Search

OBJECTIVE:To determine the protective effect of sodium fluoride on the deterioration of hearing loss in adult patients with otosclerosis.DATA SOURCES:PubMed, Embase, the Cochrane Library, and CINAHL.STUDY SELECTION:A systematic literature search was conducted. Studies reporting original study data on the deterioration of hearing loss in otosclerosis patients treated with sodium fluoride were included.DATA EXTRACTION:Directness of evidence (DoE) and risk of bias (RoB), using the Cochrane Collaboration's tool for assessing risk of bias, of the selected articles were assessed. Studies with low DoE, high RoB, or both were excluded. Absolute risks, mean deterioration of hearing in decibels, risk differences, and their 95% confidence intervals were extracted from the included studies.DATA SYNTHESIS:Our search yielded 168 original titles, of which, 2 placebo-controlled studies were eligible for data extraction. The results of these 2 studies were conflicting. One of the included studies, with high DoE and moderate RoB, reported an absolute risk reduction for deterioration of hearing loss of 18% [95% CI 17; 19] when treating with sodium fluoride. The other included study, with high DoE and moderate RoB, reported no clinically significant difference in mean deterioration of bone-conduction, air-conduction, or air-bone gap between the sodium fluoride group and the placebo group.CONCLUSION:There is weak evidence from one study with significant limitations that deterioration of hearing loss in otosclerosis patients receiving sodium fluoride treatment is less than in patients treated with a placebo.

To evaluate whether the Carhart notch on pure-tone audiometry is reliable as a diagnostic test for predicting otosclerosis in patients with conductive hearing loss. Data Sources PubMed, Embase, the Cochrane Library, CINAHL, and Scopus.A systematic search was conducted. Studies reporting original study data were included. After assessment of directness of evidence and risk of bias of the selected articles, the prevalences and the positive and negative predictive values were extracted.A total of 1402 unique studies was retrieved. Three of these satisfied the eligibility criteria. One study provided direct evidence, while all studies carried moderate to high risk of bias. One study with moderate directness of evidence and high risk of bias was not further analyzed. In a study with a high directness of evidence, a high risk of bias, and a low prevalence of otosclerosis (8%) in patients with conductive hearing loss, the presence of a Carhart notch at 2000 Hz increased the risk of otosclerosis with 33%. In a second study with moderate directness of evidence, moderate risk of bias, and a high prevalence of otosclerosis (72%) in patients with a surgically confirmed congenital ossicular anomaly or otosclerosis, the presence of a Carhart notch at 2000 Hz increased the risk of otosclerosis with 2%.Although there is insufficient high-quality evidence regarding the diagnostic value of the Carhart notch, it seems it is a useful hint for the presence of otosclerosis, but it cannot be used to confirm a diagnosis of otosclerosis.