Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial

Abstract

Objectives: This study aimed to investigate the efficacy of simultaneous steroid and hyperbaric oxygen therapy (HBOT) in patients with severe to profound idiopathic sudden sensorineural hearing loss (ISSNHL), which has a poor prognosis. Methods: Sixty patients diagnosed with severe to profound ISSNHL (≥70 dB HL) were randomly divided into two groups in a prospective controlled trial: an oral steroid + intratympanic steroid injection (ITSI) group (control group) and an oral steroid + ITSI + HBOT group (study group). Pure-tone audiometry (PTA) results and word discrimination scores (WDS) were compared between the two groups before treatment and 10 days and 1, 2, and 3 months after treatment. Hearing improvement was assessed using the modified American Academy of Otolaryngology-Head and Neck Surgery criteria. Analyses were by both intention to treat and per protocol. Results: A total of 58 patients completed the 3-month follow-up, and 2 patients in the study group were excluded due to follow-up loss in the per-protocol analysis. In the intention-to-treat and per-protocol analyses, the study group showed significantly better hearing levels than did the control group at 500 Hz (p < 0.05) 1 month after treatment and at 1 kHz (p < 0.05) 3 months after treatment. However, the average PTA values and PTA at 2, 4, and 8 kHz showed no significant difference. WDS improvement was significantly higher in the study group compared to the control group 3 months after treatment by both per-protocol (66.4 ± 13.3 and 56.7 ± 19.1%, respectively; p = 0.029) and intention-to-treat analyses (65.9 ± 14.1 and 56.7 ± 19.1%, respectively; p = 0.035). The sum of complete and partial hearing recovery for the study group was significantly higher than that for the control group by per-protocol analysis (60.7 vs. 33.3%; p = 0.037) and intention-to-treat analysis (60.0 vs. 33.3%; p = 0.038). Conclusion: These results demonstrate that the addition of HBOT to steroid combination therapy does not improve the average PTA values in severe to profound ISSNHL; however, it was associated with a better outcome at 500 Hz 1 month after treatment and, at 1 kHz, WDS 3 months after treatment. The sum of complete and partial hearing recovery was significantly higher for the study group than for the control group.

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

“…In a recent study, comparing oral+IT steroid and oral+IT steroid+HBO therapies in ISSHL patients with severe and profound hearing loss (>70 dB), the addition of HBO to steroid combination therapy did not improve the mean PTA values. However, in the same study, they reported that the addition of HBO was beneficial for improving low-frequency hearing and word discrimination scores [ 21 ]. In our study, when the patients with severe and profound hearing loss (>60 dB) were evaluated separately, there was no significant difference between the two treatment groups in terms of both hearing gain and recovery rate.…”

The Clinical Value of Periventricular White Matter Hyperintensity on MRI in Sudden Sensorineural Hearing Loss

“…Sudden sensorineural hearing loss (SSNHL) is defined as an abrupt hearing deterioration of 30 dB or greater over 3 contiguous frequencies occurring within 72 hours. 1 Although the etiology of SSNHL still remains unclear and is therefore classified as idiopathic,4 possible underlying causes have been proposed: Viral disease, vascular compromise, immune-mediated processes, and cochlear membrane rupture. 2,3 Among these causes of SSNHL, vascular compromise or damage could include thrombotic vascular events, increased plasma viscosity, and vasospasm, resulting in minor cochlear infarction that resembles an acute myocardial infarction and cerebral stroke.…”

Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

“…After assessing the remaining 99 full-text articles, 41 studies were excluded for the following reasons: foreign language (n = 3), case reports (n = 3), review or meta-analysis (n = 10), and no mention of complications (n = 25). Finally, 58 studies 1-5,9-61 were included in the systemic review and meta-analysis including 25 randomized controlled trials, 10 prospective studies, and 22 retrospective case-controlled studies ( Table 1 ). A total of 2824 patients served as participants in the meta-analysis wherein 2567 received ITSI via TC (54 articles) and 257 received ITSI via VT (4 articles).…”