Is Corticosteroid Treatment Beneficial in Sudden Sensorineural Hearing Loss? A Large Retrospective Study

Round 1

Reviewer 1 Report

This study overlooks the possibility of recovery based on the severity of SSNHL and the effectiveness of steroid treatment. Despite the potential differences in the outcomes of steroid treatment depending on the initial hearing at the time of SSNHL diagnosis between Group 1 and Group 2, a control group (Group 3 or 4) was established for comparison against steroid treatment. This is seen as a significant limitation of this study.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors of the article ask a fundamental question - is the use of corticosteroids really justified in SHL?

Doubt was raised by the data in the literature that in a significant number of cases, SHL improves or resolves without treatment (32-65%) [2,4-6].

It is not possible to plan and conduct such a study with a placebo, since the treatment is generally accepted and it is not ethical to deprive patients of the right to treatment. Therefore, the authors used retrospective data, stipulating that, unfortunately, they are not quite complete and accurate. The selection of groups is tied to the timing from the onset of the manifestation of signs of hearing loss. At the same time, two pairs were examined in parallel. There is only one principle - comparison of hearing in those who applied late and those who by this time had time to undergo treatment. The results are identical, there is no difference. But it has not been proven that these groups are comparable for correct comparisons. This equation is missing a very important link - it is not known what kind of hearing those who turned late had. There is no answer to the question - was it the same as in groups 1 and 2 before treatment? There is nothing to refute the assumption that those who heard worse turned early. Therefore, the version of the spontaneous restoration of thresholds is unproven. Maybe such thresholds existed when they appeared. Statement of the version that the treatment is not more effective than spontaneous recovery has no practical conclusion. Because in medicine, in relation to each patient, such logic will not work (the principle of “average temperature in the hospital” is not interesting in relation to a specific patient with fever). If a patient with SHL who applied early is not treated with the expectation of spontaneous recovery, and he does not enter into a favorable prognostic variant, then he can then can complain about the failure to provide proper medical care, Since he lost his chance, and no one can prove otherwise. If a warning is added to the conclusions of the article that the findings are insufficient to be accepted as a guide to action, then the article can be published. The material analyzed is large, the study is original, intermediate conclusions motivate further research. Even generally accepted standards need to be questioned and tested. But so far no better treatment option has been found.

The authors of the article ask a fundamental question - is the use of corticosteroids really justified in SHL?

Doubt was raised by the data in the literature that in a significant number of cases, SHL improves or resolves without treatment (32-65%) [2,4-6].

It is not possible to plan and conduct such a study with a placebo, since the treatment is generally accepted and it is not ethical to deprive patients of the right to treatment. Therefore, the authors used retrospective data, stipulating that, unfortunately, they are not quite complete and accurate. The selection of groups is tied to the timing from the onset of the manifestation of signs of hearing loss. At the same time, two pairs were examined in parallel. There is only one principle - comparison of hearing in those who applied late and those who by this time had time to undergo treatment. The results are identical, there is no difference. But it has not been proven that these groups are comparable for correct comparisons. This equation is missing a very important link - it is not known what kind of hearing those who turned late had. There is no answer to the question - was it the same as in groups 1 and 2 before treatment? There is nothing to refute the assumption that those who heard worse turned early. Therefore, the version of the spontaneous restoration of thresholds is unproven. Maybe such thresholds existed when they appeared. Statement of the version that the treatment is not more effective than spontaneous recovery has no practical conclusion. Because in medicine, in relation to each patient, such logic will not work (the principle of “average temperature in the hospital” is not interesting in relation to a specific patient with fever). If a patient with SHL who applied early is not treated with the expectation of spontaneous recovery, and he does not enter into a favorable prognostic variant, then he can then can complain about the failure to provide proper medical care, Since he lost his chance, and no one can prove otherwise. If a warning is added to the conclusions of the article that the findings are insufficient to be accepted as a guide to action, then the article can be published. The material analyzed is large, the study is original, intermediate conclusions motivate further research. Even generally accepted standards need to be questioned and tested. But so far no better treatment option has been found.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

In this manuscript from Chen et al., the authors report the results of a retrospective study that tested the efficacy of corticosteroid treatment for sudden sensorineural hearing loss. In the study, auditory functions were compared between post-treated early-start groups and pre-treatment late-start groups. No significant differences were observed in the audiometric tests in the group comparisons. The authors speculate that improvements in hearing thresholds could be due to a natural healing process and not a direct effect of corticosteroid treatment. Overall, the methodology and results are presented well.

Major:

Despite a large sample size, the study seems to have been underpowered. The large variance in the measurements seems to suggest so. Due to this concern, it is rather difficult to say whether the conclusion of the study is indeed valid.

Minor:

1) Table 1, which is referenced in the results, is not included in the manuscript.

2) In Figures 2 and 3, the error bars for 6 kHz are cut off.

3) In section 2.1, only three frequencies (0.5, 1, 2 kHz) are mentioned for PTA.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Authors added the requested information and corrections according the suggested comments 

non comments