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\begin{document}

\title{Association Between Vertigo and Hearing Prognosis in Patients with
Sudden Sensorineural Hearing Loss: a Systematic Review and Meta-analysis}



\author[1]{Kai Chen}%
\author[1]{Xilei Luo}%
\author[2]{Li Zhou}%
\author[1]{Fangqiong Shao}%
\author[1]{Peizheng Xiong}%
\author[2]{Ningying Song}%
\affil[1]{Hospital of Chengdu University of Traditional Chinese Medicine}%
\affil[2]{West China Hospital of Sichuan University}%


\vspace{-1em}



  
  \date{June 16, 2024}


\begingroup
\let\center\flushleft
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\selectlanguage{english}
\begin{abstract}
\textbf{ABSTRACT} \emph{Objective.} Our aim was to explore the
relationship between vertigo symptoms and the prognosis of hearing
indicators in patients with sudden sensorineural hearing loss.
\emph{Data Source.} Eligible studies were identified from the
``PubMed'', ``EMBASE'', and ``Web of Science'' databases from January
2000 to September 2023. \emph{Study Selection.} Studies were selected
from all original and retrospective or prospective studies that focused
on the relationship between vertigo and hearing prognosis in patients
with sudden sensorineural hearing loss. \emph{Data Extraction and
Synthesis.} Observational metrics for data extraction included type of
study, number of subjects with or without vertigo, treatment regimen,
definition of pure tone hearing thresholds, criteria for hearing
improvement, treatment duration, follow-up time, and age distribution of
subjects. Meta-analysis was performed using Stata 15 software.
\emph{Main Outcome and Measure.} Association of vertigo symptoms and the
prognosis of hearing indicators in patients with sudden sensorineural
hearing loss. \emph{Results.}A total of 4290 patients with sudden
sensorineural hearing loss were identified in 23 studies. The hearing
recovery rate was 40.8\% in the group with vertigo and 53.76\% in the
group without vertigo. Vertigo was significantly associated with poorer
hearing recovery (OR = 2.13; 95\% CI, 1.63-2.79; I \textsuperscript{2} =
68.3\%). Subgroup analyses revealed similar results for medication
(OR=2.65; 95\% CI, 1.84-3.83; I \textsuperscript{2} = 50.8\%). However,
an attenuated association between vertigo and the prognosis of sudden
sensorineural hearing loss was observed in the subgroups treated with
drugs combined with hyperbaric chambers (OR= 1.76; 95\% CI, 0.75-4.15; I
\textsuperscript{2} = 84.9\%) and drugs combined with intratympanic
injections (OR= 1.62; 95\% CI, 1.02-2.58; I \textsuperscript{2} =
65.6\%). \emph{Conclusions and Relevance.} Our study suggested that
vertigo may be a negative factor in sudden sensorineural hearing
loss.Based on the results of the subgroup analysis,the combined
treatment regimen has better efficacy in patients with sudden
sensorineural hearing loss with vertigo.%
\end{abstract}%



\sloppy


\textbf{Association Between Vertigo and Hearing Prognosis in Patients
with Sudden Sensorineural Hearing Loss: a Systematic Review and
Meta-analysis}

\textbf{Key Points}

\selectlanguage{ngerman}· A total of 4290 patients with sudden sensorineural hearing loss from
23 studies were included in this meta-analysis.Vertigo may be a negative
factor in sudden sensorineural hearing loss. Vertigo was significantly
associated with poorer hearing recovery (OR = 2.13\selectlanguage{english})

* the combined treatment regimen has better efficacy in patients with
sudden sensorineural hearing loss with vertigo. The association was
attenuated in the subgroup treated with hyperbaric oxygen chamber
therapy\selectlanguage{english}(OR= 1.76\selectlanguage{english}) and intracameral steroid injections\selectlanguage{english}(OR= 1.62\selectlanguage{english}).

*More original literature is required to clearly evaluate the patient's
age, underlying disease, and initial level of hearing loss in order to
quantify the specificity of the sudden sensorineural hearing loss
population. Furthermore, it elucidates the impact of vertigo on the
prognosis of sudden sensorineural hearing loss.*

\textbf{ABSTRACT}

\emph{Objective.} Our aim was to explore the relationship between
vertigo symptoms and the prognosis of hearing indicators in patients
with sudden sensorineural hearing loss.

\emph{Data Source.} Eligible studies were identified from the
``PubMed'', ``EMBASE'', and ``Web of Science'' databases from January
2000 to September 2023.

\emph{Study Selection.} Studies were selected from all original and
retrospective or prospective studies that focused on the relationship
between vertigo and hearing prognosis in patients with sudden
sensorineural hearing loss.

\emph{Data Extraction and Synthesis.} Observational metrics for data
extraction included type of study, number of subjects with or without
vertigo, treatment regimen, definition of pure tone hearing thresholds,
criteria for hearing improvement, treatment duration, follow-up time,
and age distribution of subjects. Meta-analysis was performed using
Stata 15 software.

Main Outcome and Measure. Association of vertigo symptoms and the
prognosis of hearing indicators in patients with sudden sensorineural
hearing loss.

Results. A total of 4290 patients with sudden sensorineural hearing loss
were identified in 23 studies. The hearing recovery rate was 40.8\% in
the group with vertigo and 53.76\% in the group without vertigo. Vertigo
was significantly associated with poorer hearing recovery (OR = 2.13;
95\% CI, 1.63-2.79; I\textsuperscript{2} = 68.3\%). Subgroup analyses
revealed similar results for medication (OR=2.65; 95\% CI, 1.84-3.83;
I\textsuperscript{2} = 50.8\%). However, an attenuated association
between vertigo and the prognosis of sudden sensorineural hearing loss
was observed in the subgroups treated with drugs combined with
hyperbaric chambers (OR= 1.76; 95\% CI, 0.75-4.15; I\textsuperscript{2}
= 84.9\%) and drugs combined with intratympanic injections (OR= 1.62;
95\% CI, 1.02-2.58; I\textsuperscript{2} = 65.6\%).

Conclusions and Relevance. Our study suggested that vertigo may be a
negative factor in sudden sensorineural hearing loss.Based on the
results of the subgroup analysis,the combined treatment regimen has
better efficacy in patients with sudden sensorineural hearing loss with
vertigo.

Keywords. Sudden sensorineural hearing loss, ISSNHL, vertigo, steroid,
intratympanic injection, hyperbaric oxygen chamber, meta-analysis

\textbf{INTRODUCTION}

Sudden sensorineural hearing loss\selectlanguage{english}(SSHL\selectlanguage{english})referred to a 72-hour hearing
loss of 30 dB at least, in 3 consecutive frequencies within a period of
72 hours. The etiology of most cases is unknown, and 71\% of cases are
categorized as idiopathic\textsuperscript{{[}1{]}}. In addition, the
underlying pathologic mechanisms are not fully understood, and currently
proposed hypotheses include viral infections, microcirculatory
disorders, and autoimmune diseases\textsuperscript{{[}2{]}}. The
ambiguous etiology has led to a failure to develop uniform standards for
its treatment options. The heterogeneity of sudden sensorineural hearing
loss itself has led to discussions focused on treatment options and the
prognosis of this disease being fraught with contradictions.

One way to characterize vertigo is as a feeling of movement, usually
with rotation. It is considered a sign of vestibular
impairment\textsuperscript{{[}3{]}}. Among the discussions of SSHL,
vertigo is widely reported to be a negative predictor of hearing
recovery\textsuperscript{{[}4{]}}. One possible hypothesis is that
vertigo is due to disease of the vestibular portion of the inner ear.
SSHL with vertigo has a worse prognosis in patients in whom the inner
ear vestibule and cochlea are involved than in patients with only
cochlear involvement and sudden sensorineural hearing loss without
vertigo\textsuperscript{{[}5{]}}. However, at the same time, some
researchers hold the opposite opinion: they do not consider vertigo a
sign of poor prognosis for SSHL and believe that vertigo is not
significantly related to hearing recovery\textsuperscript{{[}6-8{]}}.

To verify whether vertigo is a poor prognostic sign of SSHL, in 2018, YU
et al. reported their meta-analysis of the literature related to SSHL.
The literature included 10 studies involving 4814 patients suffering
from SSHL. These authors found that vertigo was obviously connected with
poorer hearing recovery (OR=2.22; 95\% CI, 1.54-3.20;
I\textsuperscript{2} = 74\%) \textsuperscript{{[}9{]}}. This report
seems to argue what everyone expected before, but it does not represent
a definitive conclusion. With the passage of 5 years, research on SSHL
has improved, and interventions involving the Intratympanic injection of
steroid hormones (ICs) and hyperbaric oxygen chamber therapy (HBOT) for
treating SSHL have gained increasing amounts of attention. Therefore,
our research group conducted an update of the meta-analysis of Yu et al.
taking into account these new studies.

\textbf{METHODS}

This study was reported in accordance with the PRISMA
(2020)\textsuperscript{{[}10{]}} statement and was successfully
registered on the Systematic Evaluation Register (CRD42024496989).

\textbf{2.1 Data sources and search strategy}

We screened for researches in Web of Science, PubMed, EMBASE, and other
databases from January 1st, 2000 to September 1st, 2023 that involved
assessment of the prognostic relationship between vertigo and sudden
sensorineural hearing loss. The search terms used were ''sudden hearing
loss OR deafness, sudden OR sudden deafness OR hearing loss, sudden;
vertigo OR vertical OR spinning sensation OR sensation, spinning OR
sensations, spinning OR spinning sensations; and the third, both
strings.''

\textbf{2.2 Criteria for inclusion}

The criteria for the article to be included were: 1) retrospective,
original or prospective researches involving the effect of vertigo on
the hearing prognosis in people with SSHL; 2) researches reporting on
the outcome of PTA in patients and the number of patients who improved;
3) studies involving a clear treatment plan; and 4) studies involving a
patient population with or without vestibular symptoms. Studies that did
not include hearing recovery rates or vertigo and studies with pregnant
women were eliminated, as were practice guidelines, letters, reviews,
editorials, theories, reports, and cases.

\textbf{2.3 Data Extraction}

Data extraction and efficacy evaluation criteria: Researches and
statistics were extracted and assessed independently by two researchers
(LUO and CHEN). The two researchers extracted the following data from
each selected study: type of study, number of subjects with or without
vertigo, age distribution, male/female ratio, treatment regimen,
treatment period, definition of the average pure tone hearing threshold,
standards for hearing amelioration, PTA or improvement rate after
treatment, and follow-up time. The criteria for effective treatment were
adopted according to the Siegel criteria: impaired hearing improvement
\textgreater{}15 dB was considered an effective treatment, and impaired
hearing improvement \textless{}15 dB was considered an ineffective
treatment. We also compared the hearing recovery rate of patients
suffering from SSHL among those with vertigo and those with SSHL among
those free from vertigo and the rate of hearing recovery between each
subgroup.

\textbf{2.4 Quality Assessment and Sensitivity Analysis}

The Newcastle--Ottawa scale was applied to evaluate the quality of the
included studies and their risk of bias, and all of them had
Newcastle--Ottawa scores between 7 and 8, which ensured that they all
had high quality. We also performed sensitivity analyses to assess the
robustness of the findings and investigated the heterogeneity of the
included studies, assessing the impact of each study on the pooled
results and treating a study as a causation of high heterogeneity if it
was excluded because of its significantly lower I\textsuperscript{2}.

\textbf{2.5 Data analysis}

Stata 15.0 was applied to conduct meta-analysis, and the research
results are presented as forest plots with 95\% confidence intervals.
The combined correlation between the rate of hearing recovery and
incidence of vertigo was assessed by means of the Mantel--Haenszel
method as dichotomous data, combined with the estimation of the ratio of
the two groups of patients. The data from all the eligible studies in
this research were quantitatively combined. The studies' statistical
variability was analyzed by the P value (P \selectlanguage{english}[?] .05 implying obvious
heterogeneity) and the I2 statistic as a derived Cochran Q statistic
(\selectlanguage{english}[?]50\%, high level of heterogeneity; 25\% to \textless{}50\%, moderate
level of heterogeneity; and \textless{}25\% means slight level of
heterogeneity). When I2 \textless{} 50\% and/or P \selectlanguage{english}[?]0.05, a fixed-effects
model was applied; otherwise, a random-effects model was applied. The
funnel plots, which do not have sufficient power with fewer than 10
researches involved, were applied to visually evaluate the publication
bias and potential asymmetry.\textsuperscript{{[}9{]}}

\textbf{2.6 Subgroup analysis}

The article performed the following subgroup analyses using treatment
regimen as a variable: medication alone, medication combined with
hyperbaric chamber therapy, and medication combined with intradural
steroid injection. Changes in recovery rates and changes in ORs in
people with SSHL suffering or free from vertigo were compared across
treatment regimens. Unfortunately, we tried to quantify the
heterogeneity of the study population to determine the relationships
between hearing age, degree of hearing loss, hearing graph, treatment
regimen, and level of hearing benefit; however, we had to abandon these
subgroups because of the paucity of studies that could provide relevant
information.

\textbf{RESULTS}

\textbf{3.1 Literature search and screening results}

The literature search spanned from September 1, 2000, to September 1,
2023, and the literature search and screening were completed according
to the systematic article collection flowchart (Figure 1), with a total
of 1,072 retrieved studies, including 13 duplicate articles. By reading
the titles and reviews, 996 irrelevant articles were excluded. Of the 63
articles, two had unavailable full text, and 61 papers in total were
ultimately included. 38 of the 61 papers were excluded for a variety of
reasons: 22 studies did not specify the recovery of vertigo, and 12
researches failed to satisfy the criteria for inclusion because of
improvements and outcome indicators. One study included pregnant women,
and 3 studies had missing data. A total of 23 studies and 4290 patients
were selected for the
meta-analysis\textsuperscript{{[}3,4,6-8,11-28{]}}.

\textbf{3.2 Basic features of the included researches}

Table 1 shows the clinical features of the included researches. Of the
4290 participants, 1720 were categorized into the SSHL with vertigo
group, 2507 were categorized into the SSHL without vertigo group, and
the follow-up time to the beginningof deafness were between 1-11.4
months. In 23 studies, Siegel's criteria was applied to assess the
degree of hearing improvement, and hearing improvement \textgreater{}15
db was judged to be effective. Fourteen
studies\textsuperscript{{[}4,8,11-17,19{]}} and fourteen
studies\textsuperscript{{[}4,8,11-17,19,20,22,26,28{]}} used
steroid-based systemic medication; seven
studies\textsuperscript{{[}3,7,21,23-26{]}} used a combination of
medication and intratympanic steroid injections; four
studies\textsuperscript{{[}6,24,26,27{]}} used medication in combination
with HBOT; and two studies used intratympanic steroid injections alone.
Among them, Hideaki Suzuki\textsuperscript{{[}24{]}} divided the study
population into two groups: one receiving a combination of medication
with intradermal injection of steroid hormones and one receiving a
combination of medication with HBOT. Seiji
Hosokawa\textsuperscript{{[}26{]}} divided the study population into
three groups: those receiving medication alone, those receiving a
combination of medication with intradermal injection of steroid
hormones, and those receiving a combination of medication with HBOT.

The included researches' quality and risk of bias were assessed by the
Newcastle--Ottawa scale, and the total score of the 23
studies\textsuperscript{{[}3,4,6-8,11-28{]}} ranged from 7--8 (Table 2).

All the studies depicted the incidences of better hearing outcomes in a
dichotomous pattern (groups without and with vertigo). The meta-analysis
of the data was conducted (Figure. 2A), and it presented a high degree
of heterogeneity, with I\textsuperscript{2}=68.3\%. For the analysis, a
random effects model was applied, and the meta-analysis showed that the
hearing recovery rate for SSHL without vertigo was 53.76\%, and the
hearing recovery rate for SSHL with vertigo was 40.8\%. A pronounced
difference (P = 0.000), OR = 2.13 (95\% CI, 1.63-2.79;
I\textsuperscript{2} = 68.3\%) was found. In addition, the patients were
classified into three subgroups according to treatment regimens (Figure
2B). A total of 12 studies\textsuperscript{{[}4,8,11-17,22,26,28{]}}were
conducted, and 1552 patients were included in the subgroup receiving
medication alone. In this subgroup, there were 544 patients with vertigo
and 1008 patients free from vertigo. The rate of hearing recovery was
56.75\% for SSHL free from vertigo and 35.48\% for SSHL suffering from
vertigo (P = 0.018; OR = 2.65; 95\% CI, 1.84-3.83; I\textsuperscript{2}
= 50.8\%). A total of 4 studies\textsuperscript{{[}6,24,26,27{]}} with
847 people were contained in the subgroup analysis of patients with
medical treatment combined with hyperbaric chamber therapy. In this
subgroup, there were 375 patients with vertigo and 472 patients free
from vertigo. The rate of hearing recoverywas 65.25\% for SSHL with
vertigo and 62.13\% for SSHL with vertigo (P = 0.018; OR = 1.76; 95\%
CI, 0.75-4.15; I\textsuperscript{2} = 84.9\%). In a total of
seven\textsuperscript{{[}3,7,21,23-26{]}} studies, 1372 patients were
enrolled in the pharmacologic therapy combined with intracameral steroid
injection therapy subgroup, which included 663 patients with vertigo and
709 patients free from vertigo. The rate of hearing recoverywas 47.53\%
for SSHL without vertigo and 35.74\% for SSHL with vertigo; these two
groups were significantly different (P = 0.008), OR = 1.62 (95\% CI,
1.02-2.58; I\textsuperscript{2} = 65.6\%).

The existence of publication bias was evident in our data from 23
studies,and according to the omission regulation, sensitivity analyses
were further conducted to assess and correct for publication bias, with
the following results (Figure 3).

\textbf{DISCUSSION}

This paper included 23 research papers and 4290 patients, including 1720
patients with SSHL with vertigo and 2507 patients with SSHL free from
vertigo. The rate of hearing recovery was 53.76\% in the group with SSHl
without vertigo and 40.8\% in the group with SSHL with vertigo.
According to the statistical analysis, vertigo was obviously connected
with worse hearing recovery (OR = 2.13; 95\% CI, 1.63-2.79;
I\textsuperscript{2} = 68.3\%). These findings were consistent with
those of Yu\textsuperscript{{[}9{]}} et al.

In the subgroup with medication alone, the rate of hearing recovery was
56.75\% in the SSHL without vertigo group and 35.48\% in the SSHL with
vertigo group. An obvious difference (P = 0.018), OR = 2.65 (95\% CI,
1.84-3.83; I\textsuperscript{2} = 50.8\%) was found. In the subgroup
treated with medication combined with hyperbaric chamber therapy, the
rate of hearing recovery was 65.25\% in the group with SSHL without
vertigo and 62.13\% in the group with SSHLwith vertigo; these values
were significantly different (P = 0.018), OR = 1.76 (95\% CI, 0.75-4.15;
I\textsuperscript{2} = 84.9\%). In the subgroup treated with medication
combined with intracameral steroid injection, the rate of hearing
recoverywas 47.53\% in the group with SSHL without vertigo and 35.74\%
in the group with SSHL with vertigo; these values were significantly
different (P = 0.008, OR = 1.62; 95\% CI, 1.02-2.58;
I\textsuperscript{2} = 65.6\%). In both subgroups of patients treated
with combination therapy, we found a significant reduction in the
prognostic association between vertigo and sudden sensorineural hearing
loss, which may suggest improved efficacy of combination therapy. In the
subgroup treated with pharmacological treatment combined with
intracameral steroid injection, the rate of hearing recovery was
significantly lower in people suffering from SSHL than in patients in
the other subgroups. We reviewed the seven papers included in this
subgroup and found that, in these seven papers, the level of initial
hearing loss in the target population was predominantly severe to
profound degree of hearing loss and that the degree of initial hearing
impairment in the population was greater than that in the other
subgroups, which might explain the lower rate of improvement in this
subgroup than in the other subgroups.

Sudden sensorineural hearing loss has always been a controversial
medical phenomenon and has subsequently become a research hotspot
attracting numerous people. Moreover, there is extensive heterogeneity
in terms of initial hearing loss, accompanying symptoms, and hearing
recovery in patients in clinical practice, which further exacerbates the
difficulty of related research. Clinicians have observed that patients
with severe hearing loss often have vertigo, which has been empirically
recognized as a negative factor in hearing recovery. Many researchers
have studied this issue. Anestis D.\textsuperscript{{[}12{]}} reviewed
the hearing changes and long-term prognosis of 80 patients over a
15-year period in a retrospective analysis. The study showed that
treatment was ineffective in 80.6\% of people suffering from SSHL
accompanied by vertigo; however, the ineffectiveness was only 56.1\% in
people suffering from SSHL not accompanied by vertigo. Y-J TSA et
al.\textsuperscript{{[}29{]}} concluded vertigo was a negative
prognostic indicator for SSHL in a follow-up research of 128 people
suffering from SSHL for an average of up to 11.4 months. Ryosuke
Kitoh\textsuperscript{{[}30{]}} et al. conducted a multicenter,
large-sample epidemiological survey that investigated the clinical
features of 3,419 people suffering from SSHL and statistically analyzed
the correlation between the degree of severity of hearing loss and
patient prognosis. Vertigo symptoms were found to be significantly
associated with poor prognosis. Similarly, Jae Ho Chung et
al.\textsuperscript{{[}4{]}} concluded that vertigo is a negative
predictor of hearing recovery in people suffering from SSHL and that the
labyrinth damage degree may be correlated with the severity of cochlear
impairment, with the likelihood of hearing recovery decreasing with
increasing labyrinth involvement. However, several scholars have shown
the opposite results. S HOSOKAWA et al.\textsuperscript{{[}6{]}} studied
334 patients suffering from SSHL and reported that the rate of hearing
improvement was 62.4\% in people suffering from vertigo and 72.8\% in
people free from vertigo; moreover, no statistically obvious difference
in the difference between the two recovery rates (p=0.062) was found.
Suphi Bul\selectlanguage{polish}ğ\selectlanguage{english}urcu et al.\textsuperscript{{[}31{]}} studied 154 patients
with a mean follow-up of up to 7.4 months and found that patients with
vertigo had a lower but not statistically significant treatment success
rate. According to multivariate analysis, Adriana Perez Ferreira
Neto\textsuperscript{{[}28{]}} et al. reported that the level of
statistical significance between vertigo and a poor prognosis for
hearing restoration was marginal (p=0.088). These studies suggest that
whether vertigo serves as a poor prognostic element for SSHL remains
controversial.

Yu et al. (2018) published a meta-analysis discussing whether vertigo is
a poor prognostic element for SSHL. This meta-analysis included 10
articles with 4814 patients. They found that vertigo was obviously
connected with poorer hearing improvement (OR = 2.22; 95\% CI,
1.54-3.20; I\textsuperscript{2} = 74\%) \textsuperscript{{[}9{]}}. With
the continuous updating of relevant researches, the meta-analysis was
conducted again, updating the previous articles and screening the
included literature to improve the stability of the conclusions. In the
end, we obtained the same conclusion as Yu et al.: vertigo is a negative
prognostic factor for SSHL.

\textbf{Limitations of the article}

At the beginning of this study, we attempted to analyze patient
subgroups for the presence of tinnitus, degree of hearing loss,
frequency band of hearing loss, frequency band of hearing loss, and
level of hearing benefit. We attempted to use subgroup analysis to
quantify the specificity of the SSHL population and in order to clarify
the appropriateness of the treatment regimen for a specific population.
However, we had to abandon these subgroups because of the paucity of
literature that could extract the relevant metrics.

Moreover, there is no standardization of treatment protocols among
studies on sudden sensorineural hearing loss. The means of intervention,
drug dosage, hormone type, duration of intervention, and severity of
hearing loss varied significantly among researchers, all of which may
have skewed the final results. This is a problem that cannot be avoided
in this study. Therefore, additional clinical studies are needed to
support subsequent researchers and obtain new conclusions.

\textbf{CONCLUSION}

Vertigo may be a negative factor in the hearing prognosis of people
suffering from SSHL. Moreover, the correlation between poor prognosis
and vertigo according to the SSHL became significantly reduced in both
subgroups after the combined treatment. The combination of hyperbaric
oxygen chamber therapy, intradermal injection of steroid hormone therapy
and medication had a significant effect on hearing prognosis in patients
with SSHL with vertigo.

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372 (2021).

11. Weiss, Daniel, et al. ''Predictors of hearing recovery in patients
with severe sudden sensorineural hearing loss.'' Journal of
Otolaryngology-Head \& Neck Surgery 46.1 (2017): 1-10.

12. Psifidis, Anestis D., George K. Psillas, and Jiannis Ch Daniilidis.
''Sudden sensorineural hearing loss: long-term follow-up results.''
Otolaryngology---Head and Neck Surgery 134.5 (2006): 809-815.

13.Tiong, T. S. ''Prognostic indicators of management of sudden
sensorineural.'' Singapore Med J 48.1 (2007): 45-49.

14. Li, Yan-Hong, et al. ''Vestibular function of pediatric patients
with sudden sensorineural hearing loss: based on vertigo symptom and
vestibular function testing.'' World Journal of Pediatrics 17 (2021):
637-642.

15. Vofo, Gaelle, et al. ''The impact of vestibular symptoms and
electronystagmography results on recovery from sudden sensorineural
hearing loss.'' Journal of Basic and Clinical Physiology and
Pharmacology 0 (2021): 000010151520200354.

16. Zheng, Zhong, et al. ''Serum albumin levels as a potential marker
for the predictive and prognostic factor in sudden sensorineural hearing
loss: a prospective cohort study.'' Frontiers in Neurology 12 (2021):
747561.

17. Kizkapan, Dondu Betul, et al. ''Vestibular functions in patients
with idiopathic sudden sensorineural hearing loss and its relation to
prognosis.'' Auris Nasus Larynx 49.3 (2022): 374-382.

18. Lv, Lingyun, et al. ''Comparison between postauricular steroid
injection and intratympanic steroid perfusion for refractory severe and
profound sudden sensorineural hearing loss.'' American Journal of
Otolaryngology 43.1 (2022): 103189.

19.Jiang, Zhuang, et al. ''Contribution of audiogram classification in
evaluating vestibular dysfunction in sudden sensorineural hearing loss
with vertigo.'' Frontiers in Neurology 12 (2021): 667804.

20.Shimanuki, Marie N., et al. ''Early hearing improvement predicts the
prognosis of idiopathic sudden sensorineural hearing loss.'' European
Archives of Oto-Rhino-Laryngology 278 (2021): 4251-4258.

21. Kordi\selectlanguage{polish}š, Š\selectlanguage{english}pela, et al. ''The Outcome of Prompt Concomitant
Single-Dose High-Concentration Intratympanic and Tapered Low-Dose Oral
Systemic Corticosteroid Treatment for Sudden Deafness.'' The Journal of
International Advanced Otology 16.2 (2020): 201.

22. Lim, Kang Hyeon, et al. ''Comparisons among vestibular examinations
and symptoms of vertigo in sudden sensorineural hearing loss patients.''
American Journal of Otolaryngology 41.4 (2020): 102503.

23. Jin Woong Choi, et al. ''Potential benefits of salvage intratympanic
dexamethasone injection in profound idiopathic sudden sensorineural
hearing loss.'' European Archives of Oto-Rhino-Laryngology 277 (2020):
2219-2227.

24. Suzuki, Hideaki, et al. ''Efficacy of intratympanic steroid on
idiopathic sudden sensorineural hearing loss: An analysis of cases with
negative prognostic factors.'' American journal of audiology 28.2
(2019): 308-314.

25. Rajati, Mohsen, et al. ''Intratympanic Steroid for the Management of
Sudden Hearing Loss: Introduction of a Tapering Method.'' Iranian
Journal of Otorhinolaryngology 34.120 (2022): 9.

26. Hosokawa, Seiji, et al. ''Hyperbaric oxygen therapy as concurrent
treatment with systemic steroids for idiopathic sudden sensorineural
hearing loss: a comparison of three different steroid treatments.''
Audiology and Neurotology 23.3 (2018): 145-151.

27. Shaobing Xie, et al. ''Multivariate analysis of prognostic factors
for idiopathic sudden sensorineural hearing loss treated with adjuvant
hyperbaric oxygen therapy.'' European Archives of Oto-Rhino-Laryngology
275.1 (2018): 47-51.

28.Perez Ferreira Neto, Adriana, et al. ''Clinical profile of patients
with unilateral sudden sensorineural hearing loss: Correlation with
hearing prognosis.'' Otolaryngology--Head and Neck Surgery 165.4 (2021):
563-570.

29. Tsai, Y. J., et al. ''Intratympanic injection with dexamethasone for
sudden sensorineural hearing loss.'' The Journal of Laryngology \&
Otology 125.2 (2011): 133-137.

30. Kitoh, Ryosuke, et al. ''Nationwide epidemiological survey of
idiopathic sudden sensorineural hearing loss in Japan.'' Acta
oto-laryngologica 137.sup565 (2017): S8-S16.

31. Bul\selectlanguage{polish}ğ\selectlanguage{english}urcu, Suphi, et al. ''The effects of prognostic factors in
idiopathic sudden hearing loss.'' International archives of
otorhinolaryngology 22.01 (2018): 033-037.

Table 1. Characteristics of Selected Studies in the Meta-analysis.\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Number of patients recovering from treatment/headcount}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Number of patients recovering from treatment/headcount}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Source}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Research Type}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{With} \textbf{Vertigo}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Without} \textbf{Vertigo}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Definition of PTA, kHz}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Follow-up Period}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
JaeHo Chung\textsuperscript{{[}4{]}}, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS, dextran\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
23/72\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
129/241\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5, 1, 2\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
no data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Daniel Weiss\textsuperscript{{[}11{]}}, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS po:pentoxifyllin\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
16/59\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
51/128\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.125,0.5,1,2,3,4,6,8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
no data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
S HOSOKAWA\textsuperscript{{[}6{]}}, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS and HBOT\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
158/217\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
73/117\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yu-Hsuan Wen\textsuperscript{{[}7{]},} 201\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Iv: CS and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
94/300\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
78/276\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5, 1, 2,4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Anestis D.Psifdis\textsuperscript{{[}12{]}}, 2006\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Iv: CS and piracetam\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7/36\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18/41\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5, 1, 2,4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
No data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Jacob Ben-David\textsuperscript{{[}8{]}}, 2002\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Po: CS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5/17\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
29/50\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5, 1, 2,8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
no data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Tiong TS\textsuperscript{{[}13{]}}, 2007\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Iv: CS po: Naftidrofuryl\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3/10\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
38/43\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5,1,2,3,4,6,8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3-12m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yixu Wang\textsuperscript{{[}3{]}}, 2021\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: batroxobin and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
59/112\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
84/121\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
No data\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yan-Hong Li\textsuperscript{{[}14{]}}, 2021\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Iv: CS Po: CS and GBE\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6/18\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9/11\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5, 1, 2, 4,8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Gaelle Vofo\textsuperscript{{[}15{]}}, 2021\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Observational\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
po: CS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7/17\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13/18\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}6\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Zhong Zheng\textsuperscript{{[}16{]}}, 2021\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Iv: CS and batroxobin\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
17/38\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
34/97\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}6\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Dondu Bentul Kizkapan\textsuperscript{{[}17{]}}, 2022\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Po: CS, betahistin and LAN\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7/17\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
20/29\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}6\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Lingyun Lv\textsuperscript{{[}18{]}}, 2022\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
IC or PSI\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
25/84\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
36/89\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}6\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Zhuang Jiang\textsuperscript{{[}19{]}}, 2021\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS, vasodilators, neurotrophic drugs\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10/29\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
11/21\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}6\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Marie N Shimanuki Park\textsuperscript{{[}20{]}},2021\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Iv: CS, dextran, ATP, B12\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13/88\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
84/208\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\selectlanguage{polish}Š\selectlanguage{english}pela Kordi\selectlanguage{polish}š\selectlanguage{english}\textsuperscript{{[}21{]}}, 2020\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Prospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv:CS po:PPI and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14/24\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
31/39\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Kang Hyeon Lim\textsuperscript{{[}22{]}}, 2020\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS po: CS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
65/96\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
145/167\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}3\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Jin Woong Choi\textsuperscript{{[}23{]}}, 202\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
iv: CS po:CS and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8/55\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13/48\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
2m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Hideaki Suzuki\textsuperscript{{[}24{]}}, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
GroupA: iv: CS and HBOT groupB: iv: CS and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
52/79\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
169/223\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
No data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Mohsen Rajati\textsuperscript{{[}25{]}}, 2022\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
po: CS, ASA,acyclovir and IC\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
26/122\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
48/112\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25,0.5, 1, 2, 4,8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Seiji Hosokawa, 2018\textsuperscript{{[}26{]}}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
GroupA: iv: CS and HBOT groupB: iv: CS and IC groupC: iv: CS\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
61/149\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
133/207\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.25\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
No data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Shaobing Xie, 2018 \textsuperscript{{[}27{]}}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HBOT and steroids\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
11/56\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
55/122\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}3\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
No data\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Adriana Perez Ferreira Neto, 2021\textsuperscript{{[}28{]}}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Retrospective\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Po: steriod\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
24/88\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
47/98\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Average at 0.5\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}1\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}2\begin{CJK}{UTF8}{gbsn}、\end{CJK}\selectlanguage{english}3\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
6m\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Abbreviation Description: iv, intravenous injection; po,
peroral;CS,corticosteriods; IC, Intratympanic injection of steroid
hormones; HBOT, hyperbaric oxygen therapy; GBE, Ginkgo Biloba Extract;
LAN, lansoprazole; ATP, Adenosine triphosphate; B12, vitamin B12; PSI,
Intratympanic injection behind the ear; ASA, aspirin.\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2. Assessment of Study Quality\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Source} & \textbf{Selection} & \textbf{Comparability} &
\textbf{Outcome} & \textbf{NOS Score}\tabularnewline
JaeHo Chung\textsuperscript{{[}4{]}},2015 & 3 & 2 & 3 & 8\tabularnewline
Daniel Weiss,2017 & 3 & 2 & 2 & 7\tabularnewline
S HOSOKAWA\textsuperscript{{[}6{]}},2017 & 3 & 2 & 2 & 7\tabularnewline
Yu-Hsuan Wen\textsuperscript{{[}7{]}},2013 & 3 & 2 & 3 &
8\tabularnewline
Anestis D.Psifidis\textsuperscript{{[}12{]}},2006 & 3 & 2 & 2 &
7\tabularnewline
Jacob Ben-David\textsuperscript{{[}8{]}},2002 & 3 & 2 & 2 &
7\tabularnewline
Tiong TS\textsuperscript{{[}13{]}},2007 & 3 & 2 & 3 & 8\tabularnewline
Yixu Wang\textsuperscript{{[}3{]}},2021 & 3 & 2 & 2 & 7\tabularnewline
Yan-Hong Li\textsuperscript{{[}14{]}},2021 & 3 & 2 & 2 &
7\tabularnewline
Gaelle Vofo\textsuperscript{{[}15{]}},2021 & 3 & 2 & 3 &
8\tabularnewline
Zhong Zheng\textsuperscript{{[}16{]}},2021 & 3 & 2 & 3 &
8\tabularnewline
Dondu Betul Kizkapan\textsuperscript{{[}17{]}},2022 & 2 & 2 & 3 &
7\tabularnewline
Lingyun Lv\textsuperscript{{[}18{]}},2022 & 3 & 2 & 3 & 8\tabularnewline
Zhuang Jiang\textsuperscript{{[}19{]}},2021 & 4 & 2 & 2 &
8\tabularnewline
Marie N Shimanuki Park\textsuperscript{{[}20{]}},2021 & 3 & 2 & 3 &
8\tabularnewline
\selectlanguage{polish}Š\selectlanguage{english}pela Kordi\selectlanguage{polish}š\selectlanguage{english}\textsuperscript{{[}21{]}},2020 & 3 & 2 & 2 &
7\tabularnewline
Kang Hyeon Lim\textsuperscript{{[}22{]}},2020 & 3 & 2 & 3 &
8\tabularnewline
Jin Woong Choi\textsuperscript{{[}23{]}},2020 & 3 & 2 & 2 &
7\tabularnewline
Hideaki Suzuki\textsuperscript{{[}24{]}},2019 & 4 & 2 & 2 &
8\tabularnewline
Mohsen Rajati\textsuperscript{{[}25{]}},2022 & 3 & 2 & 3 &
8\tabularnewline
Seiji Hosokawa\textsuperscript{{[}26{]}},2018 & 4 & 2 & 2 &
8\tabularnewline
Shaobing Xie\textsuperscript{{[}27{]}},2018 & 3 & 2 & 2 &
7\tabularnewline
Adriana Perez Ferreira Neto\textsuperscript{{[}28{]}},2021 & 3 & 2 & 2 &
7\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-1/figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-2A/figure-2A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-2B/figure-2B}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/figure-3/figure-3}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

