for 2 wk
Li-1 2020[37] NA MP DEX postaurieal injection IV first-line first-line 15 d 15 d 40 mg/d every other day 10 mg/d for the first 3 d, none
for 15 d 5 mg/d for the following
4d
Li-2 2020[38] At least 20 dB hearing MP DEX postaurieal injection IV NA NA 10 d 10 d 40 mg/d every other day 10 mg/d for the first 3 d, 105 mg/d ginaton for 10 d
loss in 2 CFs occurring 5 times 5 mg/d for the following
within 7 d 3d
Li-3 2020[39] At least 20 dB hearing MP DEX postaurieal injection IV first-line first-line 10 d 10 d 20 mg/d every other day 10 mg/d for the first 3 d, ginaton administered via
loss in 2 CFs occurring 5 times 5 mg/d for the following intravenous infusion and
within 7 d 7d oral mecobalamine for

13
10 d
Lu-1 2020[40] NA MP DEX postaurieal injection IV NA NA 14 d 6d 40 mg supplemented with 10 mg/d for the first 3 d, none
2% lidocaine every 3 d 6 mg/d for the following
for 2 wk 3d
Lu-2 2020[41] At least 20 dB hearing MP MP postaurieal injection IV NA NA 1 0d 10 d 40 mg/d every other day 40 mg/d for the first 5 d, neurotrophic and
loss in 2 CFs occurring for 10 d 8 mg less a day until to microcirculation
within 3 d the 10th day improving drugs
Yang 2021[42] NA DEX DEX postaurieal injection IV NA NA 14 d 14 d 5 mg/d every 3 d 10 mg/d for the first 3 d, 20~40 mg/d ginaton and
5 mg/d for the following 10 AU/d defibrase
4d supplemented with
0.5 mg/d mecobalamine
once a day for 14 d
Zhang 2021[43] At least 20 dB hearing MP MP postaurieal injection IV first-line first-line 10 d 10 d 40 mg/mL once a day 40 mg/d for 5 d 30 mL/d ginkgo-damole
loss in 2 CFs occurring for 5 d for 10 d
within 3 d
Zhu 2021[44] At least 20 dB hearing MP MP postaurieal injection IV second-line second-line 15 d 15 d 0.5 mL supplemented with NA ginaton administered via
loss in 2 CFs occurring 0.3 mL 2% lidocaine intravenous infusion and
within 3 d once a day every 3 d oral mecobalamine for
5 times 2 wk
C = control group, NA = not available, PTA = pure tone average, SSNHL = sudden sensorineural hearing loss, T = treatment.
Deng et al. • Medicine (2023) 102:32www.md-journal.com
Deng et al. • Medicine (2023) 102:32Medicine
Figure 3. Risk of bias. (A) Risk of bias graph. (B) Risk of bias summary.
3.4.4. Initial PTA. In terms of the initial PTA, we defined
subgroups as having mild (20–35 dB HL), moderate-severe
(50–65 dB HL), and severe (65–80 dB HL) hearing loss based
on the most updated criteria for hearing levels reported
by the WHO.[46] The heterogeneity in these subgroups was
markedly reduced, which demonstrated that the initial PTA
may be a source of heterogeneity. Two studies were included
in the mild hearing loss group (I² = 0%, RD = 0.1, 95% CI
= 0.00, 0.20). The RD increased to 0.23 (I2 = 46%, 95% CI
= 0.16, 0.30, P < .00001) for moderate-severe hearing loss
and to 0.13 (I2 = 44%, 95% CI = 0.08, 0.18, P < .00001)
for severe hearing loss, which indicated that postauricular
injection therapy may be more effective in the severe hearing
loss patient group (Fig. 4F).
3.4.5. Mode of application. In the subgroup analysis of
different modes of administration (Fig. 4G), the RD of the RR
was 1.10 (I2 = 56%, 95% CI = 0.06, 0.14, P < .00001) in the
postauricular injection group vs the intravenous injection (IV)
group, 0.18 (I2 = 72%, 95% CI = −0.03, 0.38. P = .10) in the
postauricular injection group vs the oral (C) group and 0.24 (I²
= 15%, 95% CI = 0.15, 0.33, P < .00001) in the postauricular
injection group vs the IV/C (IV combined with C) group,
showing that the steroid therapy effect may not be as good with
the oral administration method.
3.4.6. Time to onset. The studies were divided into 3 groups
based on the different times to onset: <7 days, 7 to 14 days, and
>14 days. The RD was 0.10 (I2 = 35%, 95% CI = 0.03, 0.17,
P = .007) using the <7 days criterion, 0.12 (I2 = 69%, 95% CI
= 0.01, 0.22, P = .03) in the 7 to 14 days group, and 0.16 (I2 =
65%, 95% CI = −0.04, 0.35, P = .11) for the > 14 days criterion
group (Figure), indicating that postauricular steroid injection
may be more effective when the disease is diagnosed and treated
in a timely manner (Fig. 4H).
3.4.7. Treatment timing. Comparing treatment timing showed
that the hearing recovery RD was 0.10 (I2 = 51%, 95% CI =
0.05, 0.15, P < .0001) in the first-line treatment group and 0.15
(I2 = 86%, 95% CI = −0.22, 0.51, P = .43) in the second-line
therapy group. This may demonstrate that the effectiveness of
14
the postauricular injection method may be improved with first-
line treatment (Fig. 4I).
3.5. Side effects
Sixteen of the 38 studies reported adverse reac-
tions[7,9,13,16,17,22,24–26,32,33,35,37–39,42] (Fig. 5A). The main adverse
effects reported in the systemic therapy group were fluctuations
in blood glucose (n = 50), gastrointestinal reactions (n = 29),
sleep disorders (n = 20) and fluctuations in blood pressure (n =
14). The postauricular injection group experienced typical side
effects of topical treatments, with fluctuations in blood glucose
(n = 9) and skin reactions (n = 8) being the most common. Other
adverse effects, such as sleep disorders, dizziness and ear pain,
were also reported. However, most of these side effects were
short-term and minor. In addition, some side effects, such as
mood change, dry mouth, and flushed face, were reported only
in the systemic group.
3.6. Sensitivity analyses
Sensitivity analyses of the RR were performed for the selected
studies to identify outliers that affected the overall results
(Fig. 5B). We also excluded studies with a high risk of bias, and
the results did not change substantially. Therefore, the results of
the meta-analysis are reliable.
3.7. Publication bias
The potential meta-analysis publication bias was evaluated with
funnel plots, as shown in Figure 5C, and the shape of the funnel
plots appeared to be approximately symmetric, which indicated
no obvious publication bias in our results. Egger test results
(PEgger’s = 0.004 > 0) (Fig. 5D) also indicated no significant pub-
lication bias among the articles included in the meta-analysis.
4. Discussion
Hearing loss can adversely impact patients’ quality of life, and
the etiologies and pathophysiological mechanisms have not
Deng et al. • Medicine (2023) 102:32www.md-journal.com

Figure 4. Forest plot. (A) Analysis comparing postauricular injection versus

systemic 27 therapy for the recovery rate in SSNHL patients. (B) Analysis
comparing postauricular injection versus systemic therapy for variation in the
PTA in SSNHL patients. (C–I) Subgroup analysis forest plot. PTA = pure-tone
audiometry, SSNHL = sudden sensorineural hearing loss.
been completely elucidated.[2] Steroids may represent a widely
used and first-line treatment in the clinic.[47–49] However, the
treatment efficacy may be largely affected by different admin-
istration methods.[49–51] The efficacy of postauricular steroid
injection was tested and confirmed by Yang in 2007,[47] who
reported that this may be an effective method for patients with
contraindications to steroids or persistent sensorineural deaf-
ness. Since then, an increasing number of clinicians have started
Figure 5. Adverse events and publication bias analysis. (A) Comparison of
adverse events between the postauricular injection and systemic therapy
groups. (B) Sensitivity analysis of included studies for the recovery rate. (C)
Funnel plot of the included studies for the recovery rate. (D) Egger test of the
included studies.
to use postauricular steroid injection as a treatment for SSNHL,
and the treatment was also included and recommended in the
guidelines for SSNHL in China.[7–44,52] Nevertheless, the efficacy
of postauricular injection is still controversial.

15
Deng et al. • Medicine (2023) 102:32Medicine
In this study, we first developed detailed search strategies
and strict inclusion criteria to obtain data for a comprehensive
meta-analysis, showing that postauricular injection could effec-
tively improve the hearing levels of SSNHL patients with greater
safety. However, the therapeutic effect varies in some ways. The
RR is widely used in clinical practice and trials as an outcome
assessment. To assess the RR, 38 studies were included, and the
pooled result showed that postauricular injection is more likely
to provide relief. We also conducted different subgroup analyses
based on studies of the RR of SSNHL for several factors.
First, a subgroup analysis by different age groups was per-
formed, with the results suggesting that postauricular injection
may be more effective than systemic therapy in all age groups.
However, compared with the RD in the young (0.12) and
middle-aged groups (0.08), the RD in the old-aged group was
increased to 0.18, which indicated that postauricular injection
may be more effective for elderly patients. However, the result
should be interpreted with caution due to the higher heteroge-
neity in the youth and middle-age groups. A second subgroup
analysis was conducted according to the different types of
drugs, and the results demonstrated that MP may increase the
therapeutic efficacy of postauricular injection; at the same time,
DEX is more suitable for use in systemic therapy. Third, in view
of most of the original studies that included some foundational
treatment, such as vasodilators and vasoactive therapy, we
defined subgroups according to whether any additional therapy
was included in the treatment strategy. The results illustrated
that foundational therapy may not be helpful with postauricu-
lar injection. However, this kind of additional treatment could
be combined with systemic steroid therapy to achieve higher
efficacy. Fourth, the initial PTA was analyzed based on differ-
ent levels, and the results indicated that the treatment efficacy
of postauricular injection was higher in the moderate-severe
and severe hearing loss groups. The baseline data should be
improved, including the initial PTA level and types of auditory
curves, and different types of SSNHL should be classified in
detail for personalized and precise therapy in the future. Fifth,
the control group was categorized by 3 different modes of
administration, including IV, oral and IV combined with oral
steroid therapy. The results demonstrated that the combination
of different methods of systemic therapy may lead to higher effi-
cacy. Sixth, in terms of different time durations before treat-
ment, we analyzed 3 subgroups, and the results indicated that
prompt treatment is necessary for postauricular injection effi-
cacy in SSNHL. Finally, treatment efficacy was analyzed based
on treatment timing, and the results showed that the therapeutic
efficacy of postauricular injection may be more suitable for first-
line therapy in SSNHL.
4.1. Conditions of relevant existing studies
Numerous systematic reviews and meta-analyses have been
conducted to compare the therapeutic efficacy of postauricular
injection and systemic therapy. The first study was conducted by
Wang[48] in 2018, who included a total of 1913 cases, and the
results showed evident differences in the total effectiveness rate
and cure rate between systemic and postauricular steroid injec-
tion treatments (RR = 1.12, 95% CI = 1.05–1.09, P = .0003; RR
= 1.25, 95% CI = 1.10–1.41, P = .0004); the study also observed
fewer complications associated with postauricular injection than
with systemic therapy. Since then, 3 related meta-analyses[49–51]
have been conducted successively, and the results were the same.
Liu concluded that the curative effect of the retroauricular injec-
tion group was better than that of the systemic hormone group,
with an RR (95% CI) of 1.29 (1.19, 1.40). Jiang reported that
the postauricular injection group had better outcomes than the
systemic therapy group in the treatment of sudden deafness (OR
= 3.18, 95% CI = 2.13–4.76, P < .00001). Finally, in the study
conducted by Mao, the results of the meta-analysis showed that
16
the total clinical efficacy of postauricular injection was better
than that of systemic treatment in the low-medium frequency
subgroup (P < .05).
4.2. Strengths and weaknesses of the study
First, to our knowledge, this is the first meta-analysis that
included RCTs in English and Chinese literature and analyzed
subgroup variables such as age, drug, foundational treatment,
initial PTA, mode of administration, time to onset and treat-
ment timing. Second, to ensure the reliability of the conclusions,
the literature search was comprehensive, encompassing 8 large
databases. Furthermore, the systematic review was performed
in accordance with the Preferred Reporting Items for Systematic
Review and Meta-analysis Protocols guidelines, including a
systematic evaluation of quality and treatment outcomes of all
studies published to date and ultimately including high-quality
RCTs related to this topic. Finally, sensitivity analyses in this
meta-analysis confirmed the validity of our conclusion, and
thus, the rationality and reliability of our meta-analysis results
was apparently improved. Given the emergence of new evidence
regarding postauricular steroid injection for SSNHL, we believe
that this route is more effective and safer than systemic therapy.
However, the following limitations of this study need to
be considered. First, the original studies included in this
meta-analysis exhibited a risk of bias. Most articles did not
explain their specific methods of randomization and conceal-
ment. Second, different factors, such as age, types of drug,
and baseline data, may have led to some heterogeneity in the
results. To address this, we defined subgroups, and the het-
erogeneity was reduced slightly. However, some other proba-
ble contributors, such as sex, affected ear, and diabetic status,
were not analyzed because of the small sample size and lack
of detailed classification in the original studies. Third, some
studies included nonsteroid therapy, such as vasoactive and
vasodilator drugs, as part of the treatment. These substances
may potentially affect the outcomes or be a source of hetero-
geneity. However, we conducted subgroup analyses according
to this factor, and the heterogeneity was reduced. Fourth, few
high-quality studies on postauricular injection treatment for
patients with diabetes or hypertension are available, making it
impossible to analyze these subgroup variables. When discuss-
ing treatment safety, it is essential to classify and include this
kind of patient. Fifth, all the included studies were published
in Chinese, and the participants were Chinese, which may con-
tribute to some risk of bias. Finally, in terms of the side effects,
only 42% of the included studies provided the relevant data,
and most of them did not describe the detailed condition or
prognosis of the side effect in the long term, especially among
patients with underlying diseases.
4.3. Future practice and research
From our study, we suggest that future studies should focus on
the following: Categorizing and grouping SSNHL participants
according to detailed baseline data. Administering treatment to
elderly individuals and observing and evaluating patients with
some underlying conditions, such as diabetes, cerebrospinal-car-
diovascular disease, hypertension and epilepsy, with long-term
follow-up to elucidate the safety profile and wide applicability
of the therapy. Using postauricular injection in a wide range of
applications in different countries. Using some new techniques,
including microneedle transdermal delivery and sustained-re-
lease materials that enable direct steroid delivery to the inner
ear for a longer duration of therapeutic drug application. These
combination of these techniques with postauricular injection
should be promising and helpful for achieving higher thera-
peutic efficacy and noninvasive effects. Addressing the adverse
reactions reported by some studies in recipients of postauricular
Deng et al. • Medicine (2023) 102:32www.md-journal.com
injections, including fluctuations in blood glucose, skin reac-
tions, sleep disorders, dizziness and ear pain. How to resolve or
reduce these adverse reactions is a topic worthy of study (e.g.,
whether co-injection with lidocaine would reduce ear pain with-
out diminishing efficacy).
5. Conclusion
In summary, this is the latest and largest sample meta-anal-
ysis comparing postauricular injection and systemic steroid
administration routes in SSNHL treatment, involving 3609
participants, and postauricular injection showed better effi-
cacy than systemic therapy, regardless of the age, drug used,
basic treatment, initial PTA, drug administration method,
time of onset, and course of treatment. Nonetheless, although
postauricular injection is a promising therapy for SSNHL, our
conclusions are based on a relatively small number of trials
and should thus be interpreted with caution. Further prospec-
tive, randomized and multicenter studies are needed to con-
firm these findings.
Acknowledgments
We acknowledge all the contributing authors.
Author contributions
Data curation: Y. W. Hou.
Formal analysis: J. N. Zhang.
Methodology: H. S. Deng.
Writing – review & editing: T. Yang.
References
[1] De Kleyn A. Sudden complete or partial loss of function of the
octavus system in apparently normal persons. Acta Otolaryngol.
1944;32:407Y–29.
[2] WHO. World report on hearing. April 1, 2021. Available at: https://
www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
(accessed April 1, 2021).
[3] Wilson WR, Byl FM, Laird N. The efficacy of steroids in the treatment
of idiopathic sudden hearing loss. A double-blind clinical study. Arch
Otolaryngol. 1980;106:772–6.
[4] Yang T, Wang B, Zhang W, et al. Research peogress on steroids adminis-
tration approaches in sudden hearing loss. Chin J Otol. 2021;19:670–3.
[5] Editorial Board of Chinese Journal of Otorhinolaryngology Head and
Neck Surgery: Society of Otorhino. Guideline of diagnosis and treat-
ment of sudden deafness. Chin J Otorhinolaryngol Head Neck Surg.
2015;50:443–7.
[6] HIGGINS JPT, GREEN S (editors). 2011. Cochrane Handbook for
Sys-tematic Reviews of Interventions Version 5.1.0. 2011. Available at:
www.co-chrane-handbook.org (assessed, 2011).
[7] Pan YB. Clinical observation on steroids administration approaches in
sudden hearing loss. World Latest Med Inf. 2019;19:225–6.
[8] Chen JX, Zhang QX, Li GF, et al. Clinical analysis the effects of postauric-
ular injection of methylprednisolone in idiopathic sudden sensorineural
hearing loss. Chin J Otorhinolaryngol Head Neck Surg. 2014;21:640–2.
[9] Wang MM, Fan ZM, Hou ZQ, et al. Topical injection and systemic
application of glucocorticoids in the treatment of idiopathic sudden
sensorineural hearing loss by type. Chin J Otorhinolaryngol Head
Neck Surg. 2014;21:640–2.
[10] Cao LL, Wang F, Meng Y, et al. The curative effect analysis between postau-
ricular injection and systemic application of glucocorticoids in the treat-
ment of sudden hearing loss. Chin J Prim Med Pharm. 2015;22:2338–40.
[11] Dong R. Analysis for the curative effect of sudden deafness with
different administration routes of glucocorticoid. Shanxi Med Univ.
2015.
[12] Qu YT, Chen HY, Zhang HP, et al. Analysis the treatment of sudden
sensorineural hearing loss with steroid from different administration
routes. J Chin Otorhinolaryngol Head Neck Surg. 2015;29:324–6.
[13] Qin HK, He ZY, Ling XQ, et al. Effects of postauricular injection and
systemic glucocorticoid treatment for sudden hearing loss. J Minim
Invasive Med. 2015;10:551–4.
17
[14] Wu SN, Li QM, Huang SH. Clinical effect on the treatment of the
low-middle frequency sudden hearing loss with postaurical injection
of methylprednisolone. J Chin Otorhinolaryngol Head Neck Surg.
2015;29:928–30.
[15] Cai L. The effect on treatment of postauricular injection of methylpred-
nisolone in sudden deafness with diabetesmellitus. People’s Mil Surg.
2016;59:597–9.
[16] Fang L, Xu JY. Clinical effect on the treatment of the low-middle fre-
quency sudden hearing loss with postaurical injection of methylpred-
nisolone. Chin J Rural Med Pharm. 2016;23:29–31.
[17] Jia HG, Yu Z, Huang XB. Efficacy of combined postauricular methyl-
prednisolone injection and systemic therapy for profound Idiopathic
sudden hearing loss. Chin Arch Otolaryngol Head Neck Surg.
2016;23:69–72.
[18] Li CL, Tang SX, Zhang LT, et al. Effects of administrating methylpred-
nisolone in three different ways in treating sudden hearing loss. Chin J
Clin Pharmacol Ther. 2016;21:1302–5.
[19] Lu X, Wang XX, Xiao CZ, et al. Clinical research on 35 cases of
sudden hearing loss treated with postauricular masteroid injec-
tion of methypredinisolone. Chin J Ethnomed Ethnopharmacy.
2016;25:88–9.
[20] Zhang Y. The analysis of the clinical efficiency of postauricular methy-
perdinisolone injection on patients with sudden hearing loss. Bengbu
Med Coll. 2016.
[21] Zhou CH, Gui MC, Xu D, et al. The effects of postauricular dexameth-
asone injection for sudden hearing loss. Chin J Otorhinolaryngol Integ
Med. 2016;24:99–100 + 98.
[22] Chen JW, Liu L. Effect of glucocorticoid injection and systemic admin-
istration in low frequency sudden deafness. J Clin Med. 2017;4:568–9.
[23] Wei TW, Cheng JY, Zhou JH, et al. Clinical effect and evaluation of the
injection of dexamethasone and mouse nerve growth factor subperios-
teum at cribriform area post aurem on sudden deafness. J Henan Med
Coll. 2017;29:428–30.
[24] Zhao DH, Zhang HP. Clinical research on different administration
of drug treatment in low frequency descent type of sudden deafness.
Guizhou Med J. 2017;41:176–7.
[25] Zhu BS. Postauricular injection of glucocorticoid therapy for the all-fre-
quency sudden sensorineural hearing loss. Zunyi Med Univ. 2017.
[26] Li QL. Clinical research on different administration of steroids in
sudden hearing loss. Prat Clin J Integr Traditional Chin West Med.
2018;18:117–8.
[27] Wang WY. The efficacy comparison among three different types
of administrations of drug in young sudden deafness. J Clin Res.
2018;35:1809–11.
[28] Zhan B, Liu YH, Gao K, et al. Clinical efficacy and safety of batroxobin
combined with post-auricular hormone injection for sudden deafness.
Mod Chin Doct. 2018;56:64–6.
[29] Zhang XL. Clinical research on 30 cases of sudden hearing loss treated
with postauricular masteroid injection of methypredinisolone. J Clin
Med. 2018;5:47.
[30] Zhang Z. Clinical analysis of three different methods of dexameth-
asone in the treatment of fully-deafness Sudden hearing loss. Yan’an
Univ. 2018.
[31] Chen P, Luo JS, Gao ZP, et al. Effects of retroauricular subperiosteal
injection of methylprednisolone and intravenous injection of dexa-
methasone on sudden deafness. Clin Res Pract. 2019;4:59–61.
[32] Huang MX, Chen FY. Statistical analysis of the relationship between
glucocorticoid administration and hearing improvement in sudden
deafness. J Prev Med Chin PLA. 2020;38:51–3.
[33] Luo QP, Wang QB. Clinical effect of intravenous injection of
Methylprednisolone at SJ 19 acupoint in treatment of sudden deafness.
China Mod Med. 2019;26:176–8.
[34] Zhang JJ, Liu HL, Liu JF, et al. Clinical efficacy and safety of different
methods of administration of glucocorticoids in the treatment of sudden
deafness. J Otolaryngol Ophthalmol Shandong Univ. 2019;33:52–5.
[35] Zhuang GB, Ni WP. Clinical effect of postauricular injection of meth-
ylprednisolone sodium succinate in sudden hearing loss. Gansu Med J.
2019;38:328–30.
[36] Jiang ZL. Effect analysis of postauricular injection of glucocorticoids
on low frequency descending sudden deafness. Chongqing Med Univ.
2020.
[37] Li LJ. Comparison of effects of glucocorticoid injection and intrave-
nous injection in the treatment of low frequency sudden deafness. Chin
J Clin Rational Drug Use. 2020;13:60–1.
[38] Li LJ, Yang YT, Luo JS, et al. Application of methylprednisolone sodium
succinate injection in treatment of low-frequency descending sudden
deafness. Shaanxi Med J. 2020;49:595–8.
Deng et al. • Medicine (2023) 102:32Medicine
[39] Li P. Efficacy of postauriclar subperiosteal injection of methylpredniso-
lone sodium succinate versus intravenous infusion of dexamethasone in
the treatment of sudden deafness. J Clin Med Pract. 2020;24:72–75 + 82.
[40] Qian HB. Comparison of systemic application and retroauricular hor-
mone injection in the treatment of low frequency descending sudden
deafness. Electron J Clin Med Lit. 2019;14:147.
[41] Lu XH, Long CQ, Tang C, et al. Effect of glucocorticoid administration
on blood glucose in patients with sudden deafness and diabetes mellitus
and its therapeutic effect. Chin Foreign Med Res. 2020;18:23–5.
[42] Yang J. Therapeutic effect of different administration routes glucocor-
ticoid on patients with low frequency idiopathic sudden deafness. Med
Equip. 2021;34:78–9.
[43] Zhang PX, Luo YX, He SW. Clinical effect of retroauricular injection of
Methylprednisolone on idiopathic sudden deafness. China Mod Med.
2021;28:113–5.
[44] Zhu MC, Zhou F, Zhang QH, et al. Efficacy of retroauricular injec-
tion of methylprednisolone for sudden deafness and persistent tinnitus
with metabolic syndrome. Chin J Otorhinolaryngol Skull Base Surg.
2021;27:420–3.
[45] WHO. Young people under 44 years of age. Health Rev. 2013;06:13.
[46] Wei BP, Stathopoulos D, O’Leary S. Steroids for idiopathic sud-
den sensorineural hearing loss. Cochrane Database Syst Rev.
2013;2013:CD003998.
[47] Chin CJ, Dorman K. Sudden sensorineural hearing loss. CMAJ.
2017;189:E437–8.
[48] Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice
guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg.
2019;161(1_suppl):S1–S45.
18
[49] El Sabbagh NG, Sewitch MJ, Bezdjian A, et al. Intratympanic dexa-
methasone in sudden sensorineural hearing loss: a systematic review
and meta-analysis. Laryngoscope. 2017;127:1897–908.
[50] limoglu Y, Inci E, Edizer DT, et al. Efficacy comparison of oral steroid,
intratympanic steroid, hyperbaric oxygen and oral steroid + hyperbaric
oxygen treatments in idiopathic sudden sensorineural hearing loss
cases. Eur Arch Otorhinolaryngol. 2011;268:1735–41.
[51] Yang XQ, Yu LS, Ma X. Postauricular injection of compound
betamethasone to treat the intractable low-frequency sensori-
neural hearing loss. Clin J Otorhinolaryngol Head Neck Surg.
2007;42:814–6.
[52] Editorial Board of Chinese Journal of Otorhinolaryngology Head
and Neck Surgery; Society of Otorhinolaryngology Head and Neck
Surgery CMA. Guideline of diagnosis and treatment of sudden
deafness (2015). Zhonghua er bi Yan Hou Tou Jing Wai ke Za Zhi.
2015;50:443–7.
[53] Wang HR, Wang HT, Hao L. Postauricular injection and systemic glu-
cocorticoid treatment for sudden hearing loss: a systematic review and
meta-analysis. Chin J Otol. 2018;16:669–75.
[54] Jiang HP. Meta-analysis of the efficacy of post-auricular injection of
methylprednisolone and systemic glucocorticoids in the treatment of
sudden deafness. Chongqing Med Univ. 2019.
[55] Liu W, Huang XZ. Meta-analysis of clinical efficacy of methylprednis-
olone sodium succinate for sudden deafness by retroauricular injection.
J Clin Res. 2019;36:1876–80.
[56] Mao XM, Liu SY, Xiao MC. Meta-analysis of clinical efficacy of meth-
ylprednisolone sodium succinate for sudden deafness by retroauricular
injection. J Clin Res. 2019;27:314–20.