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ORIGINAL ARTICLE
HYPERBARIC OXYGEN THERAPY COMBINED WITH STEROID TREATMENT FOR SUDDEN SENSORINEURAL HEARING LOSS: A PROSPECTIVE RANDOMIZED CLINICAL TRIAL
1
Department of Otorhinolaryngology, Hygeia Hospital, Greece
2
Department of Otorhinolaryngology, Konstantopouleio General Hospital of Nea Ionia-Patisia, Greece
3
1st Academic Department of Otolaryngology, Head and Neck Surgery, Hippokrateio General Hospital, Kapodistrian University of Athens, Greece
4
2nd Academic Department of Otolaryngology, Head and Neck Surgery, Attiko General Hospital, Kapodistrian University of Athens, Greece
5
Hyperbaric Medicine, Hyperbaric and Diving Medical Center of Athens, Greece
6
Otolaryngology Department, Virginia Commonwealth University Richmond, United States
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
Publication date: 2022-03-28
Corresponding author
Anastasia Piniara
Department of Otorhinolaryngology, Hygeia Hospital, 4 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece
Department of Otorhinolaryngology, Hygeia Hospital, 4 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece
J Hear Sci 2022;12(1):9-20
KEYWORDS
combined therapycorticotherapyaudiogramhyperbaric oxygenidiopathic sudden sensorineural hearing lossintratympanic steroids
TOPICS
ABSTRACT
Introduction:
The aim of this prospective randomized clinical trial was to compare the therapeutic efficacy of steroid treatment (systemic and intratympanic) versus combined administration of steroids and hyperbaric oxygen therapy (HBOT) as initial treatment in cases of idiopathic sudden sensorineural hearing loss (ISSNHL).
Material and methods:
102 patients with up to a 10-day history of ISSNHL were randomized into two groups and followed prospectively. Group A (52 patients) received prednisolone intravenously followed by methylprednisolone orally and 3 courses of intratympanic injections with dexamethasone, whereas Group B (50 patients) were administered a combination of the aforementioned treatment together with 10 sessions of HBOT. The patients were followed-up with audiograms and pure-tone averages (PTAs) were measured. Hearing change was evaluated by comparing pre- and posttreatment PTAs.
Results:
The final mean hearing gain was 21.0 for Group A and 31.1 dB HL for Group B. The 10.1 dB HL difference in favor of Group B was statistically significant (p=0.004). However, when recovery was assessed in terms of Siegel’s criteria, no statistically significant difference could be demonstrated. Patients younger than 45 years old achieved better hearing outcomes, and treatment was more effective at low frequencies (0.25 and 0.5 kHz). Combined HBOT and steroid treatment seems to provide greater hearing benefit for patients with severe hearing loss (initial PTA >70 dB HL).
Conclusions:
Early application of HBOT combined with systemic and intratympanic steroid administration significantly improved hearing outcomes with an absolute gain in PTA audiometric threshold of 10.1 dB (95% CI 1.5–29.8, p=0.004). Therefore, adding HBOT along with steroids as initial treatment in ISSNHL is recommended. Younger patients with severe hearing loss can be expected to derive most benefit.
The aim of this prospective randomized clinical trial was to compare the therapeutic efficacy of steroid treatment (systemic and intratympanic) versus combined administration of steroids and hyperbaric oxygen therapy (HBOT) as initial treatment in cases of idiopathic sudden sensorineural hearing loss (ISSNHL).
Material and methods:
102 patients with up to a 10-day history of ISSNHL were randomized into two groups and followed prospectively. Group A (52 patients) received prednisolone intravenously followed by methylprednisolone orally and 3 courses of intratympanic injections with dexamethasone, whereas Group B (50 patients) were administered a combination of the aforementioned treatment together with 10 sessions of HBOT. The patients were followed-up with audiograms and pure-tone averages (PTAs) were measured. Hearing change was evaluated by comparing pre- and posttreatment PTAs.
Results:
The final mean hearing gain was 21.0 for Group A and 31.1 dB HL for Group B. The 10.1 dB HL difference in favor of Group B was statistically significant (p=0.004). However, when recovery was assessed in terms of Siegel’s criteria, no statistically significant difference could be demonstrated. Patients younger than 45 years old achieved better hearing outcomes, and treatment was more effective at low frequencies (0.25 and 0.5 kHz). Combined HBOT and steroid treatment seems to provide greater hearing benefit for patients with severe hearing loss (initial PTA >70 dB HL).
Conclusions:
Early application of HBOT combined with systemic and intratympanic steroid administration significantly improved hearing outcomes with an absolute gain in PTA audiometric threshold of 10.1 dB (95% CI 1.5–29.8, p=0.004). Therefore, adding HBOT along with steroids as initial treatment in ISSNHL is recommended. Younger patients with severe hearing loss can be expected to derive most benefit.
REFERENCES (52)
1.
National Institute on Deafness and Other Communication Disorders (NIDCD). Sudden deafness. 2016. http://www.nidcd.nih.gov/healt....
2.
Byl FM. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope, 1984; 94: 647–61.
3.
Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol, 1977; 86: 463–80.
4.
Fetterman BL, Saunders JE, Luxford WM. Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol, 1996; 17(4): 529–36.
5.
Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope, 1976; 86(3): 389–98.
6.
Chandrasekhar SS, Tsai Do BS, Schwartz SR et al. Clinical practice guideline: sudden hearing loss (update) executive summary. Otolaryngol Head Neck Surg, 2019; 161(2): 195–210.
7.
Schuknecht HF, Kimura RS, Naufal PM. The pathology of sudden deafness. Acta Otolaryngol, 1973; 76: 75–97.
8.
Beal DD, Hemenway WG, Lindsay JR. Inner ear pathology of sudden deafness. Histopathology of acquired deafness in the adult coincident with viral infection. Arch Otolaryngol, 1967; 85: 591–8.
9.
Stokroos RJ, Alberts FW. The etiology of idiopathic sensorineural hearing loss. A review of the literature. Acta Otolaryngol, 1996; 50: 69–76.
10.
Wilson WR, Byl FM, Laird N. Viral and epidemiologic studies of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg, 1983; 91: 653–8.
11.
Fisch U, Murata K, Hossli G. Measurement of oxygen tension in human perilymph. Acta Otolaryngol, 1976; 81(3–4): 278–82.
12.
Ito S, Fuse T, Yokota M. Prognosis is predicted by early hearing improvement in patients with idiopathic sudden sensorineural hearing loss. Clin Otolaryngol Allied Sci, 2002; 27: 501–4.
13.
Moskowitz D, Lee KJ, Smith HW. Steroid use in idiopathic sudden sensorineural hearing loss. Laryngoscope, 1984; 94(5,pt1): 664–6.
14.
Conlin AE, Parnes LS. Treatment of sudden sensorineural hearing loss. A Metaanalysis. Arch Otolaryngol Head Neck Surg, 2007; 133: 582–6.
15.
Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear Nose Throat J, 1996; 75: 468–71.
16.
Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope, 1999; 109: 1–17.
17.
Choung YH, Park K, Shin YR, Cho MJ. Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss. Laryngoscope, 2006; 116: 747–52.
18.
Xenellis J, Papadimitriou N, Nikolopoulos T et al. Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study. Otolaryngol Head Neck Surg, 2006; 134(6): 940–5.
19.
Seggas I, Koltsidopoulos P, Bibas A, Tzonou A, Sismanis A. Intratympanic steroid therapy for sudden hearing loss: a review of the literature. Otol Neurotol, 2011; 32(1): 29–35.
20.
Ding XY et al. Intratympanic versus systemic steroid treatment for idiopathic sudden hearing loss: a meta-analysis. Laryngoscope, 2013; 109: 1–17.
21.
Battaglia A, Lualhati A, Lin H, Burchette R, Cueva R. A prospective, multi-centered study of the treatment of idiopathic sudden sensorineural hearing loss with combination therapy versus high-dose prednisone alone: a 139 patient follow-up. Otol Neurotol, 2014; 35(6): 1091–8.
22.
Arslan N, Oğuz H, Demirci M et al. Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss. Otol Neurotol, 2011; 32: 393–7.
23.
Lim HJ, Kim YT, Choi SJ, Lee JB, Park HY, Park K, Choung YH. Efficacy of 3 different steroid treatments for sudden sensorineural hearing loss: a prospective, randomized trial. Otolaryngol Head Neck Surg, 2013; 148(1): 121–7.
24.
Tsounis M, Psillas G, Tsalighopoulos M, Vital V, Maroudias N, Markou K. Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial. Otorhinolaryngol, 2018; 275: 103–10.
25.
Piper SM, LeGros TL, Murphy-Lavoie H et al. Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric oxygen therapy: indications. 13th Edition, 2014. Ed. L. Weaver, Best Publishing, FL.
26.
Gill AL, Bell CNA. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM, 2004; 97(7): 385–95.
27.
Fujimura T, Suzuki H, Shiomori T et al. Hyperbaric oxygen and steroid therapy for idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol, 2007; 264: 861–6.
28.
Yang CH, Wu RW, Hwang CF. Comparison of intratympanic steroid injection, hyperbaric oxygen and combination therapy in refractory sudden sensorineural hearing loss. Otol Neurotol, 2013; 34(8): 1411–6. doi: 10.1097/MAO.0b013e3182a1eb83.
29.
Topuz E, Yigit O, Cinar U et al. Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss? Eur Arch Otolaryngol, 2008; 261: 393–6.
30.
Muzzi E, Zennaro B, Visentin R et al. Hyperbaric oxygen therapy as salvage treatment for sudden hearing loss: review of rationale and preliminary report. J Laryngol Otol, 2010; 124: 22–25.
31.
Aslan I, Oysu C et al. Does the addition of hyperbaric oxygen therapy to the conventional treatment modalities influence the outcome of sudden deafness? Otolaryngol Head Neck Surg, 2002; 126: 121–6.
32.
Lamm H, Müller-Kortkamp C, Warnecke A et al. Concurrent hyperbaric oxygen therapy and intratympanic steroid application as salvage therapy after severe sudden sensorineural hearing loss. Clin Case Rep, 2016; 4: 287–93.
33.
Eryigit B, Ziylan F, Yaz F, et al. The effectiveness of hyperbaric oxygen in patients with idiopathic sudden sensorineural hearing loss: a systematic review. Eur Arch Otorhinolaryngol, 2018; 275: 2893–904.
34.
Bennett MH, Kertesz T, Perleth M, Yeung P, Lehm JP. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev, 2012; 17; 10: CD004739.
35.
British Society of Audiology Guidelines. Typical Normative Data for an Adult. 2013 corrected 2014 https://www.thebsa.org.uk/wp-c....
36.
Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol Head Neck Surg, 1970; 92: 311–24.
37.
Ramos HV, Barros FA, Yamashita H et al. Magnetic resonance imaging in sudden deafness. Braz J Otorhinolaryngol, 2005; 71: 422–6.
38.
American Speech-Language-Hearing Association. Guidelines for manual pure tone threshold audiometry. 2005. www.asha.org/policy.
39.
Shuman AG. Ethics of placebo control in trials for idiopathic sudden sensorineural hearing loss: counterpoint. Otolaryngol Head Neck Surg, 2016; 155: 13–14.
40.
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. 2015. http://www.wma.net/en/30public....
41.
Jain KK. Textbook of Hyperbaric Medicine. Göttingen, GE: Hogrefe and Huber Publishers, 2009.
42.
Trune DR, Kempton JB, Gross ND. Mineralocorticoid receptor mediates glucocorticoid treatment effects in the autoimmune mouse ear. Hear Res, 2006; 212: 22–32.
43.
Baysal E. Systemic steroid versus combined systemic and intratympanic steroid treatment for sudden sensorineural hearing loss. Otol Neurotol, 2013; 24: 432–4.
44.
Mathieu D. et al. Physiologic effects of hyperbaric oxygen on hemodynamics and microcirculation. In: The Physician’s Guide to Diving Medicine. New York, Plenum Press, 1984, 3: 99-109.
45.
Suzuki H, Hashida K, Nguyen KH et al. Efficacy of intratympanic steroid administration on idiopathic sudden sensorineural hearing loss in comparison with hyperbaric oxygen therapy. Laryngoscope, 2012; 122(5): 1154–1157.
46.
Toroslu T, Erdoğan H, Çağlar Ö, Güçlü O, Dereköy FS. Comparison of different treatment methods for idiopathic sudden sensorineural hearing loss. Turkish Archives of Otorhinolaryngology, 2018; 56 (4): 226.
47.
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med, 2017; 47(1): 24–32.
48.
Ersoy Callioglu E, Tuzuner A, Demirci S et al. Comparison of simultaneous systemic steroid and hyperbaric oxygen treatment versus only steroid in idiopathic sudden sensorineural hearing loss. Int J Clin Exp Med, 2015; 8(6): 9876–82.
49.
Sha SH, Taylor R, Forge A, Schacht J. Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals. Hear Res, 2001; 155: 1–8.
50.
Krajčovičová Z, Meluš V, Zigo R et al. Hyperbaric oxygen therapy in treatment of sudden sensorineural hearing loss: finding for the maximal therapeutic benefit of different applied pressures. Undersea Hyperb Med, 2019; 46(5): 665–72.
51.
Carlsson PJ, Hjaldahl J, Magnuson A et al. Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation. Disabil Rehabil, 2015; 37(20): 1849–56.
52.
Murphy-Lavoie HM, Mutluoglu M. Hyperbaric Treatment of Sensorineural Hearing Loss. Treasure Island (FL): StatPearls Publishing; 2020.
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