Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus (Review)

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2005 and previously updated in 2007 and2009.Idiopathic sudden sensorineural hearing loss (ISSHL) is common and has a significant effect on quality of life. Hyperbaric oxygentherapy (HBOT) may improve oxygen supply to the inner ear and result in an improvement in hearing.ObjectivesTo assess the benefits and harms of HBOT for treating ISSHL and/or tinnitus.Search methodsWe searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of ControlledTrials (CENTRAL); PubMed; EMBASE; Database of Randomised Trials in Hyperbaric Medicine (DORCTHIM); CINAHL; Web ofScience; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. Thedate of the most recent search was 2 May 2012, following previous searches in 2009, 2007 and 2004.Selection criteriaRandomised studies comparing the effect on ISSHL and tinnitus of HBOT and alternative therapies.Data collection and analysisThree authors evaluated the quality of trials using the ’Risk of bias’ tool and extracted data from the included trials.Main resultsSeven trials contributed to this review (392 participants). The studies were small and of generally poor quality. Pooled data from twotrials did not show any significant improvement in the chance of a 50% increase in hearing threshold on pure-tone average with HBOT(risk ratio (RR) with HBOT 1.53, 95% confidence interval (CI) 0.85 to 2.78, P = 0.16), but did show a significantly increased chanceof a 25% increase in pure-tone average (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). There was a 22% greater chance of improvementwith HBOT, and the number needed to treat (NNT) to achieve one extra good outcome was 5 (95% CI 3 to 20). There was also an absolute improvement in average pure-tone audiometric threshold following HBOT (mean difference (MD) 15.6 dB greater withHBOT, 95% CI 1.5 to 29.8, P = 0.03). The significance of any improvement in tinnitus could not be assessed.There were no significant improvements in hearing or tinnitus reported for chronic presentation (six months) of ISSHL and/or tinnitus.Authors’ conclusionsFor people with acute ISSHL, the application of HBOT significantly improved hearing, but the clinical significance remains unclear.We could not assess the effect of HBOT on tinnitus by pooled analysis. In view of the modest number of patients, methodologicalshortcomings and poor reporting, this result should be interpreted cautiously. An appropriately powered trial is justified to define thosepatients (if any) who can be expected to derive most benefit from HBOT.There is no evidence of a beneficial effect of HBOT on chronic ISSHL or tinnitus and we do not recommend the use of HBOT forthis purpose.