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Hyperbaric oxygen improved outcome when added to poly-pharmacy treatment of idiopathic sudden hearing loss.
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Clinical bottom line: 1. Using trial criteria, a higher proportion of patients recovered completely or partially when HBOT was added to treatment with steroids, pentoxifylline and dextran. |
Citation/s:1.Chi TH, Chiang MC, Chen RF, Yuan CH. Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?. Journal of the Royal Army Medical Corps. 2018 May 1;164(2):69-71.
Lead author's name and fax: C H Yuan han86449@gmail.com
Three-part Clinical Question:For patients with idiopathic sudden sensorineural hearing loss (ISSHL), does the addition of hyperbaric oxygen to standard treatment result in any improvement in hearing?
Search Terms: hearing loss, steroids, pentoxifylline
The Study:Non-blinded pseudo-randomised trial with intention-to-treat.
The Study Patients: Soldiers with ISSHL (1 to 10 days after onset) who were previously well.
Control group (N = 30; 30 analysed): Prednisolone 1mg/kg/day for one week then tapered to 20mg every 3 days for a further week, pentoxifylline 400mg bd for two weeks and 500 mls IV dextran daily for one week.
Experimental group (N = 30; 30 analysed): As above plus from day 8 for one week they received twice daily at 2.5 ATA for 90 minutes.
The Evidence:
Outcome |
Time to Outcome |
Standard group |
Hyperbaric group |
Relative risk reduction |
Absolute risk reduction |
NNT |
Complete recovery |
180 days |
0.10 |
0.27 |
167% |
0.17 |
6 |
95% CIs: |
-358% to 24% |
-0.36 to 0.02 |
NNT = 3 to INF NNH = 41 to INF | |||
Complete or partial recovery |
180 days |
0.47 |
0.80 |
71% |
0.33 |
3 |
95% CIs: |
22% to 120% |
0.10 to 0.56 |
2 to 10 | |||
Comments:
1. Pseudo-randomised using alternate allocation - authors suggest all eligible patients were enrolled.
2. Complete recovery is defined as a threshold of 25dB or less and partial recovery was a gain of 15dB and a final threshold between 25 and 45 dB.
3. No differences between groups at day 8 (prior to HBO) or day 13.
4. Recovery of 47% in control group is within spontaneous recovery range while 80% recovery with the addition of HBOT is higher than expected.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Saturday, 2 January 2021
Kill or Update By: June 2022
