Combination Steroid and Hyperbaric Oxygenation Therapy for Sudden Idiopathic Sensorineural Hearing Loss

Abstract

We retrospectively evaluated the efficacy of combination therapy with steroid and hyperbaric oxygenation for sudden idiopathic sensorineural hearing loss (SISNHL). Patients (n: 109; 111 ears) visited our clinic within 14 days from onset before receiving treatment between January 1999 and March 2003. Hearing loss was assessed based on criteria prepared by the Ministry of Health and Welfare Acute Severe Hearing Loss Study Group. Patients were distributed into Group I-95 patients who started treatment within 7 days from onset-, and Group II-14 patients who started treatment within 8-14 days from onset. We evaluated the outcome of therapy using grading established by The Research Committee on Acute Profound Deafness, Ministry of Health and Welfare, Japan. The complete recovery of hearing was worse in patients with severe hearing loss. It was 4.8% in grade 4a, 18.2% in grade 3a, 25% in grade 2a, 20.0% in grade 4b, 38.5% in grade 3b, and 66.7% in grade 2b. We studied the relationship between type of hearing loss and recovery after treatment. The complete recovery of hearing was most favorable in patients with low tone hearing loss, followed by those with middle tone hearing loss and those with horizontal hearing loss. These findings indicate that the type of hearing loss was the most significant determinant of SISNHL prognosis and course. Twenty patients with acute stage SISNHL had diabetes mellitus. The recovery of hearing was almost the same in those with and without diabetes mellitus. Recovery was complete in 32.4%, Niarked in 32.4%, and slight in 21.6%. In 13.5%, no change was observed. Our results and data from previous reports, involving more than 70 Japanese patients treated with steroids alone, suggest that combination therapy with steroid and hyperbaric oxygenation is effective for SISNHL.

Hyperbaric oxygen therapy as salvage treatment for sudden sensorineural hearing loss: review of rationale and preliminary report

“…Racic et al have stated that current evidence supports hyperbaric oxygen therapy as being more effective than conventional rheological treatment with pentoxifylline in idiopathic sudden SNHL 25 . Prostaglandin E-1 and stellate ganglion blockade have also been used for their vasoactive properties 26 , 27 …”

“…Considering that speech discrimination usually improves along with pure tone hearing thresholds, only improvement could result in an additional benefit to the patient's quality of life 7 . Higher recovery rates at low frequencies are common, and are found for therapies other than hyperbaric oxygen therapy 7 , 12 , 26 , 44 – 46 . Patients with the most severe hearing loss seem to improve more than patients with mild hearing loss, which can progressively worsen even during hyperbaric oxygen therapy 24 …”

“…Uzun and Yildiz recently studied the therapeutic window for the use of hyperbaric oxygen therapy in the treatment of idiopathic sudden SNHL 53 . Kawamata et al commenced hyperbaric oxygen therapy and steroids within the first week of onset in 87 per cent of their sudden SNHL patients 26 . Aslan et al commenced treatment within two weeks of onset of idiopathic sudden SNHL 8 .…”