Adjunctive Hyperbaric Oxygen Therapy or Intratympanic Steroids in Sudden Sensorineural Hearing Loss?

Abstract

The pathophysiology of sudden sensorineural hearing loss (SSNHL) is still unknown, and therefore treatment strategies are often debated. Traditionally, SSNHL is treated with steroids, either orally (OCS) and/or via intratympanic injection (ITSI). Hyperbaric oxygen treatment (HBOT) has resurged in popularity as an adjunctive therapy. The present study investigated the additive effect of HBOT to traditional steroid treatment for SSNHL. Retrospective study comparing treatment effect (pure tone average-PTA; speech recognition threshold-SRT; word recognition score-WRS) between HBOT + ITSI and ITSI treated patients. Sub-analysis of responders and nonresponders, treatment delay, and number of injection/dives. One hundred nineteen patients were divided into ITSI (n = 73) and HBOT + ITSI (n = 46) groups. While there was a significant pre-to-posttreatment improvement in PTA, SRT, and WRS (p < 0.001) within each group, there was no difference between groups in pre-to-postimprovement for PTA, SRT, or WRS (p = 0.49, 0.07, or 0.55, respectively). Of responders to treatment, 4.1% did not receive OCS compared to 24.4% of nonresponders (p < 0.001). In HBOT responders, audiogram improvement was demonstrated within 10.9 ± 6.5 (max 23) sessions. 25.8% of HBOT responders showed no response after completing ITSI and then subsequently demonstrated audiometric response after 17.5 ± 4.0 HBOT dives. No additional treatment benefit was found with adjunctive concurrent HBOT. HBOT might be of value to patients refractory to steroid treatment. No beneficial treatment effect in receiving more than 23 HBOT dives was observed. However, evaluating treatment effect in SSNHL loss is always biased by the well-known confounders that are linked to the condition.