Joshua TG, Ayub A, Wijesinghe P, Nunez DA, et al.
JAMA otolaryngology-- head & neck surgery. Date of publication 2022 Jan 1;volume 148(1):5-11.
1. JAMA Otolaryngol Head Neck Surg. 2022 Jan 1;148(1):5-11. doi:
10.1001/jamaoto.2021.2685.
Hyperbaric Oxygen Therapy for Patients With Sudden Sensorineural Hearing Loss: A
Systematic Review and Meta-analysis.
Joshua TG(1), Ayub A(1), Wijesinghe P(1), Nunez DA(1)(2).
Author information:
(1)Division of Otolaryngology, Department of Surgery, University of British
Columbia, British Columbia, Canada.
(2)Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital,
Vancouver, British Columbia, Canada.
Comment in
JAMA Otolaryngol Head Neck Surg. 2022 Jan 1;148(1):11-12.
JAMA Otolaryngol Head Neck Surg. 2022 Jun 1;148(6):584.
JAMA Otolaryngol Head Neck Surg. 2022 Jun 1;148(6):583-584.
IMPORTANCE: Sudden sensorineural hearing loss (SSNHL) is an acute, usually
unilateral deficit. Systemic and intratympanic steroids are accepted treatments.
Although evidence suggests that hyperbaric oxygen therapy (HBOT) may be
beneficial, it is not widely offered.
OBJECTIVES: To review and evaluate recent evidence of the association of HBOT
with hearing outcomes in SSNHL and to determine if HBOT should be a single or
part of a combination treatment regimen.
DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMed, EMBASE,
CINAHL, Web of Science, CAB, ICTRP, Google Scholar, Clinicaltrials.gov, and
ISRCTN databases were searched for randomized controlled trials (RCTs) published
in English from January 1, 2000, and April 30, 2020.
STUDY SELECTION: Prospective RCTs involving only adult participants (≥18 years)
with SSNHL and comparing HBOT, as a single or combination therapy, with control
therapies, such as steroids and/or placebo. Only RCTs that used the American
Academy of Otolaryngology-Head and Neck Surgery's diagnostic criteria for SSNHL
were included.
DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by 2
researchers. A fixed-effects model was used for analysis and performed from
November 30, 2020, to May 20, 2021.
MAIN OUTCOMES AND MEASURES: The mean difference in absolute hearing gain
recorded by pure-tone audiometric (PTA) thresholds averaged across 4 low (0.5,
1, 2, and 3 or 4 kHz) or 3 high (3 or 4, 6, and 8 kHz) frequencies was the
primary outcome. The secondary outcomes were the odds ratio of hearing recovery
defined as a hearing gain of ≥10 decibels (dB) in PTA average and
treatment-related adverse effects.
RESULTS: Of the 826 records initially identified, 358 duplicates and 451
articles were excluded based on article type, title, and abstract. The full
texts of 17 articles were reviewed, of which 14 were excluded because they were
either not prospective RCTs (11 articles), the participants were less than 18
years old (2 articles), or the PTA was not reported at frequencies of interest
(1 article). Three prospective RCTs with a total of 88 participants who received
HBOT in the intervention groups and 62 participants who received only medical
therapy in the control groups were studied. The intergroup difference in mean
absolute hearing gain (mean difference, 10.3 dB; 95% CI, 6.5-14.1 dB; I2 = 0%)
and the odds ratio of hearing recovery (4.3; 95% CI, 1.6-11.7; I2 = 0%) favored
HBOT over the control therapy.
CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, HBOT as
part of a combination treatment was significantly associated with improved
hearing outcomes in patients with SSNHL over control treatments.
TRIAL REGISTRATION: PROSPERO Identifier: CRD42020193191.
DOI: 10.1001/jamaoto.2021.2685
PMCID: PMC8554691
PMID: 34709348 [Indexed for MEDLINE]
Conflict of interest statement: Conflict of Interest Disclosures: None reported.
