Abstract
Idiopathic sudden sensorineural hearing loss (ISSNHL) is the rapid onset of reduced hearing due to loss of function of the inner ear or hearing nerve of unknown aetiology. Evidence supports improved hearing recovery with early steroid treatment, via oral, intravenous, intratympanic or a combination of routes. The STARFISH trial aims to identify the most clinically and cost-effective route of administration of steroids as first-line treatment for ISSNHL. STARFISH is a pragmatic, multicentre, assessor-blinded, three-arm intervention, superiority randomised controlled trial (1:1:1) with an internal pilot (ISRCTN10535105, IRAS 1004878). 525 participants with ISSNHL will be recruited from approximately 75 UK Ear, Nose and Throat units. STARFISH will recruit adults with sensorineural hearing loss averaging 30dBHL or greater across three contiguous frequencies (confirmed via pure tone audiogram), with onset over a ≤3-day period, within four weeks of randomisation. Participants will be randomised to 1) oral prednisolone 1mg/Kg/day up to 60mg/day for 7 days; 2) intratympanic dexamethasone: three intratympanic injections 3.3mg/ml or 3.8mg/ml spaced 7±2 days apart; or 3) combined oral and intratympanic steroids. The primary outcome will be absolute improvement in pure tone audiogram average at 12-weeks following randomisation (0.5, 1.0, 2.0 and 4.0kHz). Secondary outcomes at 6 and 12 weeks will include: Speech, Spatial and Qualities of hearing scale, high frequency pure tone average thresholds (4.0, 6.0 and 8.0kHz), Arthur Boothroyd speech test, Vestibular Rehabilitation Benefit Questionnaire, Tinnitus Functional Index, adverse events and optional weekly online speech and pure tone hearing tests. A health economic assessment will be performed, and presented in terms of incremental cost effectiveness ratios, and cost per quality-adjusted life-year. Primary analyses will be by intention-to-treat. Oral prednisolone will be the reference. For the primary outcome, the difference between group means and 97.5% confidence intervals at each time-point will be estimated via a repeated measures mixed-effects linear regression model.
| Original language | English |
|---|---|
| Article number | e0290480 |
| Journal | PLOS One |
| Volume | 19 |
| Issue number | 2 |
| Early online date | 29 Feb 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 29 Feb 2024 |
Bibliographical note
AcknowledgmentsThe online home hearing tests were developed in collaboration with the HearX Group, Pretoria, South Africa. We thank the following for their ongoing involvement in the STARFISH trial: Saima Rajasingam, John Hardman, Chloe Swords, Annika Feilbach, Neil Winkles, Serge Engamba and Mahmoud Keshavarzi.
We would like to thank our Data Monitoring Committee and Trial Steering Committee members and the principal investigators (PI) at our study sites. We are particularly grateful to our future study participants.
We would like to thank the NIHR HTA for funding the study. We are also most grateful for the support of the sponsor, University of Birmingham, and the University of Birmingham Clinical Trials Unit. We also acknowledge the support of the NIHR Cambridge Biomedical Research Centre.
The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health and Social Care.
