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Sudden sensorineural hearing loss (SSNHL) is defined as hearing loss of at least 30 decibels occurring over at least three consecutive audiometric frequencies and lasting at least 3 days. A specific etiology is identified only about 10 to 15 percent of the time, and the majority of cases are deemed idiopathic. Patients typically first notice symptoms upon waking and describe a sensation of aural fullness or blockage. They may also experience tinnitus, dizziness, or vertigo. The spontaneous recovery rate is difficult to determine since many patients do not seek medical care but it has been reported to range from 25 to 65 percent. In most controlled trials, the spontaneous recovery in patients receiving placebo therapy is between 35 and 39 percent. More than 60 treatment protocols have been described for SSNHL but the majority of these have not proven effective. The three most promising treatments include corticosteroids, vasodilators, and hyperbaric oxygen therapy. Of these, only hyperbaric oxygen has undergone sufficient randomized controlled trials to show a positive treatment effect in meta-analyses. This activity describes the indications, contraindications, and protocol for hyperbaric oxygen therapy as a therapy for sudden sensorineural hearing loss and highlights the role of the interprofessional team in promptly assisting patients seeking treatment. Objectives: Identify the indications for hyperbaric oxygen therapy for sudden sensorineural hearing loss. Describe the contraindications to hyperbaric oxygen therapy for sudden sensorineural hearing loss. Review the complications of hyperbaric oxygen therapy. Summarize interprofessional team strategies for enhancing care coordination for patients with sudden sensorineural hearing loss by evaluating their candidacy for hyperbaric oxygen therapy. Access free multiple choice questions on this topic.

The sudden sensorineural hearing loss is defined as a hearing loss of at least 30 decibels occurring over at least three consecutive frequencies and lasting at least 3 days. A specific etiology is identified only about 10% to 15% of the time, the majority of the time this is deemed idiopathic. Possible etiologies include vascular occlusion, viral infections, labyrinthine membrane breaks, autoimmune, trauma, toxins, cochlear membrane damage, demyelinating disease, stroke, and schwannoma. The patient typically first notices symptoms upon awakening and describes an aural fullness/blockage. They may also experience tinnitus (usual), dizziness, or vertigo. There are approximately 4000 new cases in the United States annually. The spontaneous recovery rate is difficult to determine since many patients do not seek medical care but it has been reported as low as 25% and as high as 65%. In most controlled trials, the spontaneous recovery in patients receiving placebo is between 35% and 39%. Hearing loss can impose heavy social and economic burdens and significantly impair a patient's quality of life. Adult-onset hearing loss is the most common cause of disability globally and the third leading cause of years of productivity lost due to disability according to the World Health Organization (WHO). Hearing aids are recommended for moderate (41 decibels to 60 decibels) and severe (61 decibels and greater) hearing loss. More than 60 treatment protocols have been described for sudden sensorineural hearing loss, but the majority of these are not efficacious. The three most promising treatments include corticosteroids, vasodilators, and hyperbaric oxygen therapy. Of these, only hyperbaric oxygen has sufficient randomized controlled trials to have a positive meta-analysis Cochrane review.[1][2][3]

Middle-ear barotrauma is the most common complication of hyperbaric oxygen therapy. Its incidence is approximately 13%, but the vast majority of these cases resolve with no sequela. The incidence of middle ear barotrauma can be lowered using slower compression rates, coaching proper ear clearing techniques, and oral decongestants. The O'Neill grading scale has shown greater inter-rater reliability and utility than Teed's scale in determining the degree of barotrauma and recommended treatment options.

Sensorineural hearing loss is best done with an interprofessional that includes audiology nurses. Over the years HBO has been recommended for the treatment of sensorineural loss but clinicians should be aware that the data are heterogeneous and there still remains some question about its real benefits. When to undertake HBO therapy for sensorineural loss is still being debated but some experts suggest it should be early in the course. The outcomes-based on small case series seems to suggest that some patients with sensorineural loss do have a positive outcome, but this is not a universal finding.[1] [Level 5]