Hyperbaric oxygen with steroids for sudden hearing loss: 11 to 20 sessions associated with better recovery

Design

Multicentre retrospective cohort, four hospitals

Population

1,309 patients with sudden sensorineural hearing loss (991 hyperbaric plus steroids, 318 steroids alone)

Primary outcome

Hearing recovery at end of treatment

Effect

11 to 20 sessions: partial recovery OR 2.24 (95% CI 1.43 to 3.50); complete recovery not different

This retrospective cohort at four Shanghai hospitals with hyperbaric facilities included 1,309 patients with sudden sensorineural hearing loss meeting 2019 AAO-HNS criteria. Of these, 991 received hyperbaric oxygen at 2.2 atmospheres with corticosteroids and 318 received corticosteroids alone.

Patients who had 11 to 20 hyperbaric sessions had about twice the odds of slight recovery (OR 2.21, 95% CI 1.40 to 3.47) and of partial recovery (OR 2.24, 95% CI 1.43 to 3.50) at the end of treatment, but not of complete recovery. The authors also report an association with complete recovery at 90 days. Older age, delay to treatment, vertigo and worse initial thresholds predicted poorer recovery. No serious adverse events were reported.

The design is non-randomised, and patients who could attend 11 to 20 sessions may differ from those who could not. The abstract's reporting of some outcomes is hard to interpret, and the recovery categories are not standardised across studies.

Hyperbaric oxygen is already listed as an option in some guidelines for sudden hearing loss, but access in India is limited and mostly in large centres. This study supports offering it, where available and early, as an adjunct to steroids, not as a replacement.

• Treat sudden sensorineural hearing loss as an emergency and start steroids promptly.
• Where hyperbaric oxygen is available, consider it as an adjunct within about two weeks of onset.
• Plan a course of 11 to 20 sessions if hyperbaric therapy is used.
• Counsel that older age, vertigo, severe initial loss and delay predict poorer recovery.
• Arrange an MRI of the internal auditory meatus to exclude retrocochlear causes.

Why it matters

Sudden hearing loss has few treatments with any evidence, and the number of hyperbaric sessions has been largely guesswork.

Don't overread it

This retrospective cohort cannot exclude selection bias, and complete recovery at the end of treatment did not differ.

The statistics, in plain English

Odds ratios of about 2.2 mean roughly double the odds of some recovery with hyperbaric oxygen, but in a non-randomised comparison this may partly reflect who was able and willing to attend many sessions. Partial recovery is a softer outcome than complete recovery.

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