Cho
The addition of hyperbaric oxygen to a combined steroid regimen may have improved the proportion of patients with useful return of hearing after idiopathic acute hearing loss.
Clinical Bottom Line:
|
1. Patients receiving hyperbaric oxygen were more likely to recover useful hearing, but this was not statistically significant. |
Citation/s:1. Cho I, Lee HM, Choi SW, Kong SK, Lee IW, Goh EK, Oh SJ. 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. Audiology and Neurotology. 2018;23(4):199-207.
Lead author's name and fax: Se-Jun Oh entmania @ pusan.ac.kr
Three-part Clinical Question:For patients with severe to profound sudden sensorineural hearing loss, does the addition of hyperbaric oxygen to steroid administration result in any improvement in outcome?
Search Terms: steroids; intratympanic; ISSNHL
The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients with severe to profound ISSNHL (>69 dB loss on average of four frequencies) and presenting within 10 days of onset.
Control group (N = 30; 30 analysed): Oral and intra-tympanic steroids. Oral methylprednisolone 0.8 mg/kg/day, and a maximum dose of 48 mg/day for 7 days with tapering down over 5 days. Intratympanic dexamethasone around 3mg daily for seven days.
Experimental group (N = 30; 28 analysed): As above plus daily sessions breathing 100% oxygen at 2.5 ATA for 60 minutes for 10 days.
The Evidence:
Outcome |
Time to Outcome |
Control group |
HBO group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Complete recovery to <10 dB loss and Word Discrimination Score <10 % loss compared to normal ear |
3 months |
0.17 |
0.37 |
120% |
0.2 |
5 |
95% CIs: |
-11% to 250% |
-0.02 to 0.42 |
NNT = 2 to INF; NNH = 55 to INF | |||
Measure |
Control group |
HBO group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
PTA loss over four frequencies at three months |
54.7 |
25.6 |
42.8 |
20.6 |
11.9 |
-274.4 to 298.2 |
|
Word discrimination score (% correct) at 3 months |
56.7 |
19.1 |
66.0 |
14.1 |
9.3 |
-140.6 to 159.2 |
Comments:
1. Pseudo-randomised study with consecutive alternating allocation to groups. The baseline pure tone average loss was about 90 dB in both groups, so sizeable improvement in both.
2. No sample size calculations were made and the study seems underpowered to support any apparent effect of HBOT.
2. Any improvements in the HBO group were at lower frequencies of 500 and 1000 kHz.
Appraised by:Mike Bennett m.bennett@unsw.edu.au ; Saturday, 16 October 2021
Kill or Update By: October 2023
