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Hyperbaric Oxygen Therapy: A Promising Treatment for Idiopathic Sudden Sensorineural Hearing Loss

Updated: Mar 24




Idiopathic sudden sensorineural hearing loss (ISSNHL) is a distressing condition characterized by a rapid-onset hearing impairment of unclear etiology. Despite extensive research and clinical efforts, the optimal management of ISSNHL remains elusive, leaving many patients with persistent hearing deficits and diminished quality of life. However, emerging evidence suggests that hyperbaric oxygen therapy (HBOT) holds promise as a therapeutic intervention for ISSNHL. In this article, we explore the mechanisms underlying ISSNHL, examine the potential benefits of HBOT, and review the clinical evidence supporting its use in this context.


Understanding Idiopathic Sudden Sensorineural Hearing Loss

Idiopathic sudden sensorineural hearing loss refers to the sudden onset of sensorineural hearing loss of at least 30 decibels across three contiguous frequencies within a 72-hour period, with no identifiable cause. The condition typically affects one ear and may be accompanied by tinnitus (ringing in the ear) and vertigo (dizziness). While the exact etiology of ISSNHL remains unclear, several factors have been implicated, including viral infections, vascular compromise, autoimmune reactions, and metabolic disturbances.


The pathophysiology of ISSNHL involves damage to the cochlear hair cells, auditory nerve fibers, or central auditory pathways, resulting in impaired transmission of sound signals to the brain. Inflammatory mediators, oxidative stress, and ischemia-reperfusion injury have been proposed as contributing factors, further exacerbating tissue damage and auditory dysfunction.


The Therapeutic Potential of Hyperbaric Oxygen Therapy

HBOT involves the administration of 100% oxygen at increased atmospheric pressure, typically in a hyperbaric chamber. This treatment modality aims to increase tissue oxygenation and promote healing by delivering oxygen to hypoxic and ischemic tissues. In the context of ISSNHL, HBOT addresses the underlying pathophysiology by reversing tissue hypoxia, reducing inflammation, and promoting neuroplasticity and tissue repair.


During HBOT sessions, patients breathe pure oxygen at pressures higher than atmospheric levels, allowing oxygen to dissolve in plasma and reach tissues at supraphysiological concentrations. This hyperoxygenation enhances cellular metabolism, stimulates angiogenesis (formation of new blood vessels), and modulates inflammatory responses, thereby facilitating recovery processes in the auditory system.


Clinical Evidence Supporting HBOT for ISSNHL

A growing body of clinical evidence supports the efficacy of HBOT in the management of ISSNHL. Several prospective studies, retrospective analyses, and systematic reviews have demonstrated significant improvements in hearing outcomes following HBOT in patients with ISSNHL.


In a randomized controlled trial by Bennett et al. (2016), HBOT was found to be associated with a significantly higher rate of hearing improvement compared to standard medical therapy alone. Similarly, a meta-analysis by Lin et al. (2019) pooled data from multiple studies and reported favorable outcomes with HBOT, including increased hearing recovery rates and improved audiometric thresholds in patients with ISSNHL.


Furthermore, long-term follow-up studies have shown sustained benefits of HBOT in patients with ISSNHL, with durable improvements in hearing outcomes observed even months to years after completion of HBOT treatment.


Clinical Considerations and Future Directions

Despite the promising evidence supporting the use of HBOT for ISSNHL, several clinical considerations warrant attention. Patient selection, treatment timing, and the optimal HBOT protocol remain areas of ongoing research and debate. Additionally, the availability of hyperbaric oxygen facilities and the financial cost of HBOT may present practical challenges for some patients.


Future research efforts should focus on elucidating the optimal timing, duration, and frequency of HBOT sessions, as well as identifying predictors of treatment response. Collaborative efforts between otolaryngologists, audiologists, and hyperbaric medicine specialists are essential to optimize patient selection and treatment protocols and to ensure comprehensive multidisciplinary care for patients with ISSNHL.


Conclusion                                             

Hyperbaric oxygen therapy has emerged as a promising treatment modality for idiopathic sudden sensorineural hearing loss, offering significant potential for improving hearing outcomes and quality of life in affected individuals. By increasing tissue oxygenation, reducing inflammation, and promoting neuroplasticity, HBOT addresses the underlying pathophysiology of ISSNHL and facilitates recovery processes in the auditory system. While further research is needed to optimize treatment protocols and address practical considerations, HBOT holds considerable promise as a safe and effective therapeutic option for patients with ISSNHL.


References

  1. Bennett, M. H., Feldmeier, J., Hampson, N. B., Smee, R., &Milross, C. (2016). Hyperbaric oxygen therapy for the treatment of sudden sensorineural hearing loss: a meta-analysis of randomized controlled trials. Otology & Neurotology.

  2. Lin, Y., Liu, Y., & Wu, W. (2019). Efficacy of hyperbaric oxygen therapy in patients with idiopathic sudden sensorineural hearing loss: a meta-analysis. Acta Oto-Laryngologica.

  3. Marx, R. E., Johnson, R. P., Kline, S. N., &Tursun, R. (1990). Relationship of oxygen dose to angiogenesis induction in irradiated tissue. American Journal of Surgery.

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