By Marcello Cherchi, MD PhD
For patients
Hyperbaric oxygen therapy (HBOT) involves putting a patient in a special enclosure that is pressurized, with a lot of oxygen. Some researchers believe this may help problems like hearing loss and tinnitus. HBOT is not widely available.
For clinicians
Overview
Hyperbaric oxygen therapy (HBOT) involves putting a patient in an environment of higher atmospheric pressure and 100% oxygen. This treatment probably works through multiple mechanisms. It has been attempted in several conditions relevant to otoneurology, including carbon monoxide intoxication, idiopathic sudden sensorineural hearing loss, noise induced hearing loss, tinnitus and Ménière’s disease. The evidence supporting its efficacy is modest at best.
Introduction
Hyperbaric oxygen therapy (HBOT) involves placing a patient in an environment in which (1) there is greater than 1 atmospheric pressure, and (2) the environmental gas composition is 100% oxygen.
The majority of the literature on this topic is on hyperbaric oxygen therapy. However, other protocols have been studied, including isobaric/normobaric oxygen therapy (Ata et al. 2021; Lamm et al. 1998a) in which the atmospheric pressure is 1; and alternobaric oxygen therapy (Fattori et al. 2002; Fattori et al. 1996) in which the pressure varies.
Mechanism
The mechanism by which hyperbaric oxygen therapy exerts its effects is not entirely clear. One obvious candidate mechanism is an action on mitochondria (Schottlender et al. 2021). Other potential mechanisms include modulation of protein transcription, cell-to-cell contacts, cellular adhesion, cellular transmigration, vascular signaling, response to oxidative stress, apoptosis, autophagy and inflammation (Lindenmann et al. 2021).
Adverse effects
Intuitively, HBOT seems like it should pose little if any medical risk, but in fact it is not risk-free. Reported complications from HBOT include otalgia, aural fullness, hearing loss, tinnitus and disequilibrium (Cakir et al. 2006; Yamamoto et al. 2016). These potential adverse effects should be taken into consideration, since some of these symptoms are purported therapeutic targets of HBOT, such as hearing loss and tinnitus (see below). Some of the apparent adverse effects of HBOT are probably due to barotrauma (Lima et al. 2012), so tympanostomy tube placement has been suggested to counteract this, but that procedure has its own complications (Clements et al. 1998).
Relevance in otoneurology
HBOT has been attempted in several conditions relevant to otoneurology, including carbon monoxide intoxication (Thom and Keim 1989; Weaver 2014), idiopathic sudden sensorineural hearing loss (Agrawal and Sharma 2016; Ajduk et al. 2023; Akil et al. 2017; Alde et al. 2023; Bennett et al. 2005; Bennett et al. 2007; Domachevsky et al. 2007; Dundar et al. 2007; Gaitanou et al. 2014; Holy et al. 2011; Huang et al. 2021; Lamm et al. 1998b; Narozny et al. 2004; Olex-Zarychta 2017; Sun et al. 2018; Uzun et al. 2016; Xie et al. 2018; Yildirim et al. 2015), noise induced hearing loss (Arslan et al. 2012; Ata et al. 2021; Bayoumy et al. 2020; Bayoumy et al. 2021; Cakir et al. 2006; Colombari et al. 2011; Fakhry et al. 2007; Holy et al. 2021; Koochakzadeh et al. 2020; Kuokkanen et al. 2000; Kuokkanen et al. 1997; Lafere et al. 2010; Lamm et al. 1982; Lamm et al. 1998a; Lamm et al. 1998b; Oya et al. 2019; Pilgramm and Schumann 1985; Salihoglu et al. 2015; van der Veen et al. 2014; Vavrina and Muller 1995; Ylikoski et al. 2008) and tinnitus (Baldwin 2009; Bennett et al. 2005; Bennett et al. 2007; Bohmer 1997; Desloovere 2007; Holy et al. 2016; Lamm 2003; Lamm et al. 1998b; Porubsky et al. 2007; Tan et al. 1999). Less studied applications of HBOT include Ménière’s disease (Fattori et al. 2002; Fattori et al. 1996).
Some studies have explored the use of HBOT in conjunction with other therapies, such as transtympanic steroids (Ajduk et al. 2023; Sun et al. 2018) or systemically administered steroids (Narozny et al. 2004; Salihoglu et al. 2015).
Meta-analyses of this literature suggests that additional research is required in order to assess whether HBOT is efficacious in treating these otoneurological conditions (Koochakzadeh et al. 2020).
Other notes
HBOT is fairly low-risk, but evidence supporting its efficacy in otoneurological conditions is modest at best. HBOT is not widely available.
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