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Original Investigation
September 27, 2018

Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing LossA Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Undersea and Hyperbaric Medicine, Maritime Medical Research Center, National Maritime Medical Center, Changwon, Republic of Korea
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  • 3Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
  • 4Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
JAMA Otolaryngol Head Neck Surg. Published online September 27, 2018. doi:10.1001/jamaoto.2018.2133
Key Points

Question  What is the benefit of the addition of hyperbaric oxygen therapy (HBOT) vs medical therapy alone for sudden sensorineural hearing loss (SSNHL)?

Findings  Results of this meta-analysis including 2401 patients with SSNHL significantly favored HBOT plus standard medical therapy (MT) over MT alone for complete hearing recovery and any hearing recovery, as well as for absolute hearing gain. The benefit of HBOT was greater in groups with severe hearing loss at baseline, HBOT as a salvage treatment, and a total HBOT duration of at least 1200 minutes.

Meaning  The benefit of HBOT for SSNHL may be greater for those who had severe hearing loss at baseline or who failed to recover after MT; optimal criteria for patient selection and a standardized regimen for HBOT should be established in future trials.

Abstract

Importance  Sudden sensorineural hearing loss (SSNHL) causes substantial disease burden for both individuals and socioeconomic aspects. The benefit of hyperbaric oxygen therapy (HBOT) in addition to standard medical therapy (MT) for idiopathic SSNHL has been unclear.

Objective  To perform a systematic review and meta-analysis to compare HBOT + MT with MT alone as a treatment for patients with SSNHL.

Data Sources  PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched up to February 2018.

Study Selection  Randomized clinical trials and nonrandomized studies comparing HBOT + MT with MT alone for SSNHL treatment.

Data Extraction and Synthesis  Two investigators independently screened the eligible studies, established data, and assessed quality and risk of bias. A systematic review and meta-analysis using random-effects models was conducted.

Main Outcomes and Measures  The primary outcome was complete hearing recovery, and secondary outcomes were any hearing recovery and absolute hearing gain.

Results  Three randomized clinical trials and 16 nonrandomized studies comparing outcomes after HBOT + MT vs MT alone in 2401 patients with SSNHL (mean age, 45.4 years; 55.3% female) were included. Pooled odds ratios (ORs) for complete hearing recovery and any hearing recovery were significantly higher in the HBOT + MT group than in the MT alone group (complete hearing recovery OR, 1.61; 95% CI, 1.05-2.44 and any hearing recovery OR, 1.43; 95% CI, 1.20-1.67). Absolute hearing gain was also significantly greater in the HBOT + MT group than in the MT alone group. The benefit of HBOT was greater in groups with severe to profound hearing loss at baseline, HBOT as a salvage treatment, and a total HBOT duration of at least 1200 minutes.

Conclusions and Relevance  The addition of HBOT to standard MT is a reasonable treatment option for SSNHL, particularly for those patients with severe to profound hearing loss at baseline and those who undergo HBOT as a salvage treatment with a prolonged duration. Optimal criteria for patient selection and a standardized regimen for HBOT should be applied in routine practice, with future trials to investigate maximal treatment benefit.

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