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What is the prospective randomized controlled trial evidence for using hyperbaric oxygen therapy (HBOT) as a single or combination therapy for improving hearing outcomes for patients with sudden sensorineural hearing loss (SSNHL) compared with control treatments?
This systematic review and meta-analysis included 3 prospective randomized controlled trials with a total of 88 participants who received HBOT in intervention groups and 62 participants who received routine treatment in the control groups. The meta-analysis found a significant mean difference in absolute hearing gain and odds ratio for hearing recovery following HBOT, favoring the intervention.
The findings of this systematic review and meta-analysis suggest that clinicians treating patients with SSNHL should consider including HBOT as part of a combination treatment regimen.
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.
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.
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.
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.
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.
PROSPERO Identifier: CRD42020193191
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: August 4, 2021.
Published Online: October 28, 2021. doi:10.1001/jamaoto.2021.2685
Corresponding Author: Desmond A. Nunez, MD, MBA, Division of Otolaryngology, Department of Surgery, University of British Columbia, Diamond Health Care Centre, 2775 Laurel St, 4th Floor, Vancouver, BC V5Z 1M9, Canada (email@example.com).
Author Contributions: Drs Nunez and Joshua had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Joshua, Ayub, Nunez.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Joshua, Ayub.
Critical revision of the manuscript for important intellectual content: Joshua, Wijesinghe, Nunez.
Statistical analysis: Joshua, Wijesinghe.
Conflict of Interest Disclosures: None reported.
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