Sudden sensorineural hearing loss (SSNHL) is an acute, usually unilateral deficit. Systemic and intratympanic steroids are accepted treatments. Although evidence suggests that hyperbaric oxygen therapy (HBOT) may be beneficial, it is not widely offered.OBJECTIVES To review and evaluate recent evidence of the association of HBOT with hearing outcomes in SSNHL and to determine if HBOT should be a single or part of a combination treatment regimen. DATA SOURCES Cochrane Central Register of Controlled Trials, PubMed, EMBASE, CINAHL, Web of Science, CAB, ICTRP, Google Scholar, Clinicaltrials.gov, and ISRCTN databases were searched for randomized controlled trials (RCTs) published in English from January 1, 2000, and April 30, 2020.STUDY SELECTION Prospective RCTs involving only adult participants (Ն18 years) with SSNHL and comparing HBOT, as a single or combination therapy, with control therapies, such as steroids and/or placebo. Only RCTs that used the American Academy of Otolaryngology-Head and Neck Surgery's diagnostic criteria for SSNHL were included.DATA EXTRACTION AND SYNTHESIS Data were extracted independently by 2 researchers. A fixed-effects model was used for analysis and performed from November 30, 2020, to May 20, 2021. MAIN OUTCOMES AND MEASURESThe mean difference in absolute hearing gain recorded by pure-tone audiometric (PTA) thresholds averaged across 4 low (0.5, 1, 2, and 3 or 4 kHz) or 3 high (3 or 4, 6, and 8 kHz) frequencies was the primary outcome. The secondary outcomes were the odds ratio of hearing recovery defined as a hearing gain of Ն10 decibels (dB) in PTA average and treatment-related adverse effects. RESULTSOf the 826 records initially identified, 358 duplicates and 451 articles were excluded based on article type, title, and abstract. The full texts of 17 articles were reviewed, of which 14 were excluded because they were either not prospective RCTs (11 articles), the participants were less than 18 years old (2 articles), or the PTA was not reported at frequencies of interest (1 article). Three prospective RCTs with a total of 88 participants who received HBOT in the intervention groups and 62 participants who received only medical therapy in the control groups were studied. The intergroup difference in mean absolute hearing gain (mean difference, 10.3 dB; 95% CI, 6.5-14.1 dB; I 2 = 0%) and the odds ratio of hearing recovery (4.3; 95% CI, 1.6-11.7; I 2 = 0%) favored HBOT over the control therapy. CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis, HBOT as part of a combination treatment was significantly associated with improved hearing outcomes in patients with SSNHL over control treatments.

Highlights: The COVID-19 pandemic abruptly changed the delivery of pediatric diabetes care. Our clinic has since provided all routine care by telephone and virtual technology. Telephone and virtual visits have impressive usability in this setting. Families want telephone and virtual care to play a significant role in their future.

Objectives: There is limited data on MID in children. This study aimed to compare the demographic and clinical characteristics of 1) a historical MID cohort to a new cohort and 2) children with MID based on overweight/obese BMI (O-BMI) and normal weight BMI (N-BMI). Methods: National surveillance was conducted via the CPSP. Pediatric clinicians reported new cases (children <18 years old) of non-type 1 diabetes for 24-months (cohort 1: 2006-08, cohort 2: 2017-19). MID cases were classified by the presence of diabetes as defined by Diabetes Canada and exposure to a diabetogenic medication. Comparisons were made between the two cohorts and between MID patients with O-BMI (BMI ≥85th percentile for age and sex) and N-BMI (BMI <85th percentile for age and sex). Descriptive statistics and Fisher exact, chi-squared and t-tests were used where applicable. Results: There were 55 cases of MID in cohort 1 and 51 cases in cohort 2, with no significant differences between cohorts. Mean age (+/- SD) at presentation was 13.1 +/- 3.6 years and 13.3 +/- 3.5 years in cohort 1 and 2, respectively. Glucocorticoid therapy was documented in >95% of cases in both cohorts. In the combined cohorts there were 50 cases with N-BMI and 43 cases with O-BMI. There were no statistically significant differences in age, sex or ethnicity across BMI groups. Mean hemoglobin A1c (+/- SD) (n = 40) was 6.45% +/- 1.11% in the N-BMI group and 7.26% +/- 2.51% in the O-BMI group (p = 0.184). The O-BMI group were more likely to have a parent with type 2 diabetes (T2D) (p = 0.042) and acanthosis nigricans (p = 0.007) compared to the N-BMI group. Conclusions: The demographic and clinical features of children with MID have not changed over a 10-year period. The presence of acanthosis nigricans and/or a parent with T2D may be used to identify children who require more intensive glycemic monitoring when on a diabetogenic medication. Further studies are needed to better understand the evolution of MID and the risk it confers to developing T2D. Disclosure T.J. Patel: None. A. Ayub: None. M.A. Irvine: None. S. Hadjiyannakis: None. M. Henderson: None. M.A. Nour: None. T. Pinto: None. B. Wicklow: None. J. Hamilton: None. E. Sellers: None. S. Amed: None. Funding Diabetes Canada; Manitoba Institute for Child Health and Sick Kids Hospital; Public Health Agency of Canada (F18-02353)

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ment of the orbit. In this case, CT scan revealed a large right supra agger frontal cell and lateralized right middle turbinate, which resulted in obstruction of the right frontal sinus, leading to frontal sinus atelectasis. This produced an attenuation and bowing of the right superior orbital wall into the right frontal sinus.To our knowledge, there is only 1 case of frontal SSS reported in the literature. 6 Our case shared similarities with that of Naik et al, 6 where both patients had an obstructing supra agger frontal cell and recovered well after ESS. The difference was in presentation; the previously reported patient had both enophthalmos and hyperglobus, whereas the present patient had only enophthalmos. This could be owing to earlier diagnosis and treatment before hyperglobus set in. This case highlights that SSS is not exclusively a maxillary sinus disease but in certain anatomical sinus configuration, can lead to frontal SSS. A high index of suspicion, early detection, and intervention can help prevent disease progression.