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Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitusBennett MH, Kertesz T, Yeung P
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SummaryHyperbaric oxygen may improve deafness and tinnitus after sudden hearing loss of unknown cause, but the evidence is of poor quality.Idiopathic sudden sensorineural hearing loss (ISSHL) is common, often results in permanent hearing loss and therefore has a high impact on the wellbeing of those affected. Tinnitus (abnormal persistent noises or ringing in the ear) is similarly common and often accompanies the hearing loss. Although the cause of these complaints is not clear, it may be related to a lack of oxygen secondary to a vascular problem not yet identified. Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a specially designed chamber and it is sometimes used as a treatment to increase the supply of oxygen to the ear and brain in an attempt to reduce the severity of hearing loss and tinnitus. We found some evidence from five small trials of generally poor quality, that hearing may be improved in people with ISSHL and possibly that tinnitus may also be improved. This may only be true if HBOT is used within two weeks of the onset of problems and there is no evidence that HBOT can help people who have been deaf for some months. Further research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 24. 2005 AbstractBackgroundIdiopathic sudden sensorineural hearing loss (ISSHL) with or without tinnitus is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and, it is postulated, may result in an improvement in hearing and/or a reduction in the intensity of tinnitus. ObjectivesTo assess the benefits and harms of HBOT for treating ISSHL and/or tinnitus. Search strategyWe initially searched in June 2004 and repeated the search in June 2006. Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006), CINAHL, Database of Randomised Trials in Hyperbaric Medicine (DORCTHIM), AMED, LILACS, KOREAMED, INDMED, National Research Register (NRR), CSA, ISI PROCEEDINGS and ZETOC. Selection criteriaRandomised studies comparing the effect on ISSHL and/or tinnitus of therapeutic regimens which include HBOT with those that exclude HBOT. Data collection and analysisThree authors independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. Main resultsSix trials contributed to this review (308 subjects). Pooled data from two trials involving 114 patients did not show any significant improvement in the chance of a 50% increase in hearing threshold on Pure Tone Average (PTA) when HBOT was used (relative risk [RR] with HBOT 1.53, 95% CI 0.85 to 2.78, P = 0.16), but did show a significantly increased chance of a 25% increase in PTA (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). There was a 22% greater chance of improvement with HBOT, and the number needed to treat (NNT) to achieve one extra good outcome was five (95% CI 3 to 20). A single trial involving 50 subjects also suggested significantly more improvement in the mean PTA threshold with HBOT, expressed as a percentage of baseline (WMD 37%, 95% CI 22% to 53%, P < 0.001). The significance of any improvement following HBOT in a subjective rating of tinnitus could not be assessed due to poor reporting. There were no significant improvements in hearing or tinnitus reported in the single study to examine chronic presentation (six months) of ISSHL and/or tinnitus. Authors' conclusionsFor people with early presentation of ISSHL, the application of HBOT significantly improved hearing loss, but the clinical significance of the level of improvement is not clear. We could not assess the effect of HBOT on tinnitus by pooled data analysis. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. There is no evidence of a beneficial effect of HBOT on chronic presentation of ISSHL and/or tinnitus and we do not recommend use of HBOT for this purpose based on the single study available. |