HBOT and Idiopathic Sudden Sensorineural Hearing Loss

Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is defined as hearing loss of at least 30dB occurring within 3 days over at least three contiguous frequencies.1

The most common clinical presentation involves sudden unilateral hearing loss, tinnitus, aural fullness and vertigo. The incidence is estimated at 8-15 per 10,0000 worldwide.2

There are currently over 100 publications available evaluating the use of hyperbaric oxygen therapy (HBOT) for treatment of ISSHL, including eight randomised control trials and a Cochrane meta-analysis.

On average, HBOT has been shown to impart a 19.3dB gain for moderate hearing loss and 37.7dB gain for severe cases. 3 This improvement brings hearing deficits from the moderate/severe range into the slight/no impairment range, a significant gain that can markedly improve a patient’s quality of life.

There is currently no consensus over the aetiology of ISSHL, with suggested mechanisms including vascular occlusion, ischemia, viral infection, labyrinthine membrane breaks, immune associated disease, abnormal cochlear stress response, trauma, abnormal tissue growth, toxins, ototoxic drugs and cochlear membrane damage. 4

The rationale for the mechanism of action for HBOT in ISSHL is likely due to the high metabolism and vascular paucity of the cochlea. Tissue oxygenation of the cochlear structures occurs via diffusion from cochlear capillary networks into the perilymph and cortilymph.

Perilymph oxygen tension has been shown to decrease significantly with ISSHL. 5 Animal studies have shown that compared to room air, normobaric oxygen increases perilymph PO2 3.4 fold, while HBO2 increases perilymph PO2 9.4 fold. 6 However, only HBO2 has been shown to achieve extremely high arterial perilymphatic oxygen concentration gradients in both animals and humans. Other additional postulated benefits include anti-inflammatory effects, blunting of ischemia reperfusion injury and oedema reduction.

When ISSHL is diagnosed, immediate referral to an ENT surgeon should occur. Oral steroids at 1mg/kg/day is a common initial dose tapering over the course of 2-3 weeks.

HBOT has been shown to be most effective if delivered within 2 weeks of hearing loss, with benefit possible up to 3 months post insult.7,8 Patients with a delay of greater than 14 days, advanced age and vertigo are however associated with poorer outcomes. 8

The Cochrane analysis of HBOT for ISSHL has shown a NNT of 5.3.3

A typical treatment regimen is of 10-15 treatments breathing 100% oxygen at 2.4ATA, during which routine pure tune audiometry is undertaken on a weekly basis to track changes in hearing acuity as a response to the treatment.

There is no medicare item number for treatment of ISSHL at this point in time, but the treatment is covered by Alliance health funds so there is no out of pocket expense for their clients.

Our unit will happily asses any referred patient with ISSHL. We can then discuss options and undertake treatment if required.

 

References

1 Haberkamp TJ, Tanyeri HM. Management of idiopathic sudden sensorineural hearing Loss. Am J Otol. 1999 Sep;20:587-592
2 Lionello M, Staffieri C, Breda S, Turato C, Giacomelli L, Magnavita P, de Filippis C, Staffieri A, Marioni G Uni- and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol. 2014 Mar 25.
3 Bennett MH, Kertesz T, Matthias P, Yeung P. Hyperbaric oxygen for idiopathic sensorineural hearing lossand tinnitus. Cochrane Database Sys Rev. 2010 Jan 20;(1): CD004739
4 Alimoglu Y, Inci E, Edizer DT, Ozdeilek A, Aslan M. Efficacy comparison of oral steroid, intratympanic steroid, hyperbaric oxygen and oral steroid and hyperbaric oxygen treatments in idiopathic sudden sensorineural hearing loss cases. Eur Arch otorhinology. 2011 Dec;268(12):1735-1741
5 Nagahara K, fisch U, Yagi n. Perilymph oxygenation in sudden and progressive sensorineural hearing loss. Acta Otolarygol. 1983 Jul-Aug; 96(1-2):57-68
6 Lamm C, Walliser U, Schumann K, Lamm K. Oxygen partial pressure measurements in the perilymph and the scala tympani in normo- and hyperbaric conditions. An animal experiment study. HNO. 1988 Sep;36(9):363-366
7 Marchesi G, Valetti TM, Amer M, Ross M, Tibertu R, Ferani R, Ferani R, Mauro G Di. The HBO effect in sudden hearing loss treatment. UHMS Annular Scientific Meeting Abstracts, 2000.
8 Murphy-Lavoie H, Piper S, Moon RE, LeGros T. Hyperbaric oxygen therapy for idiopathic sudden Sensorineural hearing Loss. Undersea Hyperb Med. 2012;39(3):777-792

Is Hyperbaric Treatment right for you?

Dr Graeme Kay explains the medical evidence behind what we can treat.
Dr Graeme Kay
Dr Graeme Kay
Doctor Graeme Kay is the director of a hyperbaric medicine facility. He has extensive post graduate medical experience and specialist credentials in primary care as well as diving and hyperbaric medicine. This makes him one of the most qualified and respected doctors for Hyperbaric Medicine in the region.

On a daily basis I am asked by patients who feel let down by the traditional medical establishment to treat their conditions. I almost never treat these people. I say almost because there is a role for research into treating conditions with novel therapies, but only under the guise of a formally structured research program with ethical consideration and approval.

The current flavours of condition outside my realm of accepted practice include autism, cerebral palsy, acquired brain injury, chronic fatigue syndrome and Lyme disease.

I imagine that people with these conditions seek my facility because they have exhausted what they feel traditional medicine can give them.

Unfortunately there is no shortage of unscrupulous traders out there, purveying their modern miracle magical cure.

It is possible to some degree to trace back in the literature when the current deviation from accepted practice occurred.

In 2001 a randomised sham-controlled study of 111 children with Cerebral palsy (CP) who received either 40 HBOT treatments at 1.75 ATA, or 40 air sessions at 1.3 ATA (Sham) was published.1 Both groups were found to improve in their outcome measures but with no difference between the groups. This was ascribed to a participation effect by the authors, a finding that was supported by an independent scientific advisory committee.2

There was a group within the hyperbaric medicine community, which is not supported by the community at large, that interpreted this result as an active effect of pressure, even as low as 1.3ATA which is the equivalent of 3m Salt water of pressure or 30kPa. A second sham controlled study was published in 2012 with 49 children with CP enrolled and randomised to receive 40 HBOT treatments at 1.5 ATA or 40 exposures of 1.5ATA breathing a 14% fraction of oxygen (resulting in an equivalent inspired fraction of 21%, thus eliminating the possibility of in increased inspired PO2 being attributable to any effect). Again this study found significant improvement in carer reported disability inventory but with no difference between either group.3

Similar studies for the use of HBOT for mild traumatic brain injury have been conducted. In all these studies there were reported improvements beyond that expected, but no discernible difference between treatment groups. Again a small proportion of the hyperbaric medicine community have attributed this result to a physiological effect from exposure to increased pressure, whilst the majority of the community considers the results to be that of a participation effect. 4,5

As such, the majority of hyperbaric physicians across the globe are of the opinion that delivering ‘mild hyperbaric’ treatments of 1.3ATA breathing air, concentrated oxygen or pure oxygen, has no actual physiological effect. It could be argued that at best, it is a misguided poor interpretation of the data currently available, at worst a wilful and duplicitous disregard for scientific method, being used as rationale for requesting payment for a treatment that is proven to have no benefit.

As credible hyperbaric medicine practice currently exists in Australia, a hyperbaric medicine facility must be a comprehensive hospital based hyperbaric unit with ability to treat all presentations up to and including ICU level of care, and rostered staff including a doctor with extensive training in diving and hyperbaric medicine and nursing staff also suitably trained available 24/7 in order to collect Medicare rebate and in turn access private health funds.6

As such, asking the following questions prior to undergoing hyperbaric treatments may help to sort the woo from fact:

  • Is the condition being treated one of the 14 conditions the UHMS recognises as benefiting from hyperbaric treatments?7
  • If not, does a logical and mechanism exist that has been supported by research in human, animal or in vitro models?
  • What sort of treatment is being provided? If it is less than 2ATA of pressure, and if less than 100% oxygen is being supplied, then there is no evidence that treatment has any efficacy.
  • Is the treatment being provided by a trained doctor and nursing staff? If not, the facility does not comply to the Australian standard 4774.2 and is not eligible for Medicare subsidy.
  • Am I being asked to pay out of pocket for treatment? The majority of Medicare compliant facilities exists as part of public hospitals and require no out of pocket payments. The private facilities that are Medicare Benefits Schedule and AS 4774.2 compliant access Medicare and private health funds for payment for most but not all 14 UHMS recommendations. As such there is usually no out of pocket expense other than any hospital admission co-pay that the patient has negotiated with their fund on joining plus an assessment fee.

By reviewing the above queries, you should be able to satisfy yourself that the services being provided are being applied in an evidence based manner, by trained healthcare staff operating ethically as bound by AHPRA, in a facility that is compliant to the appropriate industry standards to ensure treatments are provided as safely as possible.

References

  1. Collett J-P, Vanasse M, Marois P, Amar M, Goldberg J, Lambert J, et al. Hyperbaric oxygen for children with cerebral pals: a randomised multicentre trial. Lancet 2001;357:582-6
  2. Scientific Advisory Committee. Report Hyperbaric oxygen therapy for children with cerebral palsy: a multicentre randomised clinical trial. Quebec, Canada: Fonds dela recherche en santa du Quebec; 2000
  3. Lacey DJ, Stolfi A, pilat LE. Effects of hyperbaric oxygen on motor function in children with cerebral palsy. Ann Neurol. 2012;72:695-703
  4. Harch PG, Andrews SR, Fogarty EF, Amen D, Pessullo JC, Lucarini J, et al. A phase 1 study of low pressure hyperbaric oxygen therapy for blast induced post concussion syndrome and post traumatic stress disorder. J Neurotrauma. 2012;29:168-85
  5. Weaver LK, Cifu D, Hart B, Wolf G, Miller RS. Hyperbaric oxygen for post concussion syndrome: design of department of Defense clinical trials. Undersea hyperb Med 2012;39:807-14.
  6. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=T1.1&qt=noteID&criteria=T1.1
  7. https://www.uhms.org/resources/hbo-indications.html

Join our fight against dry mouth

Surviving from cancer is a massive achievement for many. Today’s technology in radiotherapy makes treatment more effective and potentially less damaging due to the ability to focus on the area that needs to receive radiation. There is, of course, some instances where collateral damage occurs to tissue which can lead to complications occurring some time after treatment has completed.

For head and neck cancer sufferers who have undergone treatment using radiation there is a possibility of saliva gland damage, which causes a condition known as xerostomia or dry mouth. This can negatively affect the patient’s quality of life, especially after surviving cancer. Xerostomia leaves people with a dry mouth and the inability to produce enough saliva which can cause difficulty with talking, eating and loss of taste resulting in poor nutrition, increased risk of dental decay and the inability to sleep well at night. And unfortunately, xerostomia can develop into an irreversible and life-long problem.

Wesley Hyperbaric wants to help alleviate these symptoms and is conducting a trial to help establish hyperbaric oxygen therapy as a viable treatment in patients suffering from xerostomia. Hyperbaric oxygen therapy has been successfully proven to help with soft tissue damage caused by radiation to other areas of the body, bringing hope that it can also be effective for salivary gland damage. Our trial will continue into 2019 to gain more information and produce evidence supporting the effectiveness of the treatment for the condition in the future.

Signs of xerostomia
  • Problems with eating, swallowing and talking continuously
  • Difficulty eating certain dry foods such as cereal
  • Denture issues such as fitting, sores or palate issues
  • Loss of taste
  • An increase in the need to drink water – especially at night
  • Dental and mouth issues such as inflammation, increased caries and ulcers.

Dr Ohnmar Aung, at Wesley Hyperbaric, is the principal investigator for this trial and is looking forward to helping more people suffering from Xerostomia. If you are interested in taking part in this trial, you will be able to help us gather scientific evidence and receive the treatment for free. All that is needed is that you have had radiation to the head and neck area and are now suffering from xerostomia and the ability to commit to taking part in a six-week program. You could be on the road to recovery as well as helping other people, in the future, who are suffering from the same conditions.

Please get in touch with us for more information on our services and to find out what the next steps are to take part in the trial.

Read our white paper on treating inflammatory bowel disease with HBOT

With an estimated 75,000 Australian’s living with inflammatory bowel disease and the numbers increasing each year there is good news around findings that hyperbaric oxygen therapy offers a solution.

As Australia’s pioneers in hyperbaric oxygen therapy, we have published a white paper on the topic. It covers the problems faced and offers up a solution complete with case studies to show the success in treating Crohn’s disease and also ulcerative colitis.

To find out more please access our white paper and learn more about how hyperbaric oxygen therapy can treat inflammatory bowel disease.

 

Living life after radiotherapy

If you or a loved one are one of the 1.2 million people every year who are diagnosed with an invasive cancer then the chances are this has come with a treatment with radiation. Whilst treatment has significantly improved over the years the resulting side effects can sometimes take its toll on the patient’s quality-of-life.

The radiation can sometimes cause complications with nutrients – including oxygen – from passing through the blood vessel walls. This lack of essential nutrients unfortunately hinder the healing of damaged tissues.

Here are some key facts about soft tissue radiation damage and hyperbaric oxygen therapy:

  • Occurs in less than 5% of people who undergo radiotherapy
  • Most commonly involves damage to the bladder or bowel
  • Most commonly noticed as blood in the urine and/or bowel movements
  • Randomized controlled trials have shown hyperbaric oxygen therapy can improve over 70% of people treated
  • Soft tissue radiation injury is the most common condition treated at Wesley Hyperbaric

The good news is that Wesley Hyperbaric has over two decades of experience treating people who suffer from soft tissue radiation injuries. Hyperbaric oxygen therapy is also proven to work most of the time.

So if you, or a loved one, are unfortunate to suffer from any of the conditions outlined above then we can definitely look at helping you get your life back on track. Get in contact today and find out what the next steps might be. Alternatively, speak to your GP or specialist about getting a referral.

US Chronic Radiation Proctitis study highly recommends Hyperbaric Oxygen Treatment.

The American Society of Colon and Rectal Surgeons (ASCRS) has recently released a study which looks at the treatments available for people suffering from radiation proctitis which strongly ranked hyperbaric oxygen treatment as a real solution.

Radiation is often successfully used in many types of cancer including anal, cervical, prostate and rectal. Despite the benefits, and often successful removal of tumours, collateral damage can occur to the gastrointestinal tract and the patient can be left suffering from chronic radiation proctitis. Despite advancements in technology which allow for more targeted radiation treatment, it is expected that post radiation injury is still likely to occur in some patients.

The study looked at several medical treatments available and hyperbaric oxygen treatment was one of the strongly recommended treatments based on having a moderate level of evidence. The breakdown of treatments, recommendations and level of supporting evidence is detailed below.

TYPE OF TREATMENT GRADE OF RECCOMMENDATION BASE ON
Formalin application is an effective treatment for bleeding in patients with CRP Strong recommendation moderate-quality evidence
Hyperbaric oxygen therapy is an effective treatment modality to reduce bleeding in patients with CRP Strong recommendation moderate-quality evidence
Short chain fatty acid enemas are not effective in preventing or treating chronic hemorrhagic radiation proctitis and are not recommended Weak recommendation moderate-quality evidence
Sucralfate retention enemas are a moderately effective treatment for rectal bleeding resulting from CRP Strong recommendation low-quality evidence
Alternative treatments such as mesalamine, ozone therapy, and metronidazole have not been adequately evaluated in treating radiation proctitis and are not recommended Strong recommendation low-quality evidence
Endoscopic argon beam plasma coagulation is a safe and effective treatment for rectal bleeding induced by CRP Strong recommendation moderate-quality evidence
Endoscopic bipolar electrocoagulation, radiofrequency ablation, Nd-YAG laser, and cryotherapy are alternative treatments of rectal bleeding from CRP that have been insufficiently evaluated and are thus not recommended Strong recommendation low-quality evidence

Wesley Hyperbaric has had proven results for people suffering from radiation proctitis and other radiation injuries. If you would like to find out more about what we do and how we can help, then please contact us.

Changes to our billing

As from 1st November 2018 we will be increasing our fees and changing the way we bill your consultation and wound care accounts.

As a private specialist practice, we provide outstanding, advanced wound care to our outpatients and hyperbaric patients and, as such, we will no longer bulk bill our fees, we will be adopting the AMA doctor rates. Please see the table of fees below.

To make the Medicare claiming process easier for our patients we have installed an Integrated Medicare two way claim system through our medical software program.

We will receipt your services and your rebate will be paid to your account, usually overnight.  You should be aware that the cost of treatment will be in excess of the amount Medicare will reimburse.

If you have any questions or would like more information about this please contact us to talk to one of our reception staff.

CONSULTATION DETAILS AMA FEE Out of Pocket
Wound Treatment (consumables) + doctor / specialist fee as outlined below.
You will pay for all your consumables used for treatment of your wound
Charged Out of Pocket Charged Out of Pocket
Level B Consultation GP (less than 20 minutes)

Level B Consultation Specialist (5 – 25 mins)

$79.95

$63.35

$42.35

$42.35

Level C Consultation GP (at least 20 minutes)

Level C Consultation Specialist (25 – 45mins)

$149.00

$114.20

$76.20

$76.20

Level D Consultation GP (at least 40 minutes)

Level D Consultation Specialist (more than 45 minutes)

$220.00

$172.85

$112.85

$112.85

Consultant Physician $330.00 $215.10

 

A brand new look

To help celebrate 20 years in business the hyperbaric chamber, located in the Wesley Hospital, has recently undergone a major rebrand.

We are now called Wesley Hyperbaric – a much shorter and friendlier name than the previously titled “The Wesley Centre for Hyperbaric Medicine”. One thing we have decided to keep however is our link to the Wesley Hospital. We remain proud to be part of this great hospital and hope that we can continue to offer a fantastic service to both the Wesley Hospital and the entire region.

Some of the treatments that we have helped out with over the past 20 years include non-healing wounds such as diabetic wounds, venous leg ulcers and the treatment of non-healing flaps after surgery. We also treat soft tissue injuries and ORN after patients have undergone radiation therapy.

Outside of the hyperbaric chamber, one of our key offerings to the Wesley Hospital has been our Advanced Wound Clinic. Our expertise and access to the best and most advanced wound care products has seen huge successes in treatment of wounds in patients. We have recently expanded and have now doubled the capacity to treat problematic wounds – meaning we can treat more patients and offer the excellent and friendly service we are known for.

Our team of dedicated staff are always on hand to answer any questions you may have about our services and if you are a health professional looking for more information we are very happy to come out to your place of business to give a presentation.

We look forward to many more years helping people across the region.