The use of hyperbaric oxygen therapy in acute hearing loss: a narrative review

Abstract

Introduction Acute hearing loss can have a major impact on a patient’s life. This holds true for both acute acoustic trauma (AAT) and idiopathic sudden sensorineural hearing loss (ISSHL), two devastating conditions for which no highly effective treatment options exist. This narrative review provides the rationale and evidence for HBOT in AAT and ISSHL. Methods Narrative review of all the literature available on HBOT in acute hearing loss, studies were retrieved from systematic searches on PubMed and by cross referencing. Discussion First, the etiological mechanisms of acute hearing loss and the mechanism of action of HBOT were discussed. Furthermore, we have provided an overview of 68 studies that clinically investigated the effect of HBOT in the last couple of decades. For future studies, it is recommend to start as early as possible with therapy, preferably within 48 h and to use combination therapy consisting of HBOT and corticosteroids. Implications for practice HBOT has been used quite extensively for acute hearing loss in the last couple of decades. Based on the amount of studies showing a positive effect, HBOT should be discussed with patients (shared decision making) as optional therapy in case of AAT and ISSHL.

Comparison of Steroid Treatment with and without Hyperbaric Oxygen Therapy for Idiopathic Sudden Sensorineural Hearing Loss

“…There are many reports that HBO therapy has beneficial effects for the treatment of ISSHL [6,10,12,17]. Recent studies have also shown that addition of HBO to corticosteroid treatment may be beneficial in both acute acoustic trauma and ISSHL, especially when initiated early [18]. It was reported that HBO therapy was found to cause a significant improvement in PTA thresholds in ISSHL cases where primary corticosteroid therapy failed and were within 4 weeks of onset of hearing loss [17].…”

Hyperbaric Oxygenation as Adjunctive Therapy in the Treatment of Sudden Sensorineural Hearing Loss

“…Clinically, HBOT is highly efficacious in the treatment of several conditions spanning a broad pathological range [ 19 ]. Actual European indications for the medical use of HBOT were established during the ECHM Consensus Conference in 2016, taking into account three types of recommendations for using HBOT as a medical procedure—from strongly recommended to optional use, depending on the strength of the evidence of its beneficial action [ 2 ].…”

“…This illness is considered to be a true otologic emergency [ 23 ]. For smaller losses, some patients regain their pre-loss hearing threshold without medical therapy due to the repair capacity of the cochlea, but in cases of profound hearing impairment the chance of complete recovery is limited [ 19 ]. The majority (about 90%) of SSNHL cases is idiopathic and several causes have been proposed to explain its etiopathogenesis (i.e., viral infection, otologic disease, trauma, vascular causes, and neoplastic disease, in order from the most frequent to rare [ 24 ].…”

Is Salvage Hyperbaric Oxygen Therapy Effective for Sudden Sensorineural Hearing Loss in Patients with Non-response to Corticostreoid Treatment?

“…It is suggested that ischemia due to vascular damage is involved in developing SSNHL. Thereby, it is assumed that ischemia-induced impaired hearing will be improved with HBOT by increasing the availability of oxygen in the inner ear [6][7]. Although the HBOT for SSNHL is suggested within two weeks of the onset of the disease, HBOT can also be suggested as salvage therapy within one month of onset of SSNHL [5].…”