Optimizing Hyperbaric Oxygen Therapy for Sudden Hearing Loss

OBJECTIVE: To optimize the hyperbaric oxygen therapy protocol for sudden sensorineural hearing loss by identifying the most effective treatment course and analyzing key prognostic factors through a multicenter retrospective cohort study. STUDY DESIGN: Retrospective cohort study. SETTING: The study conducted at 4 tertiary hospitals equipped with hyperbaric oxygen (HBO) facilities in Shanghai, China. Patient enrollment occurred between January 2022 and September 2024. Participants were identified from the clinical records of patients presenting with sudden sensorineural hearing loss (SSNHL) at the participating centers. METHODS: This multicenter retrospective cohort study (n = 1309) enrolled patients meeting 2019 AAO-HNS guidelines. The HBO group (n = 991) received 2.2 ATA HBO combined with corticosteroids, while the non-HBO group (n = 318) received corticosteroids alone. Primary and secondary outcomes were hearing recovery rates at treatment completion and 90-day follow-up, respectively. RESULTS: 11 to 20 HBO sessions significantly increased rates of slight (OR = 2.205, 95% CI: 1.399-3.474, P = .001) and partial recovery (OR = 2.236, 95% CI: 1.429-3.500, P < .001) at treatment completion, but not complete recovery. At 90 days, 11 to 20 sessions significantly promoted complete recovery (OR = 0.422, 95% CI: 0.224-0.793, P = .007). Efficacy was significantly influenced by initial hearing loss degree; patients with total deafness showed lower partial recovery rates versus those with milder losses, while patients with very severe deafness showed the highest (125.3%). Age, delayed treatment, vertigo, and high initial pure-tone threshold were independent prognostic factors (P < .05). No serious adverse events occurred. CONCLUSION: HBO combined with corticosteroids improves hearing recovery in SSNHL. Initiating 10 to 20 HBO sessions early, preferably within two weeks of onset, is recommended, especially for severe and total deafness. Future studies should standardize efficacy criteria to advance individualized treatment.