Comparison of Intratympanic Steroid and Hyperbaric Oxygen Salvage Therapy Hearing Outcomes in Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Study

Abstract

Objectives: Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60% of patients. It is unknown why 40% of patients do not respond to systemic steroid therapy. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation (HBO) therapy, with inconsistent results reported. This study aimed to compare the results of ITS and HBO therapy in patients with SSNHL that previously failed systemic steroid therapy. Design: This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBO therapy, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Pure-tone audiograms were performed before and after the salvage therapy in the IT and HBO groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with a cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. Results: ITS and HBO therapy were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13.6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7.4 dB in HBO therapy in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBO therapy. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4.67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. Conclusions: ITS and HBO therapy show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy.

Clinical impact of hyperbaric oxygen therapy combined with steroid treatment for sudden sensorineural hearing loss: A case–control study

“…Moreover, IPTW can only account for known variables, leaving room for potential bias from unmeasured factors. Previous studies have suggested that ITSI may contribute to hearing improvement, 27 , 37 , 38 , 39 , 40 emphasizing the need for cautious interpretation of our findings in the context of potential uncontrolled confounding. However, the sensitivity analysis comparing PSL alone to HBOT combined with PSL showed a similar trend to the overall analysis, which may indicate the robustness of the present result.…”

“…Furthermore, another meta‐analysis that evaluated 19 observational studies found that the HBOT group exhibited an average hearing improvement of 8.74 dB more than the non‐HBOT group, along with an OR for CR of 1.61. 9 Moreover, despite its role as a salvage treatment, the Ajduk et al 27 retrospective study on hyperbaric oxygen salvage therapy in SSNHL found an average hearing improvement of 7.4 dB at all frequencies (250–8000 Hz). The results of our study, demonstrating an average difference in hearing improvement of 7.6 dB and a higher CR rate with an OR of 2.57, are consistent with those previous findings, reinforcing the validity of our outcomes, although the clinical significance of the HBOT on SSNHL remains unclear.…”

The Effectiveness of Salvage Hyperbaric Oxygen Therapy Following Combined Steroid Therapy for Refractory Sudden Sensorineural Hearing Loss

“…14 However, treatment failure still exists and is reported as up to 40% in several reports, although the definition of treatment failure varies. 15 The ITS has been most studied as the salvage treatment of SSNHL, which showed at least a tendency to show better results than control for PTA improvement and/or the recovery rate. A recent meta-analysis reported a mean 11.5 dB improvement of PTA by ITS versus 2.7 dB for placebo.…”

The role of hyperbaric oxygen in idiopathic sudden sensorineural hearing loss

“…34 49 Therefore, ischemia-hypoxia and inflammation are thought to be the primary causes of ISSNHL. 13 Hypoxia leads to ciliary fusion of cochlear hair cells, edema of synapses and dendrites, and continuous depolarization. 50 HBOT has been reported to improve ischemia and hypoxia of the inner ear by increasing the oxygenation of the inner ear and the partial oxygen pressure of the perilymphatic fluid.…”

“… 6 12 HBOT is also a kind of important treatment to save hearing loss for patients who have failed steroid therapy. 13 In addition, combining HBOT with traditional steroid therapy was found to be more effective than using steroids alone. 12 Although HBOT has been successfully used as a conventional adjuvant therapy in the treatment of ISSNHL, its exact mechanisms are still unknown.…”