Utility of Hyperbaric Oxygen Therapy for Acute Acoustic Trauma: 20 years' Experience at the Japan Maritime Self-Defense Force Undersea Medical Center

Abstract

Introduction Acute acoustic trauma, which is a kind of sensorineural hearing loss, is caused by acoustic overstimulation. Hyperbaric oxygen therapy (HBOT) is reported to be effective against acute acoustic trauma. Objective We aimed to evaluate the efficacy of HBOT against acoustic hearing loss based on our 20 years of experience with such cases. Methods Patients who were treated with HBOT for acute acoustic trauma between April 1997 and August 2017 were evaluated in this study. Thirty-five patients with a mean age of 25.7 ± 9.2 (range: 16–48) years were included. Thirty-nine out of 70 ears (35 patients) were damaged. We investigated the initial level of hearing loss; the extent to which hearing recovered; subjective symptoms, such as tinnitus and aural fullness; and the treatment administered. Results The planned HBOT was completed in 37 of 39 ears. Twenty-six of the 37 ears (70.2%) displayed improved hearing, and 31 of the 37 ears (83.9%) exhibited symptom improvement. Twenty-three (76.7%) and 26 (86.7%) of the 30 ears treated with steroids demonstrated improvements in hearing and subjective symptoms, respectively. Conclusion A combination of HBOT and steroids should be considered as a treatment for acute acoustic trauma in cases involving symptoms such as tinnitus and aural fullness.

Efficacy of Oral Steroids for Acute Acoustic Trauma

“…We acknowledge some limitations: (1) our study is limited by its retrospective nature; however, randomized control trials on the subject are not ethically feasible (2) because all our study subjects were recruits of young age (18-35 years), without any substantial morbidities and contraindications to steroid therapy, and thus our findings may not be generalizable to subjects with comorbidities presenting with AAT injury; (3) HBOT, with or without concurrent steroid treatment, is increasingly being investigated as playing a major role in AAT injury treatment [Yilikoski et al, 2008;Oya et al, 2019;Holy et al, 2021]. In our study cohort, it was not part of our study protocol, and therefore we cannot comment on the efficacy of this modality; (4) we observed a tendency to prescribe oral steroid treatment to subjects presenting with more severe hearing losses, when compared to those presenting with milder losses, as documented in the first audiometry.…”

“…A few studies investigated the efficacy of HBOT in AAT injuries: Ylikoski et al demonstrated significantly better audiometric results both in low and high frequencies in patients with AAT injuries who were treated with early-onset HBOT (within 3-4 days after injury), compared with those who did not receive HBOT at all [Ylikoski et al, 2008]. Furthermore, Oya et al [2019] showed that a combination of oral steroids and HBOT significantly improved audiometric results together with alleviation of subjective symptoms (i.e., aural fullness and tinnitus), even when treatment was given 3-4 weeks after initial injury. However, the latter study did not compare between patients receiving only steroid treatment and patients treated with steroids and HBOT, and therefore the exact contribution of HBOT in AAT injury is not clear.…”

The Use of Hyperbaric Oxygen Therapy and Corticosteroid Therapy in Acute Acoustic Trauma: 15 Years’ Experience at the Czech Military Health Service

“…A similar conclusion was given in a paper by Lafère et al [ 26 ]. Also, Oya et al published data on HBO2 therapy: 26 of the 37 ears (70%) displayed improved hearing [ 27 ].…”

It's all about timing, early treatment with hyperbaric oxygen therapy and corticosteroids is essential in acute acoustic trauma

“…PF: pentoxifylline, Dx: dextran, VD: vasodilators, OS: oral steroids, IVS: intravenous steroids, PT: piracetam, NBOT: normobaric oxygen therapy, HBOT: hyperbaric oxygen therapy, IV: intravenous, MT: medical therapy, NA: not available. Author, year Groups that included HBOT Groups that did not include HBOT Absolute hearing gain (dB) Relative hearing gain (%) Current analysis, 2021 HBOT + OS None 24.5 dB 58.4% Bayoumy ( Bayoumy et al., 2020 ) , 2019 HBOT + OS OS HBOT + OS: 23.5 dB OS: 12.5 dB HBOT + OS: 57.6% OS: 31.4% Oya ( Oya et al., 2019 ) , 2019 1: HBOT + OS 2: HBOT - OS None NA HBOT + OS: 42.5% HBOT - OS: 25.4% Van Haesendonck ( Van Haesendonck et al., 2018 ) , 2018 HBOT + OS OS HBOT: 2.5 dB OS: 3.0 dB NA Salihoğlu ( Salihoğlu et al., 2015 ) , 2015 1: HBOT + OS ≤ 10d 2: HBOT + OS > 10d None NA NA Bonfort ( Bonfort et al., 2014 ) , 2014 HBOT + IVS + PF None 18.3 dB 53.8% Lafère ( Lafère et al., 2010 ) , 2010 1: HBOT (o.d.for 10 days) + OS + PT 2: HBOT (b.d. for three days, followed by o.d.…”