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Hyperbaric Oxygen as a Treatment for Sudden Hearing Loss

New Hope for Sudden Idiopathic Sensorineural Hearing Loss

Imagine waking up one morning to discover that you had spontaneously lost most of your hearing in one or both ears, with no warning or explanation. The U.S. incidence of sudden idiopathic hearing loss is 5-20 per 100,000, or about 4000 cases annually.  This condition does not have any consistent risk factors and can happen to virtually anyone. In the past, sudden onset hearing loss (occurring within 72 hours) has had very limited treatment options. At one time, it was theorized that a viral componenet was involved, however, treatment with antivirals has shown no benefit. Glucocorticosteriods have shown some success in regaining hearing function in the case of a mild or moderate loss, but only about 65% of the time (Bennett, et.al., 2012). Patients with profound hearing loss often do not regain any hearing function with steroid treatment.

The presentation of this condition can include tinnitus (ringing in ears), vertigo (dizziness or imbalance), and a feeling of pressure or fullness in the ear.  Sudden sensorineural hearing loss is treated as a medical emergency, since it is well known that in these cases, if corticosteroid treatment is not initiated within 10 days of onset, hearing function will have no chance of recovery.  This is problematic particularly due to the lack of awareness of this condition in the general public...sufferers often wait to seek treatment, thinking that the hearing loss will go away.  Unfortunately this logic can also affect treatment within primary care and ER settings as well, due to a lack of awareness even in the general healthcare community regarding the nature of sudden hearing loss. Ninety-seven percent of cases result in unilateral hearing loss (loss in only one ear).  Even though the better hearing ear is unaffected, unilateral hearing loss can present a variety of listening challenges when dealing with noisy environments, multiple talkers, and localizing sounds.  This type of a hearing loss can result in social and economic hardships, difficulty maintaining employment, depression and isolation, and carries the 15th leading cause of burden of disease in this country. 

In the face of limited treatment options, surprising research findings have recently revealed success with a new treatment for sudden idiopathic sensorineural hearing loss: Hyperbaric Oxygen therapy (HBOT).  HBOT involves breathing pure oxygen in a pressurized room.  In a hyperbaric oxygen therapy room, the air pressure is raised up to three times higher than normal air pressure. Under these conditions, your lungs can gather up to three times more oxygen than would be possible breathing pure oxygen at normal air pressure. Human blood carries this oxygen throughout the body, stimulating the release of substances called growth factors and stem cells, which promote healing.

A wealth of positive data, including 12 retrospective and prospective case-controlled studies including a total of more than 1650 patients has shown that HBOT treatment in conjunction with oral glucocorticosteroids can be more effective in hearing recovery than treating with steroids alone (Bennett, et.al, 2012; Murphy-Lavoie, et.al., 2012).  Out of these 12 studies, only 2 studies did not support the hypothesis of significant hearing improvement with HBOT. No negative results of this treatment have been reported.  It is also noteworthy that there is increased improvement for those with moderate and severe loss in comparison to steroid treatment alone. 

Although HBOT is not widely available in the United States and is not recognized by many US clinicians as an intervention for sudden hearing loss, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) asserts that the level of evidence for hearing improvement is sufficient to promote greater awareness of HBOT as an intervention for sudden idiopathic sensorineural hearing loss.  Most large metropolitan cities have two to three centers equipped to admister hyperbaric oxygen treatment. Many insurance carriers are approving this costly procedure without question for victims of sudden hearing loss. Candidates for this treatment are as follows:

*  Patients under 60 years of age
*  Experiencing a sudden onset of significant hearing loss within a 72 hour time frame or less
*  Early in the course of the disease (within 10 days)

If you or a loved one experiences a sudden hearing loss, please call your doctor or visit an ER or urgent care center immediately! Sudden hearing loss is a medical emergency and is treatable within a very short time frame.  In addition, make sure you have a hearing test right away, and have follow-up hearing tests for baseline comparisons to monitor progress and change in hearing. With hyperbaric oxygen treatment, the hope of hearing recovery is better than ever before.

 
References:
Bennett, M.H.; Kertesz, T.; Perleth, M.; Yeung, P.; Lehm, J.P. (2012).  Hyperbaric oxygen for idiopathic sudden sensorinerual hearing loss and tinnitus.  Cochrane Database of Sytematic Reviews, Oct 17.  doi: 10.1002/14651858.CD004739.pub4.
Murphy-Lavoie, H.; Piper, S.; Moon, R.E.; legros, T. (2012).  Hyperbaric oxygen therapy for suden sensorineural hearing loss. Undersea and Hyperbaric Medicine, 39(3), 777-92.