Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus

 

Abstract

Background

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2005 and previously updated in 2007.

Idiopathic sudden sensorineural hearing loss (ISSHL) is common and has a significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and result in an improvement in hearing.

Objectives

To assess the benefits and harms of HBOT for treating ISSHL and/or tinnitus.

Search methods

We repeated the search in July 2009. Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and the Database of Randomised Trials in Hyperbaric Medicine (DORCTHIM).

Selection criteria

Randomised studies comparing the effect on ISSHL and tinnitus of HBOT and alternative therapies.

Data collection and analysis

Three authors evaluated the quality of trials using the 'Risk of bias' tool and extracted data from the included trials.

Main results

Seven trials contributed to this review (392 participants). Pooled data from two trials did not show any significant improvement in the chance of a 50% increase in hearing threshold on Pure Tone Average with HBOT (risk ratio (RR) with HBOT 1.53, 95% CI 0.85 to 2.78, P = 0.16), but did show a significantly increased chance of a 25% increase in PTA (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). There was a 22% greater chance of improvement with HBOT, and the number needed to treat (NNT) to achieve one extra good outcome was five (95% CI 3 to 20). There was also an absolute improvement in average pure tone audiometric threshold following HBOT (MD 15.6 dB greater with HBOT, 95% CI 1.5 to 29.8, P = 0.03). The significance of any improvement in tinnitus could not be assessed.

There were no significant improvements in hearing or tinnitus reported for chronic presentation (six months) of ISSHL and/or tinnitus.

Authors' conclusions

For people with acute ISSHL, the application of HBOT significantly improved hearing, but the clinical significance remains unclear. We could not assess the effect of HBOT on tinnitus by pooled analysis. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously. An appropriately powered trial is justified to define those patients (if any) who can be expected to derive most benefit from HBOT.

There is no evidence of a beneficial effect of HBOT on chronic ISSHL or tinnitus and we do not recommend use of HBOT for this purpose.

 

Plain language summary

Hyperbaric oxygen for sudden hearing loss and tinnitus (ringing in the ears) of unknown cause

Idiopathic sudden sensorineural hearing loss (ISSHL) is common and often results in permanent hearing loss. It therefore has a high impact on the well-being of those affected. Tinnitus (abnormal persistent noises or ringing in the ear) is similarly common and often accompanies the hearing loss. Although the cause of these complaints is not clear, they may be related to a lack of oxygen secondary to a vascular problem not yet identified. Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a specially designed chamber and it is sometimes used as a treatment to increase the supply of oxygen to the ear and brain in an attempt to reduce the severity of hearing loss and tinnitus.

We found some evidence from seven small trials of generally poor quality, that hearing may be improved in people with ISSHL and possibly that tinnitus may also be improved. This may only be true if HBOT is used within two weeks of the onset of problems and there is no evidence that HBOT can help people who have been deaf for some months. Further research is needed.

 

摘要

背景

高壓氧對自發性突發性感覺神經性聽力喪失及耳鳴的治療

自發性突發性感覺神經性聽力喪失(ISSHL)無論是否合併耳鳴是個常見且明顯影響生活品質的健康問題。高壓氧治療(HBOT)也許可改善內耳的氧氣供應，因此被假設可能會讓聽力改善及減少耳鳴的強度

目標

評估用高壓氧治療自發性突發性感覺神經性聽力喪失 及/或 耳鳴的優缺點

搜尋策略

於2004年6月第一次搜尋，於2006年6月再次搜尋了the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006), CINAHL, Database of Randomised Trials in Hyperbaric Medicine (DORCTHIM), AMED, LILACS, KOREAMED, INDMED, National Research Register (NRR), CSA, ISI PROCEEDINGS及 ZETOC.

選擇標準

治療自發性突發性感覺神經性聽力喪失 及/或 耳鳴的隨機研究，比較包含高壓氧與不包含高壓氧的治療效果

資料收集與分析

三位作者各自用有效度的OxfordScale (Jadad 1996)評估相關試驗的設計品質，並從所收集的試驗中摘選資料

主要結論

這篇回顧包含6個試驗308位病患。其中2個試驗共含114位病患的整合資料中，並沒有顯示用了高壓氧治療後可讓純音聽力平均閾值(PTA)的進步機會有50%(高壓氧治療相對風險(RR)1.53, 95% CI 0.85 to 2.78, P = 0.16)，但發現明顯增加25%的機會可讓純音聽力平均閾值進步(RR 1.39, 95% CI 1.05 to 1.84, P = 0.02)。用高壓氧治療有超過22%的機會可改善，如要達到特別好之治療結果的需要治療次數是5(95% CI 3 to 20)。另一個試驗含50位病人也顯示高壓氧治療讓純音聽力平均閾值更加進步許多，它以基準值的百分比表示(WMD 37%, 95% CI 22% to 53%, P < 0.001)。關於高壓氧治療耳鳴後的進步程度是病患主觀的分等級，由於報告不完整所以無法評估。在一個試驗中調查了自發性突發性感覺神經性聽力喪失 及/或 耳鳴的慢性(6個月)表現症狀，顯示聽力或耳鳴並沒有明顯進步

作者結論

對於早期的自發性突發性感覺神經性聽力喪失，利用高壓氧治療可讓聽力喪失明顯進步，但其進步程度在臨床上的重要性並不清楚。從這些整合的資料分析中，我們無法評估高壓氧治療對耳鳴的效果。從這篇回顧無法證明常規用高壓氧治療這類病人是正確的。由於不多的病患數目、方法學上的缺點、及報告的不完整，說明這個結論必須小心，而且我們需要一個非常嚴格設計且有適當強度的試驗來證明並定義高壓氧治療預期對何類病患最有幫助。高壓氧對於自發性突發性感覺神經性聽力喪失 及/或 耳鳴的慢性表現症狀沒有證實有幫助，基於只有一個研究的結論，不能建議高壓氧用在這類目的

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

高壓氧可能可改善不明原因突然聽力喪失後的耳聾與耳鳴，但這些證據不夠有力。自發性突發性感覺神經性聽力喪失很常見，通常造成永久性聽力喪失，因此對病患的健康有很大影響。耳鳴(不正常的耳內持續性噪音及聲響)同樣常見，且常伴隨聽力喪失。雖然這些疾病的原因不明，但可能與還未被發現的血管性問題間接造成缺氧有關。高壓氧治療是在一個特殊設計的房間中吸入純氧，有時會利用其增加耳內及腦內的供氧來讓聽障及耳鳴嚴重度減輕而當成一種治療。我們從5個小型且設計品質不優的研究證據中得知自發性突發性感覺神經性聽力喪失的病患聽力可能會進步、其耳鳴也可能改善。在發生突發性聽障的2週內用高壓氧治療者才能適用這個結論，沒有證據顯示對於已經聽障數月後才用高壓氧治療的病患有幫助。我們需要更多研究