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

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.

 

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.

Doctor’s Education Evening 2018 – Book your seat today!

Our annual RAGCP Doctor’s Education Evening is now open for registrations. Any health professional who has an interest in Hyperbaric Medicine are encouraged to come along to find out how it works and what it can do for patients. Even better, those attending will be eligible to receive CPD points.

The course will be once again facilitated by Wesley Hyperbaric Medical Director Dr. Graeme Kay. You will learn all about the approved medical conditions that are treated at Wesley Hyperbaric as well as having the opportunity to tour the facility and see the chamber up close. There will be informative case studies from recent successful outcomes enabling you to make informed and educated decisions around referring your patients to us for treatment.

Facilitator Dr Graeme Kay

Dr Graeme Kay has been the Medical Director of Wesley Hyperbaric since 2015, serving as the Deputy Director from 2013-2015. Prior to starting at Wesley Hyperbaric he has had a varied medical career wearing many different hats; GP, hyperbaric medicine registrar at The Townsville Hospital, anaesthetic PHO and full-time rural relief doctor serving locations as varied as Hughenden, Ingham, Palm Island and Magnetic Island. He has a very keen interest in medical training and doctor’s welfare since serving as RMO president as a junior doctor in Rockhampton.

He has been a SCUBA diver from the age of 15, started his training in diving medicine in 2003, and holds the qualification of Diploma of Diving and Hyperbaric Medicine awarded by the South Pacific Underwater Medicine Society.

When not working or diving, Graeme can be found enjoying the life of a stay at home dad with his wife and daughters.

The event will take place on Tuesday 27 November and will run for around 2 hours from 6.00pm. The chamber facility is located within the Samford Jackson Building at the Wesley Hospital.

Places are limited so you should register today to ensure you can make this fun and informative event. Please call us on 07 3371 6033 or fill out the below form.

Doctor Education Evening Registration

Please complete to book your place.