番茄社区

Hyperbaric oxygen therapy (HBOT) in conjunction with standard medical therapy (MT) was more beneficial for patients with sudden sensorineural hearing loss than standard treatment alone, a systemic review and meta-analysis found.

The primary endpoint of complete hearing recovery was met by 29.4% of the HBOT/MT group versus 20.7% with MT alone, reported Tae-Min Rhee, MD, DMO/UMO, of National Maritime Medical Center in Changwon, South Korea, in .

"HBOT is basically a very safe and effective treatment with few side effects," Rhee told 番茄社区, saying it works for almost all patients and rarely leads to adverse side effects. The main cautions are in patients with history of claustrophobia or pneumothorax.

Rhee added that HBOT is cost-effective, making it a worthwhile approach "at least for refractory cases after the failure of medical treatment with steroids," Rhee continued.

Heather Murphy-Lavoie, MD, of Louisiana State University School of Medicine in New Orleans, was even more enthusiastic about hyperbaric therapy, but less so about the meta-analysis, in which she was not involved.

"It is possible patients may be denied early HBOT based on this data which I feel would be a mistake," she said in an interview with 番茄社区, explaining that waiting until the patient hasn't responded to standard care may cause HBOT to be less beneficial later on.

"Early treatment leads to the best outcomes. The optimal treatment depth and time cannot be determined by this data, but it seems that at least 10 treatments are probably indicated," Murphy-Lavoie said.

Rhee and colleagues evaluated 2,401 patients with sudden sensorineural hearing loss (mean age 45.4 years and 55.3% female), using data from three previous randomized clinical trials and 16 nonrandomized studies.

The secondary endpoints for complete hearing recovery and any hearing recovery using HBOT and MT, the investigators found, were significantly higher than the MT group. The pooled odds ratio were 1.61 (95% CI 1.05-2.44) for complete hearing recovery and 1.43 (95% CI 1.20-1.67) for any recovery.

A subgroup analysis showed "the higher maximal pressure during HBOT of at least 2.5 ATA [atmospheres absolute pressure] was not beneficial for complete hearing recovery," the investigators wrote.

The findings indicated that HBOT combined with MT significantly benefited patients by comparison to MT alone for complete hearing recovery, any hearing recovery, and absolute hearing gain, Rhee and colleagues reported.

They found that HBOT's advantages were greater among patients with severe hearing loss from the beginning; those receiving the therapy as a salvage treatment; and those with 1,200 minutes of HBOT use.

Murphy-Lavoie took issue with some of these findings. It was "interesting," she said, that the researchers found pressures higher than 2.5 atmospheres absolute pressure (ATA) were less effective than pressures at or below 2.5 ATA.

"This is a rather arbitrary conclusion to draw from this data since the two pressures were not directly compared to each other and so many other variables were present in each of the different trials that may have accounted for the differences such as time to treatment and dosage of steroids," she told 番茄社区.

Moreover, saying that greater than 1,200 minutes is more effective than less than 1,200 minutes of HBOT "implies that the two were compared to each other and in fact they were not," Murphy-Lavoie highlighted.

She also criticized the meta-analysis for not including all of the key randomized control trials regarding HBOT.

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