No evidence of benefit with hyperbaric oxygen therapy for sudden hearing loss.

Bottom line
  1. Statistically non-significant small benefit for those treated with HBOT.

Citations
Çekin E, Cincik H, Ulubil SA, Gungor A. Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. The journal of laryngology and otology 2009; 123: 609-12.

Three-part clinical question
For patients with sudden hearing loss within 3 days of onset, does the application of hyperbaric oxygen combined with systemic corticosteroid therapy, compared to corticosteroid therapy alone, improve hearing recovery.

Search Terms
Sudden Hearing Loss, Inner Ear

The study
Non-blinded randomised controlled trial. Intention to treat not stated.

The study patients
Males and females aged 18-82 with sudden onset hearing loss either or both ears, within 3 days. Hearing loss defined as loss of at least 30dB in three frequencies within three days of enrolment.
EXPERIMENTAL GROUP (n=36), 100% oxygen at 2.5 ATA for 90 minutes, 10 daily sessions over 10 days plus prednisolone 1mg/kg starting dose reducing over three weeks plus famotidine 40mg daily.
CONTROL GROUP (n=21) Drugs as above but no HBOT.


The evidence:

Outcome
Time to Outcome
Control Group Rate
HBOT Group Rate
Relative Risk Reduction
Absolute Risk Reduction
NNT
Improved with treatment*
10 days
0.71
0.83
14%
0.12
8
95% CIs:
-13% to 42%
-0.11 to 0.35
NNT = 3 to INF; NNH = 9 to INF
*Complete or ‘moderate’ improvement

Comments
  1. Large difference in patient numbers between treatment and control arms is not explained.
  2. Time period of outcome assessment not defined (possibly at 10 days).
  3. Reducing dose of prednisolone regimen not stated.
  4. Average mean audiometry quoted in dB, but how many frequencies affected not described.
  5. Power calculation is inadequately described – no suggestion what effect they were aiming to confirm.
  6. 12 years to collect data at a single centre
  7. Two patients in study group recruited outside the protocol period
  8. Some discrepancy between text and Table II results.

Appraised by: D. Smart Monday 1st August 2016
Email : dsmart@iinet.net.au

Kill or Update by : August 2018




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