Lost and sound: exploring hyperbaric oxygen therapy for refractory SSNHL
Reviewed by Thomas William Binnersley

Can hyperbaric oxygen therapy (HBOT) offer a breakthrough for patients with refractory sudden sensorineural hearing loss (SSNHL)? SSNHL is defined as acute hearing loss of ≥30 decibels in three consecutive frequencies within three days. Typically, it’s treated with two weeks of high-dose oral corticosteroids, although a 2022 Cochrane review suggests combination therapy with intratympanic steroids may be more efficacious. HBOT involves inhalation of 100% oxygen at ≥1 atmosphere absolute (ATA) pressure. Whilst HBOT has no role in UK guidance, our American colleagues recognise it as an adjunct treatment to oral corticosteroids for SSNHL. However, little evidence exists regarding its effectiveness as monotherapy following combination steroid therapy failure. Lee and colleagues have set out to investigate whether high-pressure oxygen can help in this high-pressure scenario. In total, 84 patients with unilateral SSNHL and primary combination steroid treatment failure were retrospectively analysed. HBOT was administered to 18 patients at 2.5 ATA in a hyperbaric chamber for one hour over 10 consecutive days. These were compared to 66 control patients who received no further treatment. At three months post treatment, no statistically significant differences in final pure tone audiometry or word discrimination score was found. However, mean hearing gain in the HBOT cohort (16.8±4.5 dB) was significantly higher than the control group (4.5±1.0 dB) (P=.015), correlating with several previous studies on salvage HBOT therapy. The authors did not address risks including barotrauma, oxygen toxicity, and worsening of cataracts. They also relied on retrospective data from a relatively underpowered intervention group. Despite these limitations, the observed hearing gains indicate potential benefits worth exploring. Whilst not a miracle cure for SSNHL, HBOT shows enough promise to keep our ears pricked for more future research. So, whilst the jury’s still out, Lee and their team have certainly given us something to talk about – just make sure you’re listening closely!

The Effectiveness of Salvage Hyperbaric Oxygen Therapy Following Combined Steroid Therapy for Refractory Sudden Sensorineural Hearing Loss.
Lee JW, Kim H, Kong SK, et al.
ANN OTOL, RHINOL LARYNGOL
2024;133(4):400–5.