A Cochrane review [Abstract] 1 included 4 studies with a total of 257 subjects with idiopathic sudden sensorineural hearing loss (ISSHL). Two trials (n=113) compared the addition of iv. acyclovir to prednisolone. Neither demonstrated any hearing improvement with ISSHL. Another trial (n=84) did not show any significant difference between groups with the addition of valacyclovir to prednisolone (compared to steroid plus placebo) with respect to change in pure-tone audiogram. Comparing the addition of iv. acyclovir to hydrocortisone with hydrocortisone alone, the fourth trial (n=60) did not show any statistically significant difference between groups. No trial documented any serious adverse effects related to the use of antiviral treatment. Even though no meta-analysis was possible, evidence from 4 RCTs has demonstrated no significant advantage in the use of antivirals in the treatment of ISSHL.
Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes) and imprecise results (small sample size in each trial).
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