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.
Background The pathogenesis of Sudden Sensorineural Hearing Loss is complex, and the prognosis for recovery is variable. While the pathological lesion is thought to be localized to the cochlea, recent microRNA findings suggest a primarily neuro-topic pathogenesis at least in some patients. This study seeks to use established hearing-loss categorization systems to distinguish neural from non-neural hearing loss patients and determine if the two groups differ in functional recovery. Methods The Charts of 132 Sudden Sensorineural Hearing Loss patients presenting at Vancouver General Hospital (November 2013-June 2019) were retrospectively reviewed. Patients’ characteristics, treatment modality, Pure Tone Audiometric thresholds (averaged across four frequencies: 0.5, 1, 2, and 3 kHz), and Word Recognition Scores were collected. Neural type Sudden Sensorineural Hearing Loss was defined as a presenting Word Recognition Score (<60%), with a Word Recognition Score reduction 20% greater than expected based on the averaged pure tone audiometric loss. Hearing recovery was defined as an improvement of ≥ 10 decibels in pure tone audiometric thresholds. Results 48 patients meeting the American Academy of Otolaryngology Head and Neck Surgery 2019 diagnostic criteria and with comprehensive data were included. 12 (mean age ± standard deviation: 57.7±14.9 years) and 36 (55.3±15.2 years) patients were classified as neural and sensory Sudden Sensorineural Hearing Loss, respectively. 66.7% (8/12) and (24/36) of neural and non-neural Sudden Sensorineural hearing loss patients, respectively demonstrated hearing recovery. The affected ear’s initial Word Recognition Score (mean ± standard deviation %): 17.1±17.6 and 71.5±35.5 (p < 0.0001), and Word Recognition Score change with treatment: 46.9±29.8 and 3.2±25.8 (p < 0.0001), in neural and non-neural patients, respectively were significantly different. Conclusion The hearing recovery rate in neural and sensory type Sudden Sensorineural Hearing Loss patients was similar. Patients with a neural type of hearing loss demonstrated greater word recognition score recovery after treatment than those in the sensory group.
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