Antioxidants and hyperbaric oxygenation in the treatment of sensorineural hearing loss in children

Article in Russian

Muminov AI, Khatamov ZhA, Masharipov RR.

Efficiency of hyperbaric oxygenation (HBO) in combination with antioxidants was studied in 36 children aged 1-14 years with neurosensory hypoacusis vs standard treatment. A course of HBO consisted of 10 sessions (1.4 atm) for 40 min. The response was registered in 72.2% patients. It manifested in improvement of sound perception at 5-25 dB. The highest effectiveness was seen in acute neurosensory hypoacusis.

Thus, HBO in combination with antioxidants is recommended in combined treatment of neurosensory hypoacusis in children.

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HOW MANY HBO TREATMENTS ARE NECCESSARY FOR THE THERAPY OF SUDDEN DEAFNESS AND ACUTE TINNITUS?

W. Welslau1, A. Lammerding2, M. Almeling1, R. Busch1, G. Trombitas1 & G. Hesse3. 1Druckkammerzentrum, Hansteinstr. 29, 34121 Kassel, Germany; 2Druckkammerzentrum, 34454 Bad Arolsen, Germany & 3Tinnitus Klinik, Große Allee 3, 34454 Bad Arolsen, Germany.

INTRODUCTION:

Since the 1st ECHM conference (1994) sudden deafness is an accepted HBO indication. The aim of this study was to evaluate HBO effectiveness in sudden deafness/acute tinnitus according to number of treatments (10/15).

METHODS:

Patients with sudden deafness and acute tinnitus were treated with HBO after standard treatment (i.v. infusions, rheological drugs) without sufficient improvement. Prior to HBO therapy, after 10 and 15 treatments, and at least 3 months later, we took a tone audiogram and/or a questionaire with a visual analogue scale (VAS) according to recommendations of the 4th International Tinnitus Seminar, Bordeaux (´91) to determine tinnitus loudness. In the tone audiogram, a threshold recovery in 2 frequencies of over 10 dB and up to 20 dB was regarded as improvement, and over 20 dB as good improvement. In VAS we regarded 50% or less of initial loudness as improvement. Patients were treated 15 times on six days/week, breathing 100% oxygen for 60 min. at 250 kPa.

RESULTS:

From January to June 1996 we treated 129 patients. Mean delay after onset of symptoms was 6 weeks. In patients with sudden deafness (n=43) improvement in hearing was achieved in 11 patients (25.6%) after the 10th treatment and 14 patients (32.6%) after the 15th HBO session. Follow up at >3 months after HBO showed similar results (13 patients). Acute tinnitus loudness was found to decrease by < 50% in 10.9% of the patients after 10 treatments, and in 45.0% of the patients after 15 treatments (n=129). In the follow up, these results were kept within 39.8% (n=123).

CONCLUSIONS:

In sudden deafness and tinnitus 15 HBO-treatments show better results than 10 treatments. These results are confirmed by a follow up 3 months after HBO

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Hyperbaric oxygen as a method of therapy of sudden sensorineural hearing loss.

Racic G, Petri NM, Andric D.

Clinical Hospital Split, Croatia, Department of ENT. racic@doc.kbsplit.hr

Sudden hearing loss is a sensorineural hearing impairment, which develops over a period of few hours to a few days. Several theories have been proposed regarding the development of sudden sensorineural hearing loss. The incidence of sudden sensorineural hearing loss has been reported to range from 5 to 20 per 100,000 persons per year. Hearing loss is treated with drugs that provide better blood supply to the inner ear and decrease inflammation. The aim of this study is to examine the influence of hyperbaric oxygen therapy in treating sudden sensorineural hearing loss. The beneficial effects of HBO2 on sudden sensorineural hearing loss are probably achieved by an increase in the distribution of O2 dissolved per volume unit of blood circulating trough the regions affected by the lack of oxygen. Sessions were performed on 17 patients, with sudden sensorineural hearing loss that began within 10 days prior to the tests. In the hyperbaric chamber, all patients breathed 100% oxygen at 2.8 bars, for 60 minutes twice a day, either until recovered or for a maximum of 30 sessions. Of the total number of study participants, 12 were male and 5 were female, and their average age was 35.3 years (range: 18 to 68). Before the therapy, an average hearing value was obtained out of five basic frequencies. Hearing was found to be in the range of 61-93 dB in 12 patients, while 5 patients had hearing in the range of 41-60 dB. Following therapy with hyperbaric oxygen, the hearing level of 14 patients was within the range of 0-26 dB, two patients' hearing level increased to 27-40 dB, and one patient's hearing level remained in the range of 41-60 dB. The average hearing level for all patients and for all five basic frequencies was 67.8 dB before therapy, in comparison with 21.6 dB after oxygen therapy (p=0.0003). The average number of sessions in the hyperbaric chamber was 11.9 (range: 5 to 20). The therapy was taken well by all patients. The results of this study, as well as the results of similar studies performed by other authors, inicated for the necessity of performing an additional prospective, random, double-blind study of the effects of hyperbaric oxygen therapy on sudden sensorineural hearing loss, on a large number of patients.

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Hyperbaric Oxygen in the Treatment of Sudden Hearing Loss
Goran Racica, Sinisa Maslovaraa, Zeljka Rojea, Zoran Dogasb, Robert Tafraa
Original Paper

ENT Department, University Hospital Split, and
Department of Neuroscience, Split University School of Medicine, Split, Croatia

ORL 2003;65:317-320 (DOI: 10.1159/000076048)

Key Words

   * Hearing loss
   * Sudden deafness
   * Pentoxifylline
   * Hyperbaric oxygenation

Abstract

Treatment of idiopathic sudden hearing loss (SHL) is still a great problem for the physicians, due to the still unexplained etiopathogenesis of the disease. This retrospective study includes 115 patients with idiopathic SHL and compares two therapy regimens. Of the total number of patients, 51 had been primarily treated by hyperbaric oxygen (HBO) at 2.8 bar. The remaining 64 patients had been treated by pentoxifylline infusions in increasing and decreasing doses. Hearing thresholds were ascertained at the frequencies of 250, 500, 1,000, 2,000 and 4,000 Hz using pure-tone audiometry. The results after treatment showed a statistically significant improvement of hearing by 46.35 (SD ±18.58) dB hearing level (HL) in the group of patients treated with HBO, compared with an improvement of hearing by 21.48 dB HL (SD ±13.5) in the group of patients treated with pentoxifylline infusions (p < 0.001). Furthermore, hearing recovered to physiological values in 24 of 51 (47.1%) HBO-treated patients, compared to only 4 of 64 (6.2%) of the pentoxifylline-treated patients. Furthermore, after pentoxifylline treatment only 8/64 (12.5%) patients showed partial recovery, whereas after HBO therapy 21/51 (41.2%) patients improved up to a mild persistent hearing loss.

This indicates strong evidence that HBO therapy is more effective in the treatment of idiopathic SHL than conventional rheological treatment. However, more prospective clinical trials should confirm the efficiency of HBO therapy and lead to its wider application.

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Hyperbaric Oxygen Shows Promise as Initial Therapy for Sudden Deafness

NEW YORK (Reuters Health) Mar 29 - In patients with sudden deafness, initial treatment with hyperbaric oxygen (HBO) plus conventional therapy is associated with improved hearing outcomes compared with conventional therapy alone, according to a recent report.

While the exact cause of sudden deafness is unknown, cochlear hypoxia appears to play an important role. In an attempt to improve the hypoxic state, some centers have begun using HBO therapy. The reported success of such an approach has varied, but in most studies, HBO therapy was only pursued after conventional therapy had failed.

Dr. Cagatay Oysu, from Taksim State Hospital in Istanbul, Turkey, and colleagues assessed the hearing outcomes of 50 patients with sudden deafness who were treated at initial presentation with conventional therapy with or without HBO therapy.

Conventional therapy involved treatment with betahistine hydrochloride and prednisone, as well as a daily stellate ganglion block. Patients treated with HBO received a total of 20 sessions over a 13-day period.

The average hearing gain was 17.9 dB higher in patients who received combination therapy compared with those who received only conventional therapy, the authors state in the February issue of Otolaryngology-Head and Neck Surgery.

In the combination therapy group, mean hearing gain was highest in patients younger than 50 years of age. In fact, for patients older than 60 years, the addition of HBO therapy did not offer any hearing gain over conventional therapy.

HBO therapy is strongly recommended for patients younger than 50 years with sudden deafness, the authors state. "For patients between the ages of 50 and 60, the physician should explain to the patient the limited value of HBO therapy and discuss the cost and benefits of the treatment," they add. Given its potential complications and lack of benefit, HBO therapy is not recommended for patients older than 60 years.

Otolaryngol Head Neck Surg 2002;126:121-126.

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Hyperbaric oxygen therapy after unilateral idiopathic sudden deafness

[Article in German]

Kessler R.

HNO-Praxis, Gera. renekessler@telemed.de

The use of hyperbaric oxygenation therapy (HBOT) after acute one-sided deafness is a treatment option if conventional methods fail. Five cases have been reported in which an improvement in hearing after HBOT was achieved following unsuccessful conventional therapy.

In view of this, and after a careful study of the literature, we suggest that timely treatment with HBOT should be used in every case of unilateral idiopathic deafness.

PMID: 14740118 [PubMed - indexed for MEDLINE]

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Hyperbaric Oxygen Therapy and Alternobaric oxygen therapy in long-term treatment of Meniere's disease.
1: Undersea Hyperb Med. 2002 Winter;29(4):260-70.

Fattori B, De Iaco G, Nacci A, Casani A, Ursino F.

Department of Neurosciences, E.N.T. Unit, Pisa University, Pisa, Italy.

Hyperbaric oxygen therapy (HBQ) has been used for several years as a treatment for Meniere's disease, particularly in Sweden. In this study continuous variations in pressure (from 1.7 to 2.2 ATA; alternobaric oxygen therapy: HBOT) were used to decrease endolymphatic hydrops, the typical histopathological substrate of Meniere's disease by increasing hydrostatic pressure and mechanical stimulation of the endolymphatic flow toward the duct and the endolymphatic sac, which produces a consequent increase in the dissolved O2 content in the labyrinth liquid, which should contribute to recovering cell metabolism and restoring cochlear electrophysiological function to normal. An experimental group of 20 patients suffering from unilateral Meniere's disease received a total of 15 HBOT treatment sessions during the acute episodes. Treatment foresaw two days without therapy every five days of application. Maintenance treatment consisted of one session per day for five consecutive days every month for one year. Thereafter, during the second, third, and fourth years of treatment, patients were submitted to one session per day for five consecutive days every three months. A control group of 18 patients suffering from Meniere's disease was treated with 10% glycerol i.v. (during the acute episodes) and with betahistine (8 mg x 3/day) in the periods in between. Mean pure tone average (PTA in dBHL) hearing thresholds at octave frequencies from 500 to 3,000Hz, and frequency of episodes of vertigo and tinnitus, both after 15 days of treatment and at the end of a four-year follow-up, were compared for both groups according to the 1995 Committee on Hearing and Equilibrium criteria. No statistically significant differences were found between the two groups at the end of the first 15 days of treatment. However, at the end of the follow-up period, patients treated with HBOT had significantly fewer vertiginous episodes and improved PTAs and tinnitus compared to the controls.

The results support the use of HBOT as a valid alternative to drugs in the long-term treatment of Meniere's disease.

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Hyperbaric Oxygen Therapy in the long term treatment of Meniere's disease

Acta Otorhinolaryngol Ital 2001 Feb;21(1):1-9 (ISSN: 0392-100X)
Fattori B; Nacci A; Casani A; Donati C; De Iaco G
Dipartimento di Neuroscienze, Clinica ORL, Universita di Pisa.

Endolymphatic hydrops is the hystopathological substrate characteristic of Meniere's disease. Besides the classical treatment with diuretics and/or osmotic drugs for some time, now treatment in a "pressure chamber" (OTI) has also been applied.

The oxygen administered in the hyperbaric chamber can reduce the hydrops both by increasing the hydrostatic pressure and by mechanically stimulating the flow of endolymph toward the duct and endolymphatic sac. In addition, an increase is seen in the amount of O2 dissolved in the labyrinthine fluids and this contributes to recovering cell metabolism and restoring normal cochlear electrophysiological functions.

Between 1992 and 1996 40 patients with monolateral Meniere's disease were studied: 15 underwent oxygen therapy at a constant pressure (2.2 ATA) (HOT), 25 with a continuous variation in pressure (from 1.7 to 2.2 ATA) (Alternobaric therapy, AOT). During the acute phase the patients underwent daily OTI treatment for 15 days in a row. The maintenance treatment called for one treatment cycle (one session a day for 5 days in a row) a month for 1 year, followed by for one treatment cycle (one session a day for 5 days in a row) every three months during the 2nd, 3rd and 4th years. The controls consisted of a group of 18 patients treated with 10% glycerol i.v. (during the acute phase) and betahystine (8 mg x 3/die) between episodes. A comparison was made of the average hearing threshold for the frequencies 500-3000 Hz (PTA), how frequently episodes of dizziness arose and extent of hearing loss in the three groups after the initial 15 days of treatment and at the end of the 4-year follow-up, in compliance with the criteria laid down by the Committee on Hearing and Equilibrium in 1995. At the end of the first 15 days of treatment, there were no statistically significant differences between the three groups. At the end of the follow-up, on the other hand, Hyperbaric treatment, and in particular alternobaric therapy, enabled a significant reduction in the episodes of dizziness as compared to the control group. PTA and deafness also improved significantly in the patients who had undergone hyperbaric treatment.

The results of the present work show that HBOT, and in particular AOT, offer a valid alternative to drugs in the treatment of Meniere's disease.

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Hyperbaric oxygen treatment in sudden hearing loss after unsuccessful medical treatment

Kulak Burun Bogaz Ihtis Derg 2002 Sep-Oct;9(5):337-41
[Article in Turkish]

Inci E, Erisir F, Ada M, Ozturk O, Guclu E, Oktem F, Toprak M.

Department of Otolaryngology (KBB Anabilim Dali), Medicine Faculty of Cerrahpasa, Istanbul University, 34300 Istanbul, Turkey.

OBJECTIVES: We evaluated the efficacy of hyperbaric oxygen (HBO) treatment in patients with sudden hearing loss unresponsive to medical treatment. PATIENTS AND METHODS: Fifty-one patients (37 males, 14 females; mean age 37 years; range 9 to 63 years) with sudden hearing loss were treated with HBO following unsuccessful medical treatment. Time elapsed from the occurrence of sudden hearing loss ranged between 15 to 45 days. Treatment included two sessions daily for the first three days, followed by a single daily session, to make 20 sessions of 90 minutes. Treatment was discontinued because of early recovery in two patients. Audiometric examinations were made at the end of every five sessions. The patients were classified according to age, gender, and audiogram curves.

RESULTS: The mean hearing thresholds were 75.3 dB and 65.6 dB before and after treatment, respectively. Recovery was rated as complete in two patients (3.9%), moderate in two patients (3.9%), mild in 19 patients (37.25%), and as no recovery in 28 patients (54.9%). No significant differences were found between the patient groups in terms of improvement and hearing gain (p>0.05). CONCLUSION: We propose that HBO be resorted to when other means of medical treatment prove unsuccessful in patients with sudden hearing loss.

PMID: 12471279 [PubMed - in process]

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Otolaryngology - Head And Neck Surgery

February 2002 •

Original Articles

Does the addition of hyperbaric oxygen therapy to the conventional treatment modalities influence the outcome of sudden deafness?

   * Ismet Aslan, MD
   * Cagaty Oysu, MD
   * Bayram Veyseller, MD
   * Nermin Baserer, MD
   * Istanbul, Turkey

Abstract

Objective: To investigate the therapeutic effects of the addition of hyperbaric oxygen (HBO) therapy to the conventional therapies in sudden deafness (SD) and to investigate the influence of patient age on the effectiveness of HBO therapy.

Study Design and Setting: We undertook a retrospective review of 50 cases of SD treated at a tertiary university hospital. Twenty-five patients (group 1) were treated with betahistine hydrochloride, prednisone, and daily stellate ganglion block. A second group (group 2) of 25 patients received the same basic treatment with the addition of HBO therapy.

Results: The mean hearing gain was 20.0 dB in group 1 and 37.9 dB in group 2 (P < 0.05). In group 2 patients, the mean gains were 51.4 and 23.3 dB for those younger and older than 50 years (P < 0.05) and 48.9 and 14.5 dB for those younger and older than 60 years (P < 0.001), respectively. In patients older than 60 years, the mean gains were 14.5 and 14.4 dB in group 2 and group 1, respectively (P > 0.05).

Conclusions: The addition of HBO therapy to the conventional treatment significantly improves the outcome of SD, especially in patients younger than 50 years. Additional HBO therapy provides limited benefit in patients older than 50 years and no benefit in patients older than 60 years. (Otolaryngol Head Neck Surg 2002;126:121-26.)

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Sudden Deafness, Acute Tinnitus and Acute Acoustic
Trauma treated with Hyperbaric Oxygen ( HBO2 )
Presentation at the
Congress on Cerebral Ischemia, Vascular Dementia, Epilepsy and CNS Injury
Washington, DC May 9-13, 1998
by

Ch. Heiden, E. Biesinger, R. Hoeing
ENT Department Traunstein, Germany

Summary:

The pathophysiological reasons for sudden deafness and acute tinnitus, if not result of acoustic trauma, are not identifiable in the individual patient. Various hypotheses suggest that their development may be the result of an acute oxygen deficit. Experimental results show a significant decrease in partial pressure of oxygen in the lymph of the corti organ following exposure to noise.

The report deals with the statistical evaluation of treatment success of own studies and is displaying those from literature. The principles behind the use of hyperbaric oxygen therapy for inner ear disorders are explained.

Introduction:

Sudden deafness – one of the most impressive and easiest to evaluate inner ear dysfunctions – is one of the most common reasons to apply hyperbaric oxygenation in many countries around the world. We learned this at the joint meeting of a UHMS delegation to Chinese hyperbaric Centres 1996. Also in Japan and Europe a large number of these patients has been evaluated ( 1 ).

In Germany there are approximately 80 multiplace chambers. 80% of their patients are treated because of inner ear dysfunctions. The German Society for ENT Diseases, Head and Neck Surgery developed guidelines in accordance with the German Association of Scientific Medical Societies ( AWMF ). These guidelines ( 3 ) refer to hyperbaric oxygen as one among other treatment options for those symptoms listed in Table 1

This table is very surprising compared to the situation in the United States of America. Why do the German Society for ENT as well as the German national and the European scientific societies for hyperbaric medicine recommend HBO2 for inner ear dysfunctions?

Table 1 : Indications for HBO2 in the field of ENT
Indications for HBO2 in the field of ENT
From Guidelines of the
German Soc. ENT-Diseases, Head and Neck Surgery

Tinnitus

Related to acoustic trauma, head injury, sudden deafness, M. Ménière

Hearing Loss:

Related to sudden deafness, M. Ménière, ototoxic damage, acoustic trauma, trauma, infection

Deafness:

Related to sudden deafness, M. Ménière, ototoxic damage, acoustic trauma, contusio labyrinthii, barotrauma, zoster oticus, postoperative

Vertigo:

Related to acute functional loss of peripher vestibular organ, irritation of labyrinth, contusio labyrinthii, M. Ménière, sudden deafness

Otitis externa maligna

Pathophysiologic Aspects of Inner Ear Dysfunctions

The inner ear, with its anatomical and functional unit of cochlear and vestibular organs falls ill as a whole or in its parts. Any sensory organ is only able to show reactions according to its function. For instance a patient receiving a blow on an eye will tell you of optical phenomenons like seeing stars and darkness. So, in our case, we will find varying combinations of the three symptoms referring to inner ear function: vertigo, hearing loss and tinnitus.

In the literature it is well documented, that irrespective of the source of damage the stria vascularis and the cells of the organ of corti in the inner ear react uniformly ( 4 ).

In the cochlea histological findings are swelling and structural damage of the dendrites ( 5 ), alterations of mitochondria and the cell-structure, separation of hair-cells from tectorial membrane (6), oedema of the endothelium, oedematous closure of functional endarteries with blocking of the microcirculation. These alterations due to damage or vascular reactions limit the function. Improved oxygen supply and enhanced healing processes are seen as the solving keys for dysfunction of the inner ear. ( 7, 8, 9, 10 ).

Table 2 : Reactions of inner ear to noxious agents
Reactions of inner ear structures
to noxious agents
swelling of dendrites
structural damage of dendrites
alterations of mitochondria
alteration of cell-structure
separation of hair-cells from tectorial membrane
swelling of endothelium
oedematous closure of endarteries

Because of the uniform pathophysiological response of the cochlea, the therapy of inner ear dysfunctions is also uniform for sudden deafness, hearing losses, acute tinnitus and vertigo whether you prefer haemodilution, cortisone or HBO2 (see table 3). Exeptions are few diseases for which we have causal approach, for instance Ménière´s disease and autoimmunologic failures.

Table 3 : Therapy of inner ear disturbances
Therapy of inner ear disturbances
Haemodilution ( NaCl, Haes, Dextrane )
”vasodilative” ( Naftidrofuryl, Pentoxifylline, Flunarizine, Ginkgo biloba, Cinnarizine, Nicotinamide, Piracetam etc.)
Prednisolone
Vitamines
Stellate Ganglion block
Hyperbaric Oxygen ( HBO2 )

Until today it is not possible to state the reasons for the failure of inner ear malfunction in an individual. Therefore I will not discuss the large scale of pathogenetic factors.

Table 4 : Noxius factors causing inner ear disturbance
Noxious Factors for inner Ear
Perfusion disturbance Oedema
Vasomotoric disturb. Prolif. of endothelia
Hypotonia Ototoxic substances
Endolymphhydrops Bact. Toxines
Allergy Angiopathy
Viral infection Diabetes
Thrombocyte aggreg. Immunologic disease
Noise Trauma etc.

Experimental results

Usually the model for experimental work is the guinea pig exposed to noise, gun shots or explosions to produce acoustic trauma. The groups Lamm, Fisch and Japanese authors have published a profound decrease in the O2 partial-pressure in the lymph of the cochlea in animal and man during and after acoustic stress and in acute hearing loss. During exposure to HBO2 the pO2 increases up to 460 % in the cochlea and is still 60% above normal 1 hour after the termination of HBO2 ( 11 ).

Table 3 : Models for inner ear disturbances
Models for examination of inner ear dysfunction

Sudden deafness:
subjective / objective audiometry

Guinea pig / acoustic trauma
in situ measurements of pO²

With an increase of the partial-pressure of oxygen in the cochlea, which means in the perilymph and endolymph, it is possible to influence the sensory cells of the inner ear. These cells have no direct vascular supply and depend entirely on oxygen supply by diffusion. Only an increase in oxygen partial-pressure can compensate oxygen deficiency. With transcutaneous pO2 monitoring hyperoxygenation of the organism can be controlled. Evidence for the effect of hyperbaric oxygen is obtained by measuring microphonepotentials and summationpotentials of the auditory nerve after acoustic trauma with a significant increase in the speed of recovery.

The efficiency of HBO2 against oedema, infection, reperfusion-injury etc. and to supply oxygen even to areas of poor perfusion is well established and applies also for inner ear disorders.

Evaluation of a hearing loss by subjective or objective audiometry is comparatively easy to perform and the results are reproducible. That is the main reason why these parameters are used to evaluate treatment of inner ear dysfunction in the model of sudden deafness. But we have to stress the point, that for the patient vertigo and tinnitus are much more disabling than the hearing loss.

These basic considerations provide our argument for the use of HBO2 in otoneurologic disorders.

Literature Survey

Some controlled trials concerning around 1100 patients in 8 publications ( 12, - 19 ) confirm the results of retrospective case evaluations of around 7280 patients in 19 publications with sudden deafness. After ineffective conservative treatment including plasmaexpander such as Hydroxyaethylstarch or others, normovolaemic haemodilution, cortisone and oral haemo-rheological substances HBO2 is effective in 50% of the cases to reduce hearing loss by 20 dB or more. Approximately 11% have a complete recovery. Late application of HBO2 with a delay of more than 3 month reduce a beneficial outcome to 30 %. All authors confirm better results with earlier onset of HBO2 ( 1 ).

A randomised prospective trial of primary HBO2 versus primary conservative treatment in Germany is 50% completed and shows a better outcome in the HBO2-group with substantial recovery in 80% of the patients. Another controlled prospective trial including patients after ineffective conservative treatment including cortisone shows substantial improvement in more than 30% of the cases even if the delay was more than 3 month. Another identical trial of a university department showed the same results.

The evidence for HBO2 therapy for acute isolated tinnitus based on controlled trials is poor. But retrospective studies show encouraging results equal to those tinnitus-symptoms arising in combination with sudden deafness and acoustic trauma.

Tinnitus as a accompanying symptom is the predominant reason for patients to search relief. Often the hearing loss is not even realised.

Evaluations of 7766 patients in 13 publications show reduction of the molestation and intensity of tinnitus by 50% in around 70% of the cases ( 30% - 88% ) if treated within 3 month of onset. Around 30% loose their tinnitus completely.

Chronic tinnitus with a duration of more than 3 month or bilateral manifestation shows improvement rates of 50% in around 30% of the cases after ineffective conservative treatment. Follow ups show no change in 12 month ( 1 ).

Based on 1200 cases of acoustic trauma – partially evaluated in prospective studies - Pilgramm ( 20 ) states the best results by HBO2 in combination with Haes. Because of 50% spontaneous remission within the first 48 hours, HBO2 should start immediately the third day after trauma. If hyperbaric oxygenation is begun later, the effectiveness decreases rapidly.

So far we learned, that the outcome of HBO2 treatment of inner ear dysfunctin depends on the underlying disease. We have the impression that results are unsatisfying after viral otitis and head trauma. But at present our data are not sufficient to exclude some of the listed maladies from HBO2 treatment because of poor response. Own Results:

Since August 1995 in our multiplace chamber 70% of the patients have been treated for inner ear dysfunction. In 2200 sessions 1600 patients were treated for acute tinnitus, sudden deafness and acoustic trauma. The retrospectively evaluated results compared favourably to those in the literature.

A prospective controlled study was performed 1996 ( 2 ):

Out of 625 patients treated for tinnitus in our clinic from Okt. 1996 to Dec 1996 211 cases with acute tinnitus were included in the study.

69 Patients were treated with haemodilution and cortisone alone and had no HBO2

142 patients had HBO2, 72 of these after unsuccessful haemodilution
Results of Haemodilution for Tinnitus

69 cases
36,2 % healed completely
63,8% unchanged (25% decompensation)
Results of HBO2 for Tinnitus

142 cases
64,1 % healed completely
35,9% unchanged (18% decompensation)
Results of secondary HBO2 for Tinnitus

72 cases
51,4% healed completely
37,5 % improved
11,1% unchanged
0% worsened

These results show a better outcome for patients with acute tinnitus ( duration less than 3 month ) if they get HBO2. Especially the high rate of decompensated tinnitus from 63% chronifications ( duration more than 3 month ) after conservative therapy with the consequence of long lasting and expensive treatment with tinnitus masker, psychological based retraining procedures and often intensive behaviour therapy as in-patient treatment shows HBO2 not only as effective but also cost saving.

In Germany refunding by health insurances for HBO2 treatment of sudden deafness and tinnitus is accepted by the majority of these institutions.

To support this therapy from the scientific and economic aspect 5 major prospective trials are carried out in Germany at the moment – with a sixth in planning.

Controlled prospective studies

  1. University Düsseldorf:
     Ineffective conservative treated patients continued with HBO2-therapy
  2. techn. University Munich
     Ineffective conservative treated patients continued with HBO2-therapy
  3. University Hannover
     Randomised primary treatment conservative vs. HBO2
  4. University Homburg and University Freiburg
     Randomised: Haemorheologic and antiinflammatory treatment tested against this treatment in combination with HBO2
  5. University Lübeck and German Navy
     Randomised sudden deafness, acoustic trauma, tinnitus controlled against conservative treatment and controlled against hyperbaric air
  6. University Hannover
     randomised primary treatment HBO2, conservative treatment, no treatment

The results of established, conservative but unproven medical treatment regimes for the mentioned inner ear dysfunctions are unsatisfying. Therefore it is necessary to search for new treatment options based on pathological considerations. Hyperbaric oxygen has beneficial effect for these patients. This has been demonstrated in various retrospective studies and in controlled prospective trials. A final evidence based recommendation will be possible after conclusion of the randomised trials which are now in progress.

Literature:

  1. Lamm H: Der Einfluß der hyperbaren Sauerstofftherapie auf den Tinnitus und den Hörverlust bei akuten und chronischen Innenohrschäden. Otolaryngol Nova 5 (1995) 161-9
  2. Biesinger E, Ch. Heiden, V. Greimel, T. Lendle, R. Höing, K. Albegger: Strategien in der ambulanten Behandlung des Tinnitus. HNO 46 (1998) 157-169
  3. Ganzer, E., Arnold, W.: Leitlinien / Algorithmen der Deutschen Gesellschaft für Hals- Nasen- Ohrenheilkunde, Kopf- und Halschirurgie. Laryngo. Rhino. Otol. 75 (1996): 499-512 Internet : http://www.hno.org/leitl.htm
  4. Beck C: Pathologie der Innenohrschwerhörigkeiten. Arch Otorhinolaryngol Suppl I (1984) 1-57
  5. Robertson: Functional significance of dendritic swelling after loud sounds in the guinea pig cochlea. Hear Res. 9 (1983) 263-78
  6. Tonndorf: Acute cochlear disorder: The combination of hearing loss, recruitment, poor speech discrimination and tinnitus. Ann Otol 89 (1980) 353-8
  7. Yamane et al.: Strial circulation impairment due to acoustic trauma. Acta Otolaryngol. 111 (1991) 85-93
  8. Hawkins: Comparative otopathology: aging, noise and ototoxic drugs. Adv.Oto-Rhino-Laryng 20 (1973) 124-41
  9. Beck et al.: Morphologische Veränderungen an der Schnecke des Meerschweinchens bei Sauerstoffmangel und Lärmbelastung. Arch. Otolaryngol. 172 (1957) 238-45
  10. Axelsson et al.: The effect of noise on histological measures of cochlear vasculature and red cell: A review. Hear Res. 31, (1987) 183-92
  11. Lamm K.: Simultane Sauerstoffpartialdruckbestimmung in der Skala Tympani, Elektrokochleographie und Blutdruckmessungen nach Knalltraumata bei Meerschweinchen. HNO 37 (1989) 48-55
  12. Takahashi H, Sakakibara K, Murahashi K, Yanagita N: HBO for sudden deafness - a statistical survey over 907 ears. In: Bakker DJ, Schmutz J (eds) Hyperbaric Medicine. Proceedings of the Joint Meeting 2nd Swiss Symposium and 2nd European Conference on Hyperbaric Medicine. Basel, Switzerland, Sep 1988. Foundation for Hyperbaric Medicine, Basel, 1990 (ISBN : 3-908229-01-4) : 249-258
  13. Pilgramm M, Lamm H, Schumann K: Zur hyperbaren Sauerstofftherapie beim Hörsturz. (Hyperbaric oxygentherapy in sudden deafness). Laryngol Rhinol Otol (Stuttg) 64 (1985) 351-354
  14. Schmidt R.: Hyperbare Sauerstofftherapie bei therapieresistentem Hörsturz. Dissertation Uni Frankfurt 1995
  15. Dauman R, Poisot D, Cros AM, Mehsen M: Hemodilution, oxygenotherapie hyperbare et vasodilatateurs dans les surdites brusques. J Fr Otorhinolaryng (Lyon) 34 (1985) 93-96
  16. Daumann R., AM. Cros, D. Poisot: Traitements des surdites brusques: premiers resultats d'une etude comparative. (Treatment of sudden deafness: first results of a comparative Study.). J. Otolaryngol (Toronto)14 (1985) 49-56
  17. Desloovere C., Knecht R., B.Rosemann, R.Schmidt, D.Böhmer, G.Hoffmann, B.Böckler: Hyperbare Sauerstofftherapie bei therapieresistenten Hörstürzen. Eur Arch Otolaryngol Suppl II, (1992) 195-7
  18. Goto F, Fujita T, Kitani Y, Kanno M, Kamei T, Ishii H.: Hyperbaric oxygen and stellate ganglion blocks for idiopathic sudden hearing loss. Acta Otolaryngol (Stockh) 88 (1979) 335-342
  19. Hoffmann G., D Böhmer, Chr Desloovere: Hyperbaric oxygenation as a treatment for sudden deafness and acute Tinnitus. Proc. 11. Int. Kongr. Hyperb. Med. Best Publ. Comp. 1995, 146 – 152 und 24 – 25
  20. Pilgramm: Zur Anwendung der HBO-Therapie beim akuten Knalltrauma. in Tirpitz (Hrsg): Therapie mit hyperbarem Sauerstoff (HBO) in Traumatologie und Notfallmedizin. Symposium Duisburg 1993. Springer (1994) 51 – 62

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Sudden Deafness, Acute Tinnitus and Acute Acoustic Trauma, treated with Hyperbaric Oxygen

We combine I.V. Drips therapy plus
HBOT for the best results

The role of hyperbaric oxygen therapy in otolaryngology has mostly been investigational in the past, but its clinical applications in diseases of the inner ear are being increasingly recognized by physicians in Germany, Japan and China. HBOT is used in the treatment of infections such as malignant otitis external and osteomyelitis of the jaw and is well recognized in North America.

Indications for HBOT (as practiced in Germany) in ENT disorders and related areas

   * Barotraumas (Labyrinthine contusions, Decompression sickness of inner ear)
   * Bone involvement in ENT area (Osteomyelitis, Osteonecrosis)
   * Hearing loss

   * Acute acoustic trauma
   * Drug-induced hearing loss
   * Noise-induced hearing loss
   * Postoperative hearing loss
   * Retrocochlear hearing loss of unknown origin

   * Meniere's disease
   * Otitis external maligna
   * Tinnitus
   * Vertigo

In studies done on tinnitus, it has been shown to significantly improve this condition if treated in the first 3 months. If HBOT is started between 3-6 months after the onset, the improvement rate drops and after 1 year there is usually only little improvement in the tinnitus.

In sudden hearing loss and acoustic trauma, the pO2 decreases significantly in the fluid spaces of the inner ear, during noise exposure. Morphological damage results from noise of gunfire, leading to intra and extracellular ion imbalances, hearing damage, and decline of p02 in the fluid spaces of the inner ear.

Animal experimental studies showed the hair cells of the inner ear react in a uniform way to damage caused by noise, viruses, ototoxic substances and hypoxia. The hair cells first swell and lose their function. This effect is reversible with HBOT in cases of minor damage. In cases of severe damage or if the swelling persists for more than one year, the hair cells degenerate and are replaced by non-functioning endothelial cells.

Studies have shown that more than 90% of the patients showed an improvement of hearing and in 40% of these a normal hearing was achieved. From the numerous studies it is concluded that HBOT improves the results of the conventional treatment for sudden deafness and best results are achieved if the treatment is stared early after the onset of deafness.

Rationale for HBOT in Sudden Deafness

  1. HBO increases the pO2 in the inner ear. The experimental evidence for this has been provided by Lamm et al (l988). The insertion of oxygen-sensitive microelectrodes into the inner ears of guinea pigs led to a drop of pO2 in the scala tympani. The animals were placed in the hyperbaric chamber and after is was flooded with oxygen at normal pressure, pO2 was noted to increase by 204%; when pressure was raised to 1.6 bar, pO2 increased by 563% as compared with the original value. The increased oxygen supply corrects the hypoxia.
  2. HBO improves hemorrheology (Mathieu et all 1984) and contributes to improved microcirculation. HBO not only lowers the hematocrit and whole blood viscosity, it also improves the erythrocyte elasticity (Pilgramm et all 1988).

Acute Acoustic Trauma

Acute acoustic trauma is defined as an acute impairment of hearing caused by sharp sounds like that of a gun going off near an unprotected ear. Sounds of moderate intensity as encountered in everyday life usually do not affect the oxygen tension within the cochlea, but high intensity sounds can reduce it.

The published clinical data on the use of HBO for sudden hearing loss were reviewed by Lamm et at (1998).

   * In conclusion, HBO therapy is recommended and warranted in patients with idiopathic sudden deafness, acoustic trauma or noise-induced hearing loss within 3 months after onset of disorder.

References

Textbook of Hyperbaric Medicine, 3rd Revised Edition, K.K. Jain

Proceedings of the Eighth International Congress on Hyperbaric Medicine, H.Lamm, Kerstin Lamm, Germany

Lamm H. Klinische Ergebnisse nach Behandlung von Innenohrschwerhorigkeiten mit hyperbarem Saustoff. (Results and conditions of inner-ear hearing loss with hyperbaric oxygen.) Diskuss. Halle/Salle: Beitrag HNO-Jahrekongress der DDR, 1966.

Presentation at the Congress on Cerebral Ischemia, Vascular Dementia, Epilepsy and CNS Injury,Washington, DC May 9-13, 1998 by Ch. Heiden, E. Biesinger, R. Hoeing ENT Department Traunstein, Germany.

Summary:

The pathophysiological reasons for sudden deafness and acute tinnitus, if not result of acoustic trauma, are not identifiable in the individual patient. Various hypotheses suggest that their development may be the result of an acute oxygen deficit. Experimental results show a significant decrease in partial pressure of oxygen in the lymph of the corti organ following exposure to noise.

The report deals with the statistical evaluation of treatment success of own studies and is displaying those from literature. The principles behind the use of hyperbaric oxygen therapy for inner ear disorders are explained.

Introduction:

Sudden deafness – one of the most impressive and easiest to evaluate inner ear dysfunctions – is one of the most common reasons to apply hyperbaric oxygenation in many countries around the world. We learned this at the joint meeting of a UHMS delegation to Chinese hyperbaric Centers 1996. Also in Japan and Europe a large number of these patients has been evaluated (1).

In Germany there are approximately 80 multiplace chambers. 80% of their patients are treated because of inner ear dysfunctions. The German Society for ENT Diseases, Head and Neck Surgery developed guidelines in accordance with the German Association of Scientific Medical Societies ( AWMF ). These guidelines (3) refer to hyperbaric oxygen as one among other treatment options for those symptoms listed in Table 1.

This table is very surprising compared to the situation in the United States of America. Why do the German Society for ENT as well as the German national and the European scientific societies for hyperbaric medicine recommend HBO2 for inner ear dysfunctions?

Table 1, Indications for HBO2 in the field of ENT

Pathophysiologic Aspects of Inner Ear Dysfunctions

The inner ear, with its anatomical and functional unit of cochlear and vestibular organs falls ill as a whole or in its parts. Any sensory organ is only able to show reactions according to its function. For instance a patient receiving a blow on an eye will tell you of optical phenomenons like seeing stars and darkness. So, in our case, we will find varying combinations of the three symptoms referring to inner ear function: vertigo, hearing loss and tinnitus.

In the literature it is well documented, that irrespective of the source of damage the stria vascularis and the cells of the organ of corti in the inner ear react uniformly (4).

In the cochlea histological findings are swelling and structural damage of the dendrites (5), alterations of mitochondria and the cell-structure, separation of hair-cells from tectorial membrane (6), oedema of the endothelium, oedematous closure of functional endarteries with blocking of the microcirculation. These alterations due to damage or vascular reactions limit the function. Improved oxygen supply and enhanced healing processes are seen as the solving keys for dysfunction of the inner ear. (7, 8, 9, 10).

Table 2 Reactions of inner ear to noxious agents

Because of the uniform pathophysiological response of the cochlea, the therapy of inner ear dysfunctions is also uniform for sudden deafness, hearing losses, acute tinnitus and vertigo whether you prefer haemodilution, cortisone or HBO2 (see table 3). Exeptions are few diseases for which we have causal approach, for instance Ménière´s disease and autoimmunologic failures.

Table 3 Therapy of inner ear disturbances

Until today it is not possible to state the reasons for the failure of inner ear malfunction in an individual. Therefore I will not discuss the large scale of pathogenetic factors.

Table 4 Noxius factors causing inner ear disturbance

Experimental results

Usually the model for experimental work is the guinea pig exposed to noise, gun shots or explosions to produce acoustic trauma. The groups Lamm, Fisch and Japanese authors have published a profound decrease in the O2 partial-pressure in the lymph of the cochlea in animal and man during and after acoustic stress and in acute hearing loss. During exposure to HBO2 the pO2 increases up to 460 % in the cochlea and is still 60% above normal 1 hour after the termination of HBO2 (11).

Table 5 Models for inner ear disturbances

With an increase of the partial-pressure of oxygen in the cochlea, which means in the perilymph and endolymph, it is possible to influence the sensory cells of the inner ear. These cells have no direct vascular supply and depend entirely on oxygen supply by diffusion. Only an increase in oxygen partial-pressure can compensate oxygen deficiency. With transcutaneous pO2 monitoring hyperoxygenation of the organism can be controlled. Evidence for the effect of hyperbaric oxygen is obtained by measuring microphonepotentials and summationpotentials of the auditory nerve after acoustic trauma with a significant increase in the speed of recovery.

The efficiency of HBO2 against oedema, infection, reperfusion-injury etc. and to supply oxygen even to areas of poor perfusion is well established and applies also for inner ear disorders.

Evaluation of a hearing loss by subjective or objective audiometry is comparatively easy to perform and the results are reproducible. That is the main reason why these parameters are used to evaluate treatment of inner ear dysfunction in the model of sudden deafness. But we have to stress the point, that for the patient vertigo and tinnitus are much more disabling than the hearing loss.

These basic considerations provide our argument for the use of HBO2 in otoneurologic disorders.

Literature Survey

Some controlled trials concerning around 1100 patients in 8 publications (12, - 19) confirm the results of retrospective case evaluations of around 7280 patients in 19 publications with sudden deafness. After ineffective conservative treatment including plasmaexpander such as Hydroxyaethylstarch or others, normovolaemic haemodilution, cortisone and oral haemo-rheological substances HBO2 is effective in 50% of the cases to reduce hearing loss by 20 dB or more. Approximately 11% have a complete recovery. Late application of HBO2 with a delay of more than 3 month reduce a beneficial outcome to 30 %. All authors confirm better results with earlier onset of HBO2 (1).

A randomised prospective trial of primary HBO2 versus primary conservative treatment in Germany is 50% completed and shows a better outcome in the HBO2-group with substantial recovery in 80% of the patients. Another controlled prospective trial including patients after ineffective conservative treatment including cortisone shows substantial improvement in more than 30% of the cases even if the delay was more than 3 month. Another identical trial of a university department showed the same results.

The evidence for HBO2 therapy for acute isolated tinnitus based on controlled trials is poor. But retrospective studies show encouraging results equal to those tinnitus-symptoms arising in combination with sudden deafness and acoustic trauma.

Tinnitus as a accompanying symptom is the predominant reason for patients to search relief. Often the hearing loss is not even realised.

Evaluations of 7766 patients in 13 publications show reduction of the molestation and intensity of tinnitus by 50% in around 70% of the cases (30% - 88%) if treated within 3 month of onset. Around 30% loose their tinnitus completely.

Chronic tinnitus with a duration of more than 3 month or bilateral manifestation shows improvement rates of 50% in around 30% of the cases after ineffective conservative treatment. Follow ups show no change in 12 month (1).

Based on 1200 cases of acoustic trauma – partially evaluated in prospective studies - Pilgramm (20) states the best results by HBO2 in combination with Haes. Because of 50% spontaneous remission within the first 48 hours, HBO2 should start immediately the third day after trauma. If hyperbaric oxygenation is begun later, the effectiveness decreases rapidly.

So far we learned, that the outcome of HBO2 treatment of inner ear dysfunctin depends on the underlying disease. We have the impression that results are unsatisfying after viral otitis and head trauma. But at present our data are not sufficient to exclude some of the listed maladies from HBO2 treatment because of poor response.

Own Results

Since August 1995 in our multiplace chamber 70% of the patients have been treated for inner ear dysfunction. In 2200 sessions 1600 patients were treated for acute tinnitus, sudden deafness and acoustic trauma. The retrospectively evaluated results compared favourably to those in the literature.

A prospective controlled study was performed 1996 (2): Out of 625 patients treated for tinnitus in our clinic from Okt. 1996 to Dec 1996 211 cases with acute tinnitus were included in the study.

69 Patients were treated with haemodilution and cortisone alone and had no HBO2

142 patients had HBO2, 72 of these after unsuccessful haemodilution

These results show a better outcome for patients with acute tinnitus ( duration less than 3 month ) if they get HBO2. Especially the high rate of decompensated tinnitus from 63% chronifications ( duration more than 3 month ) after conservative therapy with the consequence of long lasting and expensive treatment with tinnitus masker, psychological based retraining procedures and often intensive behaviour therapy as in-patient treatment shows HBO2 not only as effective but also cost saving.

In Germany refunding by health insurances for HBO2 treatment of sudden deafness and tinnitus is accepted by the majority of these institutions.

To support this therapy from the scientific and economic aspect 5 major prospective trials are carried out in Germany at the moment – with a sixth in planning.

Controlled prospective studies

  1. University Düsseldorf: Ineffective conservative treated patients continued with HBO2-therapy
  2. Ttechn. University Munich Ineffective conservative treated patients continued with HBO2-therapy
  3. University Hannover Randomised primary treatment conservative vs. HBO2
  4. University Homburg and University Freiburg Randomised: Haemorheologic and antiinflammatory treatment tested against this treatment in combination with HBO2
  5. University Lübeck and German Navy Randomised sudden deafness, acoustic trauma, tinnitus controlled against conservative treatment and controlled against hyperbaric air
  6. University Hannover randomised primary treatment HBO2, conservative treatment, no treatment

The results of established, conservative but unproven medical treatment regimes for the mentioned inner ear dysfunctions are unsatisfying. Therefore it is necessary to search for new treatment options based on pathological considerations. Hyperbaric oxygen has beneficial effect for these patients. This has been demonstrated in various retrospective studies and in controlled prospective trials. A final evidence based recommendation will be possible after conclusion of the randomised trials which are now in progress.

Literature:

  1. Lamm H: Der Einfluß der hyperbaren Sauerstofftherapie auf den Tinnitus und den Hörverlust bei akuten und chronischen Innenohrschäden. Otolaryngol Nova 5 (1995) 161-9
  2. Biesinger E, Ch. Heiden, V. Greimel, T. Lendle, R. Höing, K. Albegger: Strategien in der ambulanten Behandlung des Tinnitus. HNO 46 (1998) 157-169
  3. Ganzer, E., Arnold, W.: Leitlinien / Algorithmen der Deutschen Gesellschaft für Hals- Nasen- Ohrenheilkunde, Kopf- und Halschirurgie. Laryngo. Rhino. Otol. 75 (1996): 499-512 Internet : http://www.hno.org/leitl.htm
  4. Beck C: Pathologie der Innenohrschwerhörigkeiten. Arch Otorhinolaryngol Suppl I (1984) 1-57
  5. Robertson: Functional significance of dendritic swelling after loud sounds in the guinea pig cochlea. Hear Res. 9 (1983) 263-78
  6. Tonndorf: Acute cochlear disorder: The combination of hearing loss, recruitment, poor speech discrimination and tinnitus. Ann Otol 89 (1980) 353-8
  7. Yamane et al.: Strial circulation impairment due to acoustic trauma. Acta Otolaryngol. 111 (1991) 85-93
  8. Hawkins: Comparative otopathology: aging, noise and ototoxic drugs. Adv.Oto-Rhino-Laryng 20 (1973) 124-41
  9. Beck et al.: Morphologische Veränderungen an der Schnecke des Meerschweinchens bei Sauerstoffmangel und Lärmbelastung. Arch. Otolaryngol. 172 (1957) 238-45
  10. Axelsson et al.: The effect of noise on histological measures of cochlear vasculature and red cell: A review. Hear Res. 31, (1987) 183-92
  11. Lamm K.: Simultane Sauerstoffpartialdruckbestimmung in der Skala Tympani, Elektrokochleographie und Blutdruckmessungen nach Knalltraumata bei Meerschweinchen. HNO 37 (1989) 48-55
  12. Takahashi H, Sakakibara K, Murahashi K, Yanagita N: HBO for sudden deafness - a statistical survey over 907 ears. In: Bakker DJ, Schmutz J (eds) Hyperbaric Medicine. Proceedings of the Joint Meeting 2nd Swiss Symposium and 2nd European Conference on Hyperbaric Medicine. Basel, Switzerland, Sep 1988. Foundation for Hyperbaric Medicine, Basel, 1990 (ISBN : 3-908229-01-4) : 249-258
  13. Pilgramm M, Lamm H, Schumann K: Zur hyperbaren Sauerstofftherapie beim Hörsturz. (Hyperbaric oxygentherapy in sudden deafness). Laryngol Rhinol Otol (Stuttg) 64 (1985) 351-354
  14. Schmidt R.: Hyperbare Sauerstofftherapie bei therapieresistentem Hörsturz. Dissertation Uni Frankfurt 1995
  15. Dauman R, Poisot D, Cros AM, Mehsen M: Hemodilution, oxygenotherapie hyperbare et vasodilatateurs dans les surdites brusques. J Fr Otorhinolaryng (Lyon) 34 (1985) 93-96
  16. Daumann R., AM. Cros, D. Poisot: Traitements des surdites brusques: premiers resultats d'une etude comparative. (Treatment of sudden deafness: first results of a comparative Study.). J. Otolaryngol (Toronto)14 (1985) 49-56
  17. Desloovere C., Knecht R., B.Rosemann, R.Schmidt, D.Böhmer, G.Hoffmann, B.Böckler: Hyperbare Sauerstofftherapie bei therapieresistenten Hörstürzen. Eur Arch Otolaryngol Suppl II, (1992) 195-7
  18. Goto F, Fujita T, Kitani Y, Kanno M, Kamei T, Ishii H.: Hyperbaric oxygen and stellate ganglion blocks for idiopathic sudden hearing loss. Acta Otolaryngol (Stockh) 88 (1979) 335-342
  19. Hoffmann G., D Böhmer, Chr Desloovere: Hyperbaric oxygenation as a treatment for sudden deafness and acute Tinnitus. Proc. 11. Int. Kongr. Hyperb. Med. Best Publ. Comp. 1995, 146 – 152 und 24 – 25
  20. Pilgramm: Zur Anwendung der HBO-Therapie beim akuten Knalltrauma. in Tirpitz (Hrsg): Therapie mit hyperbarem Sauerstoff (HBO) in Traumatologie und Notfallmedizin. Symposium Duisburg 1993. Springer (1994) 51 – 62

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SUDDEN SENSORINEURAL DEAFNESS: TREATMENT WITH HYPERBARIC OXYGEN THERAPY AFTER FAILURE OF A TEN DAY COURSE OF "CLASSICAL" DRUG THERAPY

C. Desloovere & P. Germonpre2. ENT Department, University of Leuven, Belgium & 2Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium

INTRODUCTION:

The optimal treatment of Idiopathic Sudden Sensorineural Deafness (ISSD) is not well defined. This is partly due to the fact that there can be no causal therapy for a disease of which the cause is not known. The therapeutic outcome of several proposed drug treatment regimes is in the same range as the spontaneous recovery rate, which can be as high as 65%.

METHODS:

During the last two years, 26 patients have been treated with Hyperbaric Oxygen Therapy (HBOT) following a strict stepwise therapeutic protocol. All patients were treated initially with high-dose intravenous steroids, associated with hypervolemic haemodilution, if indicated. Only upon failure of this treatment after 10 treatment days, were patients additionally treated with HBOT (daily sessions at 2.5 ATA for 90 minutes).

RESULTS AND CONCLUSIONS:

After a mean of 11 HBOT sessions (9-30), we observed an average hearing gain of 43% (±23%), that persisted up to a 3-month follow-up. This compares favourably with reports in the literature, and is consistent with a previous study by one of us (Desloovere, 1988). Because of the lack of randomised prospective studies, this preliminary uncontrolled study will now be extended and randomised versus placebo, to include a valid control group.

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Deafness, Meniere's disease, Tinnitus, other Ear..............
Chapter 19 of the HBOT Manual