Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
 
 
 
 
 
                  
 
                  
                       
                       
The
Senso
            
 ...
Original Article
The role of hyperbaric oxygen therapy in Sudden
Sensorineural Hearing Loss: A retrospective review
of 50 ...
Conclusion: Addition of HBOT to standard treatment significantly improves outcome of
SSNHL in a subset of patients. We reco...
The initial and final mean hearing levels at 500, 1000, 2000,
4000 and 6000 Hz of patients are presented in Table 2. The
me...
There is no consensus on the right number of treatments
with HBOT in the treatment of SSNHL. While some cases show
improve...
18. Desloovere C, Knecht R, Germonpre. Hyperbaric oxygen
therapy after failure of conventional therapy for sudden
deafness...
Apollohospitals:http://www.apollohospitals.com/
Twitter:https://twitter.com/HospitalsApollo
Youtube:http://www.youtube.com...
Upcoming SlideShare
Loading in …5
×

The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients

230 views

Published on

Sudden Sensorineural Hearing Loss (SSNHL) is a hearing impairment of more than 30 dB occurring within a period of upto 3 days in three consecutive pure tone frequencies. Hyperbaric oxygen therapy (HBOT) in recent years has gained relevance for treating SSNHL in combination with other agents. The aim of this study is to review the outcomes in patients with SSNHL treated with HBOT at our centre.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients

  1. 1.                                                                                                   The Senso                                      e role of h orineural        hyperbaric Hearing of 5 c oxygen Loss: A r 50 patient      therapy i retrospec ts in Sudden tive revie n ew
  2. 2. Original Article The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients Tarun Sahni a,* , Rachin Aggarwal b , Anil Kumar Monga c , Rajeev Puri d , Pavithra Shivkumar e , Shweta Gupta f , Sapna Verma f a Senior Consultant, Department of Internal and Hyperbaric Medicine, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India b Department of Internal and Hyperbaric Medicine, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India c Department of ENT, Sir Ganga Ram Hospital, New Delhi 110060, India d Prof., Department of ENT, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India e Department of Genetics, Dr.ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Chennai 600113, India f Research Associate, Department of Hyperbaric Medicine, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India a r t i c l e i n f o Article history: Received 11 July 2014 Accepted 19 July 2014 Available online xxx Keywords: Hearing loss Hyperbaric oxygen Sensorineural Inner ear a b s t r a c t Background: Sudden Sensorineural Hearing Loss (SSNHL) is a hearing impairment of more than 30 dB occurring within a period of upto 3 days in three consecutive pure tone fre- quencies. Hyperbaric oxygen therapy (HBOT) in recent years has gained relevance for treating SSNHL in combination with other agents. The aim of this study is to review the outcomes in patients with SSNHL treated with HBOT at our centre. Materials & methods: Records of 50 patients with SSNHL who received HBOT with conven- tional management were retrospectively reviewed. They were treated in a multiplace hy- perbaric chamber at 2.4 ATA, for 90 min once a day. Pre and post treatment audiograms at 500, 1000, 2000, 4000 and 6000 Hz were compared to assess improvement. Hearing gain in relation to severity, age of patients, therapeutic delay and coexisting symptoms in prog- nosis was evaluated. Results: 94% patients had overall hearing improvement. 82% patients of severe hearing loss presenting to us within 2 weeks of onset showed maximum gain. Those who received treatment within 14 days showed highest gain from 76 ± 20.06 dB to 51.9 ± 17.1 dB as compared to other patients. The hearing gain was greater at frequencies above 500 Hz. Patients younger than 50 years showed greater gain of 25 ± 13.2 dB as compared to those older than 50 years with gain of 19 ± 10.2 dB. * Corresponding author. Tel.: þ91 9810038010; fax: þ91 (0)11 26823629. E-mail addresses: aimhu@live.in, sshwetaa0186@gmail.com (T. Sahni). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e5 Please cite this article in press as: Sahni T, et al., The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.006 http://dx.doi.org/10.1016/j.apme.2014.07.006 0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
  3. 3. Conclusion: Addition of HBOT to standard treatment significantly improves outcome of SSNHL in a subset of patients. We recommend additional multicentric, prospective studies be carried out to define the role of HBOT in SSNHL. Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved. 1. Introduction Sudden Sensorineural Hearing Loss (SSNHL) is hearing impairment of more than 30 dB of three consecutive pure tone frequencies developing within 3 days or less.1e3 It is a clinical manifestation with proposed diverse aetiologies such as viral infection, vascular compromise, intra-cochlear membrane rupture or inner ear disease among others.3e5 It is more common in young and middle aged people with unilateral ear involvement in more than 90% cases.1,5e8 Due to lack of definite cause of SSNHL, its treatment is largely empirical and includes use of a wide variety of thera- pies like systemic and intratympannic steroids, vasodilators, osmotic drugs, antiviral and anticoagulants to counteract possible inflammatory mechanism, modify hydrostatic pres- sure and improving cochlear blood flow.8e12 The possible final goal of any treatment modality of SSNHL has been the resto- ration of oxygen tension in the cochlea to encourage healing and return of hearing to normal levels. Hyperbaric oxygen therapy (HBOT) is a treatment modality involving the intermittent inhalation of 100% oxygen in chambers pressurized above 1 atmosphere absolute (ATA). HBOT has been used as an adjunctive therapy for SSNHL as it raises the amount of oxygen in the inner ear by diffusion which activates cell metabolism leading to restoration of ionic balance and electrophysiological functions of cochlea.2,13e16 This study aims to analyse retrospective data of this centre to evaluate the efficacy of addition of HBOT to con- ventional treatment in patients with SSNHL and identify specific groups of patients likely to benefit from the addition of this therapy. 2. Materials and methods In this retrospective study we reviewed records of 150 patients with SSNHL who presented to our unit during the period 2006e2011. 50 Patients who met the following inclusion criteria were taken for the study: unilateral onset of SSNHL of 30 dB or greater in atleast three contiguous frequencies, un- known cause of hearing loss and no previous surgery in the affected ear. These patients received HBOT in addition to conventional treatment as prescribed by the referring ENT Surgeon. The conventional treatment however was not stan- dardized for patients in our study. HBOT was administered in a multiplace chamber at 2.40 ATA for 90 min once daily for atleast 10 days. The data collected included demographics, initial symptoms of hearing loss, tinnitus, vertigo or any other coexisting symptom, pure tone audiogram (PTA) and duration of onset of hearing loss from starting of HBOT. The patient's audiograms were reviewed before starting treatment and after 10 sessions of HBOT. If the audiogram showed improvement after 10 treatments, patients were advised for additional 10 sessions of HBOT, this process was repeated after further 10 sessions and a maximum of 30 sessions were given if they continuously showed improve- ment. All patients were assessed with PTA at 500, 1000, 2000, 4000 and 6000 Hz and hearing gain at these frequencies was calculated separately. The level of hearing loss at these 5 frequencies was evaluated in 3 groups: <40 dB (mild), be- tween 41 and 70 dB (moderate), >70 dB (severe). The average of mean hearing gain of patients according to age group and therapeutic delay along with presence of associated com- plaints as contributory factors to prognosis of SSNHL was assessed. Data of study was evaluated using descriptive statistical methods i.e. mean and standard deviation. 3. Results The clinical profile of the patients in our study is shown in Table 1. The 50 subjects in our study were in the age range of 18e75 (28 males and 22 females). The co-morbid factors in them were hypertension (8% cases), Diabetes Mellitus (16% cases) and coronary artery disease (8%). There was history of smoking in 22% of cases and 34% additionally complained of tinnitus and vertigo. Table 1 e Clinical profile of patients with sudden sensorineural hearing loss. Variables n ¼ 50 % Gender Male 28 56 Female 22 44 Age 50 yrs 34 68 50 yrs 16 32 Affected ear Right 37 74 Left 13 26 Time lag 14 days 26 52 15e30 days 17 34 30 days 07 14 Severity Mild 06 12 Moderate 12 24 Severe 32 64 Presence of associated complaints Tinnitus 13 26 Vertigo 04 08 Coexisting illnesses Hypertension 05 10 Diabetes 08 16 CAD 04 08 Smoking 11 22 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e52 Please cite this article in press as: Sahni T, et al., The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.006
  4. 4. The initial and final mean hearing levels at 500, 1000, 2000, 4000 and 6000 Hz of patients are presented in Table 2. The mean hearing gain was highest at frequencies above 1000 Hz. The mean hearing gain after treatment is shown in Table 3. The average hearing gain at the five frequencies was signifi- cantly higher in patients with initial level of 70 dB in com- parison to patients with hearing levels of 70 dB. Table 4 shows the mean hearing gain according to thera- peutic delay of starting HBOT. Time of presentation ranged between 1 and 60 days. The patients who received treatment within 14 days had higher hearing gain (76 ± 20.06 dBe51.9 ± 17.1 dB) as compared to patients with therapeutic delay of 15e30 days (77.85 ± 29.12 dBe59.85 ± 22.50 dB) and in patients who started therapy after 30 days (77.8 ± 23.81 dBe64.5 ± 21.82 dB). Table 5shows acorrelationbetweenthetime lagandseverity on the improvement in mean hearing gain in patients. 82% pa- tients presenting to us within 14 days showed maximum improvement as compared to other subset of patients. Average hearing gain of patients according to age group is presented in Table 6 and was significantly high in patients younger than 50 years. No statistically significant difference was found among patients with coexisting complaints of hypertension, diabetes, smoking and presence of tinnitus or vertigo. The hearing gain were 30 dB or more in 40%, between 20 and 30 dB in 20% and upto 20 dB in 34% of patients. There was no response to HBOT in 6% patients (n ¼ 3). The average number of hyperbaric sessions ranged from 10 to 25 with maximum number of patients showing improve- ment after 10 exposures. Only one patient was given 25 ses- sions of HBOT; however the patient did not show additional improvement. In all patients the treatment was well tolerated and no patient complained of any side effects. Hearing loss did not worsen in any case. 4. Discussion SSNHL is a loss of hearing greater than 30 dB in three contig- uous frequencies occurring in less than 3 days.1e3 Most sud- den hearing loss occurs within minutes to several hours. It is considered as a clinical manifestation of possible several un- derlying causes such as viral infection, vascular compromise, intra-cochlear membrane rupture or inner ear disease.2e7 This diversity demonstrates the prevailing uncertainty in aetiol- ogies and an inability to predict the prognosis. The high spontaneous recovery rate of SSNHL and its low incidence make validation of empirical treatment modalities difficult. Many treatment regimens have been proposed such as antiviral agents, vasodilators, anti-inflammatory and oral and intratympannic steroids. Hyperbaric oxygen therapy in recent years has gained relevance for treating SSNHL in combination with other agents.8e13 The Undersea Hyper- baric Medicine Society (UHMS) has approved the use of HBOT in SSNHL in October 2011. HBOT increases oxygen tension (pO2) in blood by dissolving in the plasma and diffuses into tissue fluids such as those surrounding the sensory and neural elements of the coch- lea.14e17 Gills showed oxygen induced osmosis as the mech- anism for healing property of HBOT in such cases.11 Aslan et al and Bennett et al demonstrated that earlier the treatment received, better is the prognosis.17 This was confirmed in our study. The maximum recovery was in the 26 cases which received HBOT within 14 days after onset. They showed significant mean hearing gain from 75.93 ± 20.06 dB to 51.90 ± 17.19 dB. Topuz et al reported HBOT as more effective in severe hearing loss.14 In our study, 64% cases had hearing loss of 70 dB and 81% of these patients showed improvement of 30 dB with mean hearing gain of 86 ± 11.9 dBe58.75 ± 13.0 dB. We observed a significant correlation between patients with severe hearing loss presenting to us within 2 weeks of onset. 82% of patients in this subset showed maximum improvement. Presence of tinnitus and vertigo has been reported to affect reversibility of hearing loss in various studies.14,15 In our study, 34% cases (n ¼ 17) with hearing loss had accompanied tinnitus and vertigo but no significant difference was observed between cases with and without these complaints. Age has been found to be a prognostic factor for improve- ment.18 In our study, patients in 50 year age group showed better hearing gain as compared to patients with age of 50 years. Presence of diabetes, hypertension and other associ- ated complaints in this age group might have been the contributory factors to poor prognosis; however we were not able to establish any correlations. Table 2 e Mean hearing levels (MHL) at different frequencies before and after treatment. Frequency (Hz) Initial MHL Final MHL % Of patients 500 66.12 ± 22.0 49.16 ± 23.12 25 1000 64.68 ± 24.60 48.0 ± 20.46 40 2000 68.17 ± 21.90 52.83 ± 24.30 45 4000 74.0 ± 23.32 52.16 ± 21.00 65 6000 74.83 ± 19.76 54.83 ± 21.11 55 Table 3 e Change in mean hearing level before and after treatment on basis of intensity. Intensity (db) Pre MHL Post MHL % Of patients with hearing improvementa 40 35.5 ± 6.40 27.50 ± 3.53 16 41e70 60.55 ± 10.46 43.27 ± 11.6 33 70 86.50 ± 11.90 58.75 ± 13.0 81 a Hearing improvement denotes 30 db gain in audiometry. Table 4 e Change in mean hearing level before and after treatment on basis of therapeutic delay. Days of onset Pre MHL Post MHL % Of patients with hearing improvement 14 75.93 ± 20.06 51.90 ± 17.19 56.25 14e30 77.85 ± 29.12 59.85 ± 22.50 42.10 30 77.8 ± 23.81 64.5 ± 21.82 25 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e5 3 Please cite this article in press as: Sahni T, et al., The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.006
  5. 5. There is no consensus on the right number of treatments with HBOT in the treatment of SSNHL. While some cases show improvement within a few days other cases might need it longer to achieve good results, however few studies report the optimum number of sessions. In our study, maximum pa- tients showed improvement after 10 exposures and maximum improvement was seen on an average of 20 ses- sions.19,20 We recommend that 20 sessions of HBOT may be optimum for recovery in a majority of patients. While the number of cases in this study is small, 94% of patients in the study group showed statistically significant improvement in hearing, when HBOT was administered along with conventional therapy. While all patients were on oral steroids the conventional treatment was not standardized in our patients. There appears to be a scientific rationale for use of HBOT in SSNHL and our results are encouraging. We recommend additional multicentric, prospective trials be carried out with a standardized protocol to establish role of HBOT in SSNHL patients. 5. Conclusion This retrospective study reveals that the addition of HBOT to conventional therapy significantly improves outcome inpatients of SSNHL if started within 14 days. Improvement is best at fre- quencies above 500 Hz and in hearing loss of above 70 dB. HBOT was more effective in patients younger than 50 years of age. Conflicts of interest All authors have none to declare. Acknowledgement The Hyperbaric Oxygen Therapy Unit acknowledges the sup- port given by the Department of ENT namely Dr Sindhu, Dr Kishore, Dr Soni, Dr Raheja, Dr Nagpal, Dr Dhingra, Dr Prakash Dr Ansari in this hospital and other clinicians from within and outside Delhi. r e f e r e n c e s 1. Korpinar S, Alkan Z, Yigit O, et al. Factors influencing the outcome of idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy. Eur Arch Otorhinolaryngol. 2011;268(1):41e47. 2. Liu S-C, Kang B-H, Lee, et al. Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases. Clin Otolaryngol. 2011;36:121e128. 3. O’Malley MR, Haynes DS. Sudden hearing loss. Otolaryngol Clin North Am. 2008;41:633e649. 4. Muzzi E, Zeenaro B, Visetin R, Soldano F. Hyperbaric oxygen therapy as salvage treatment for sudden sensorineural hearing loss: review of rationale and preliminary report. J Laryngol Otol. 2010 Feb;124(2). 5. Agarwal L, Pothier DD. Vasodilators and vasoactive substances for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev. 2009 Oct 7;(4). 6. Kanzaki J, Inoue Y, Ogawa K, et al. Effect of single-drug treatment on idiopathic sudden sensorineural hearing loss. Auris Nasus Larynx. 2003;30:123e127. 7. Conlin AE, Parnes LS. Treatment of sudden sensorineural hearing loss: I. A systemic review. Arch Otolaryngol Head Neck Surg. 2007;133:573e581. 8. Plontke SK, Bauer M, Meisner C. Comparison of pure tone audiometry analysis in sudden hearing loss studies: lack of agreement for different outcome measures. Otol Neurotol. 2007;28:753e763. 9. Racic G, Maslovara S, Roje Z, Dogas Z, Tafra R. Hyperbaric oxygen in treatment of sudden hearing loss. ORL J Otorhinolaryngol Relat Spec. 2007;65:317e320. 10. Gill AL, Bell CN. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM. 2004;97:385e395. 11. Fattori B, Berrettini S, Casani A, et al. Sudden hypoacusis treated with hyperbaric oxygen therapy: a controlled study. Ear Nose Throat J. 2001;80:655e660. 12. Satar B, Hidir Y, Yetiser S. Effectiveness of hyperbaric oxygen therapy in idiopathic sudden hearing loss. J Laryngol Otol. 2004;120:665e669. 13. C¸ ekin E, Cincik H, Ulubil SA, et al. Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. J Laryngol Otol. 2009;123:609e612. 14. Topuz E, Yigit O, Cinar U, et al. Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss? Eur Arch Otorhinolaryngol. 2004;261:393e396. 15. Lamm K, Lamm H, Arnold W. Effect of hyperbaric oxygen therapy in comparison to conventional or placebo therapy or no treatment in idiopathic sudden hearing loss, acoustic trauma, noise-induced hearing loss and tinnitus. A literature survey. Adv Otorhinolaryngol. 1998;54:86e99. 16. Aslan I, Oysu C, Veyseller B, et al. Does the addition of hyperbaric oxygen therapy to the conventional treatment modalities influence the outcome of sudden deafness? Otolaryngol Head Neck Surg. 2002;126:121e126. 17. Bennett M, Kertesz T, Yeung P. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: a systemic review of randomized controlled trials. J Laryngol Otol. 2005;119:791e798. Table 5 e Correlation between hearing improvement on basis of severity and time lag. Time lag Severity (% of patients showing improvement) Days Mild Moderate Severe 14 45 50 82 15e30 35 43 50 30 0 33 25 Table 6 e Comparison of mean hearing level according to age group. Age group (yr) Pre MHL Post MHL % Patients with hearing improvement 50 77.0 ± 19.30 52.0 ± 13.70 32 50 68.4 ± 17.22 49.4 ± 17.34 26 a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e54 Please cite this article in press as: Sahni T, et al., The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.006
  6. 6. 18. Desloovere C, Knecht R, Germonpre. Hyperbaric oxygen therapy after failure of conventional therapy for sudden deafness. ENT. 2:69e73. 19. Bennett MH, Kertesz T, Yeung P. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2007:CD004739. 20. Uzun G, Yildiz S. Therapeutic window for the use of hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss. Auris Nasus Larynx. 2008;35: 318. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e5 5 Please cite this article in press as: Sahni T, et al., The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A retrospective review of 50 patients, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.006
  7. 7. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/

×