Idiopathic Sudden Sensorineural Hearing Loss (ISSHL)

Also know as 'sudden deafness' ISSHL is defined as the onset of unexplained one-sided hearing loss in less than 72 hours.

Info for Patients

Striking an estimated 5 – 20/100,000 persons per year, ISSHL has the following symptoms:

  • Sudden hearing loss
  • Tinnitus
  • A sensation of fullness in the ear
  • Vertigo

Hyberbaric Oxygen Therapy & ISSHL

For people with acute ISSHL the application of Hyperbaric Oxygen can significantly improve hearing.

Multiple controlled studies have also demonstrated a greater degree of hearing improvement when patients receive early intervention in conjunction with hyperbaric oxygen and oral steroids

This condition requires ENT and audiology assessment to determine severity and potential cause. If ISSHL then patients are referred.

Criteria for referral

  • The patient must have a hearing loss greater than 41 decibels.
  • The patient to be referred within 14 days of symptoms – Later presentation might improve but best evidence supports the use of hyperbaric oxygen therapy within 2 weeks of symptom onset

Treatment

  • Treated with 100% oxygen for 90 minutes daily. 10-20 treatments and then reviewed after 20 treatments.
Info for Professionals

Idiopathic Sensorineural Hearing Loss for professionalsThe UHMS define ISSHL as greater than 30db occurring within 3 days and over at least 3 contiguous frequencies.

Individuals commonly report one or a combination of the following clinically,

  • Sudden unilateral hearing loss
  • Tinnitus
  • Fullness in the affected ear
  • Vertigo

It is well understood that the cause of ISSHL is uncertain and many different aetiologies and pathological theories have been cited. However, it is known that the cochlea has a high metabolism and poor vascularity. Thus in theory the use of HBO will improve oxygenation of the organ. There have been a small number of trials to investigate whether this increase in oxygenation will improve outcomes.

This was first explored as a treatment options in 1985 by Pilgramm. His reports on 37 patients showed significant benefits to those who had acute hearing loss alongside standard medical treatment at the time. This was further supported in 1995 by Hoffman.

The most significant of recent studies was performed by Topuz in 2004. An average of 50.7dB improvement in individuals with severe hearing loss treated with HBO in addition to Medical therapy (including steroids) was seen across all frequency ranges except 2000Hz.

The latest Cochrane review has suggested that the use of HBO within 2 weeks of onset of symptoms is a worthwhile treatment option.

Further information regarding the Referral and Funding can be found here.

Reference

Hyperbaric Oxygen Therapy Indications (2014)
Lindell K, Weaver MD Editors
Undersea and Hyperbaric Medical Society
13th Edition
2014 :P139-151

 

Cochrane Database(2017)
Hyperbaric oxygen for sudden hearing loss and tinnitus of unknown cause
http://www.cochrane.org/CD004739/ENT_hyperbaric-oxygen-for-sudden-hearing-loss-and-tinnitus-ringing-in-the-ears-of-unknown-cause
(Last accessed 18/7/17 1700)

 

Hoffman(1995)
Hoffman G, Bohmer D, Desloovere C.
Hyperbaric oxygenation as a treatment for sudden deafness and acute tinnitus.
In: Proceedings of the eleventh international congress on hyperbaric medicine.
Flagstaff, AZ:Best Publishing Co.;1995.P.146-152

 

Hoffman(1995)
Hoffman G, Bohmer D, Desloovere C.
Hyperbaric oxygenation as a treatment for chronic forms of inner ear hearing loss and tinnitus.
In: Proceedings of the eleventh international congress on hyperbaric medicine.
Flagstaff, AZ:Best Publishing Co.;1995.P.141-145

 

Pilgramm(1985)
Pilgramm M, Lamm H, Schumann K
Hyperbaric oxygen thepray in sudden deafness.
Laryngol Rhinol Otol (Stuttg)
1985;64(7):351-354

 

Topuz(2004)
Topuz E, Yigit O, Cinar U, Seven H
Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss.
Eur Arch Otorhinolargol
2004 Aug;261(7):393-396

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