Evaluating hyperbaric oxygen therapy as an adjunct to corticosteroids in sudden sensorineural hearing loss: a systematic review and meta-analysis.

Abstract

Background: Sudden sensorineural hearing loss (SSNHL) is a medical emergency characterized by unexplained hearing loss, usually one-sided, of at least 30 dB across three or more contiguous frequencies within 72 h. This condition significantly impairs daily communication and has serious consequences for mental health, social relationships, and the overall quality of life. Hyperbaric oxygen therapy (HBOT) is being investigated as a potential adjuvant treatment for SSNHL alongside systemic steroids.

Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of HBOT combined with systemic corticosteroids compared with corticosteroids alone in patients with SSNHL.

Method: We searched PubMed, Cochrane, Scopus, Web of Science, and Google Scholar to identify 14 studies that matched our inclusion criteria of randomized controlled trials (RCTs) published in English, which evaluated HBOT alone or with corticosteroids in adults (≥ 18 years) diagnosed with SSNHL based on the AAO-HNS criteria, reporting pure-tone audiometry (PTA)-based outcomes. The analysis included 794 participants and evaluated outcomes such as improvements in Pure Tone Audiometry (PTA) thresholds, rates of hearing recovery, and adverse events.

Results: Results indicated that the combined therapy of HBOT and systemic corticosteroids significantly improved low-frequency hearing thresholds (SMD: 0.83, 95% CI: 0.66-1.00, p < 0.0001) and increased the odds of complete recovery (OR: 2.05, 95% CI: 1.41-2.98, p = 0.0002). However, significant heterogeneity (I² = 96.7%) and variations in the treatment protocols were observed. Adverse events, including vertigo, have been reported but are generally mild.

Conclusion: This meta-analysis suggests that combining systemic corticosteroids with HBOT may improve hearing recovery in ISSNHL, particularly at lower frequencies within the first three months. However, high heterogeneity and the lack of statistical significance in the random-effects model call for cautious interpretation. Well-designed RCTs with standardized protocols and clear patient selection criteria are needed to confirm these findings. Future research should focus on identifying subgroups most likely to benefit and optimizing treatment protocols.