ABSTRACT
OBJECTIVES/HYPOTHESIS: To determine the evidence for different etiologies of sudden sensorineural hearing loss (SSNHL) identified by clinical diagnostic tests in the adult population. STUDY DESIGN: Systematic literature review. METHODS: Review of MEDLINE (1950-October 2009), EMBASE (1980-October 2009), and EBM Review databases in addition to manual reference search of identified papers. Randomized controlled trials, prospective cohort studies, and retrospective reviews of consecutive patients in which a clear definition of SSNHL was stated and data from consecutive patients were reported with respect to etiology of hearing loss. Three researchers independently extracted data regarding patient demographic information, diagnostic tests employed, and the identified presumed etiologies. Discrepancies were resolved by mutual consensus. RESULTS: : Twenty-three articles met the inclusion criteria. The first group of papers searched for different etiologies among patients with SSNHL. Multiple etiologies were identified, including viral infection, vascular impairment, autoimmune disease, inner ear pathology, and central nervous system anomalies. The diagnosis for the majority of patients remained idiopathic. The second group of papers evaluated SSNHL patients with specific diagnostic tests such as autoimmune markers, hemostatic parameters, and diagnostic imaging. CONCLUSIONS: The suspected etiologies for patients suffering sudden sensorineural hearing loss included idiopathic (71.0%), infectious disease (12.8%), otologic disease (4.7%), trauma (4.2%), vascular or hematologic (2.8%), neoplastic (2.3%), and other causes (2.2%). Establishment of a direct causal link between SSNHL and these etiologies remains elusive. Diagnostic imaging is a useful method for identification of temporal bone or intracranial pathology that can present with SSNHL as a primary symptom.
Subject(s)
Evidence-Based Medicine , Hearing Loss, Sudden/etiology , Adult , Humans , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: To conduct a comprehensive systematic review and high-quality meta-analysis to determine whether prophylactic drain placement reduces adverse bleeding events in thyroid surgery. DATA SOURCES: MEDLINE (OVID and PubMed), CENTRAL, CDSR, ACP Journal Club, DARE, EMBASE, PREMEDLINE, OLDMEDLINE, CINAHL, BIOSIS Previews, LILACS, KOREAMED, SAMED, IndMED, SIGLE, ScienceDirect, and INGENTACONNECT. REVIEW METHODS: Studies for evaluation included all prospective trials assessing the use of drainage in thyroid surgery. We excluded case studies, retrospective studies, reviews, and studies that had a "selective" method of postoperative drainage that was not defined or was based on surgeon preference. Search strategies were broad and based on Cochrane Collaboration search filters. There was no language restriction. Article selection was conducted by two independent reviewers under QUORUM guidelines. RESULTS: Four hundred sixty-two articles were identified by the search strategy used, and 16 articles were included in the final review. Ten studies were randomized controlled trials, with 8 used for quantitative meta-analysis. No study showed a statistically significant benefit or harm with drain use. Meta-analysis of data estimated an odds ratio of 1.47 for reoperation for bleeding and 0.88 for visible hematoma for suction drains versus no drains. The results were not statistically significant, and 95% confidence intervals were wide. CONCLUSION: The literature has insufficient evidence to recommend routine drainage in thyroid surgery. It is possible that drains may increase the risk of reoperation for bleeding, although the data are not statistically significant. If there is a benefit to drainage, absolute risk reductions of bleeding outcomes may not warrant routine use.
