WCJC #6 HBO and hearing loss
Hyperbaric oxygen (HBO) therapy as an effective approach to the treatment of patients with severe idiopathic sudden sensorineural hearing loss
Yeonjoo Choi, Hye Lim Choi, A Young Jeong, Woo Seok Kang, Hong Ju Park,
Jong Woo Chung & Joong Ho Ahn
2020 Acta Oto-Laryngologica, DOI: 10.1080/00016489.2020.1717607
Idiopathic sudden sensorineural hearing loss (ISSNHL) is one of the 14 indications for hyperbaric oxygen therapy (HBO) as determined by the Undersea and Hyperbaric Medical Society (UHMS). Regrettably, the CMS guidelines for Medicare patients do not allow for the use of HBO with ISSNHL. In my practice, since most of the patients referred to my clinic with ISSNHL are of Medicare age, it is very frustrating to have to explain to the referring otolaryngologist that the patient will have to pay out of pocket for the treatment. Many patients do not have the financial resources to do this and hence do not receive the treatment they need. Because of this, I highlighted this article to review.
This study is a retrospective analysis of consecutive patients diagnosed with severe ISSNHL between January 2016 to December 2017 at the Asan Medical Center in South Korea. Patients were included in the study if they had a hearing loss of greater than or equal to 70 dB involving three or more frequencies over three days or less without any underlying cause. Patients must have started their HBO treatment within two weeks from the onset of symptoms, and were required to have follow up of at least one year.
All patients received systemic and intratympanic steroid therapy. The control group only had steroid therapy, and the treatment group had greater than 14 HBO treatments.
A total of 82 patients with 83 years were eligible for inclusion in the study. The HBO Group enrolled 37 patients with 38 ears, and the control group enrolled 45 patients with 45 ears. None of the patients suffered HBO complications. The average interval from onset to treatment was 5.37 days in the HBO group compared to 6.43 days in the control group. Three months after treatment, all patients underwent audiological testing.
The HBO group showed improvement of 29.7± 27.9 dB compared to the control group with 14.4 ± 12.5 dB, p = 0.003 for the three-frequency average. The HBO group showed improvement of 27.8 ± 27.5 dB compared to the control group with 14.7 ± 11.9 dB, p = 0.009 for the four-frequency average. The HBO group showed improvement of 28.1 ± 26.9 dB compared to the control group with 14.8 ± 13.5 dB, p = 0.008 for the weighted four-frequency average.
Using Siegel’s criteria where complete recovery was defined as final hearing better than 25 dB, 20 of the 38 patients (52.6%) in the HBO group showed complete recovery versus 15 of 45 (33.3%) patients in the control group; however, the p was not statistically significant at 0.180. Evaluating frequency-specific hearing level, the results showed significantly greater hearing improvement in the HBO group versus the control group, p = 0.004.
The authors concluded that HBO therapy is a safe and well-tolerated treatment modality for patients with ISSNHL.
My interpretation: As has been reported in other studies, I feel the results of this study are significant enough that CMS needs to change the approved indications for HBO therapy to include ISSNHL. While the study was unable to show statistical significance for complete recovery, it was able to show a clinically significant improvement in hearing in the HBO Patients must have started their HBO treatment within two weeks from the onset of symptoms, and were required to have followed up of at least one year.on for ISSNHL, and patients should strongly considering pay out of pocket if necessary to be treated with HBO.