Utility of Hyperbaric Oxygen Therapy for Acute Acoustic Trauma: 20 years' Experience at the Japan Maritime Self-Defense Force Undersea Medical Center

Hyperbaric oxygen therapy and corticosteroids as combined treatment for acute acoustic trauma

PURPOSE

Acute acoustic trauma (AAT) is a sudden sensorineural hearing loss (SNHL) due to exposure to high intensity impulse noise. There are no acceptable treatment guidelines, although several studies showed steroids could be effective in restoring hearing levels. A recent report suggested that steroids combined with hyperbaric oxygen therapy (HBOT) are a superior regiment for AAT. The purpose of the current study is to investigate the effectiveness of steroids and HBOT for AAT treatment.

METHODS

the medical records 90 patients (118 ears) afflicted with AAT and treated with steroids and HBOT were retrospectively reviewed. Inclusion criteria were sensorineural hearing loss of at least 30 dB at the high frequency range (> 3,000 Hz) following exposure to intense sound. Patients who started treatment within 7 days were classified as "Early treatment" group whereas patients who started treatment ≥ 8 days after AAT were classified as "Late treatment".

RESULTS

The high frequency (3-8 kHz) Pure Tone Average (hPTA) of the entire study population (n = 118) was 40.26 ± 15.42 dB pretreatment vs. 24.99 ± 15.83 dB post treatment (Wilcoxon matched-pairs test, P < 0.0001). Pre-treatment hPTA was not statistically different between early and late study groups, 39.87 ± 16.00 vs. 40.86 ± 14.35 dB in the early vs. late group, respectively (ANOVA, F[3,232] = 22.574, P > 0.05). The post-treatment hPTA on the other hand, was significantly lower in the early vs. late treatment groups (21.93 ± 15.38 vs.31.19 ± 15.09 dB, respectively; ANOVA, F[3,232] = 22.574, P < 0.05).

CONCLUSION

Combination treatment with corticosteroids and HBOT is highly beneficial in improving hearing outcomes following AAT, when initiated within 7 days. This study was retrospectively registered on July 19th 2020 and assigned the identifier number NCT04482998.

Recovery rate after acute acoustic trauma: a case series and meta-analysis

OBJECTIVE

Steroids given systemically, locally, or both are the mainstay of treatment for acute acoustic trauma (AAT). The overall recovery rate (full, partial, and none) is undetermined.

STUDY DESIGN

Original case series and systematic literature review.

SETTING

Case series of a tertiary referral center and a systematic literature review.

METHODS

Cases of AAT between 2012 and 2022 were retrospectively analyzed for demographics, acoustic trauma characteristics, treatment modality and delay and prognosis. This case series was added to the series identified by a systematic literature review. This review included "Medline" via "PubMed", "EMBASE", and "Google scholar". All series were pooled for meta-analysis defining prognosis following steroidal treatment for AAT patients.

RESULTS

The pooled analyses included 662 ears, out of which 250 underwent complete recovery of hearing (overall proportion = 0.2809, 95%confidence interval [CI] = 0.1611-0.4178). Any recovery was recorded for 477 ears (overall proportion = 0.7185, 95% CI = 0.5671-0.8493) and no recovery was documented for 185 ears (overall proportion = 0.2815, 95% CI = 0.1507-0.4329).

CONCLUSION

The rate of overall recovery for AAT is around 70%, and around 30% for full recovery when steroids are initiated within the first 2 weeks following the insult.

LEVEL OF EVIDENCE: 3

Analysis of Therapeutic Options for Noise-Induced Hearing Loss: Retroauricular Injection of Methylprednisolone Sodium Succinate Combined with Hyperbaric Oxygenation

OBJECTIVE

To evaluate the clinical effect of retroaural injection of methylprednisolone sodium succinate combined with hyperbaric oxygen (HBO) on the treatment of noise-induced hearing loss.

METHODS

Case data of 220 patients with hearing loss treated at the Zhongda Hospital Southeast University from January 1, 2019 to August 1, 2023 were obtained. As per the treatment plan, the recruited patients were divided into two cohorts: 158 cases in the combined-treatment group (retroaural injection of methylprednisolone sodium succinate combined with HBO) and 62 cases in the single-hormone group (retroaural injection of methylprednisolone sodium succinate). Comparison of the clinical efficacies and postoperative complication rates of the two groups was performed after treatment. MS-Excel was used to build a database for all data, and SPSS26.0 was utilized in the statistical analysis of recorded data.

RESULTS

For patients with low-frequency, high-frequency, and flat descending type, the combined-treatment group showed significantly higher clinical effective rate than the single-hormone group (P < 0.05). For patients with disease duration ≤7 days, the combined-treatment group attained a significantly higher clinical effective rate was than the single-hormone group (P < 0.05). The safety of patients in both groups was evaluated mainly through their adverse reactions. The total incidence of adverse reactions in the single-hormone group reached 9.68%, and that in the combined-treatment group was 8.23%. The two groups revealed no significant difference in terms of incidence of adverse reactions (P > 0.05).

CONCLUSION

HBO combined with retroaural injection of methylprednisolone sodium succinate has good clinical efficacy and safety in the treatment of hearing loss.

Noise-Induced Hearing Loss

Noise-induced hearing loss (NIHL) is the second most common cause of sensorineural hearing loss, after age-related hearing loss, and affects approximately 5% of the world's population. NIHL is associated with substantial physical, mental, social, and economic impacts at the patient and societal levels. Stress and social isolation in patients' workplace and personal lives contribute to quality-of-life decrements which may often go undetected. The pathophysiology of NIHL is multifactorial and complex, encompassing genetic and environmental factors with substantial occupational contributions. The diagnosis and screening of NIHL are conducted by reviewing a patient's history of noise exposure, audiograms, speech-in-noise test results, and measurements of distortion product otoacoustic emissions and auditory brainstem response. Essential aspects of decreasing the burden of NIHL are prevention and early detection, such as implementation of educational and screening programs in routine primary care and specialty clinics. Additionally, current research on the pharmacological treatment of NIHL includes anti-inflammatory, antioxidant, anti-excitatory, and anti-apoptotic agents. Although there have been substantial advances in understanding the pathophysiology of NIHL, there remain low levels of evidence for effective pharmacotherapeutic interventions. Future directions should include personalized prevention and targeted treatment strategies based on a holistic view of an individual's occupation, genetics, and pathology.

Efficacy of Oral Steroids for Acute Acoustic Trauma

Objective

This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury.

Study Design

This is a case-control study.

Methods

We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016–2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2–8 kHz.

Results

Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13–14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7–8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups.

Conclusions

Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

It's all about timing, early treatment with hyperbaric oxygen therapy and corticosteroids is essential in acute acoustic trauma

Background

Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noise-impact. The current management strategy for AAT with substantial hearing loss in the Dutch military is the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previous study, early initiation of the combination therapy was associated with better outcomes. Therefore, we performed a new analysis to assess the difference in hearing outcome between patients in whom combination therapy was started within two days, versus after more than two days.

Methods

A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relative hearing improvement between first and last audiograms were calculated for all affected frequencies (defined as loss of ≥20 dB on initial audiogram). We also determined the amount of patients who recovered to the level of Dutch military requirement, and performed speech discrimination tests.

Results

In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5 years (IQR 23-29). The median time to initiation of therapy with corticosteroids and HBOT were one and two days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18 ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on all affected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB (gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearing improvement when HBOT was started in ≤2 days, compared to >2 days.

Conclusion

Our analysis shows results in favor of early initiation (≤2 days) of the combination treatment of HBOT and corticosteroids in patients with AAT.

The Use of Hyperbaric Oxygen Therapy and Corticosteroid Therapy in Acute Acoustic Trauma: 15 Years' Experience at the Czech Military Health Service

Background: Acute acoustic trauma (AAT) ranks, among others, as one common cause of inner ear function impairment, especially in terms of military personnel, who are at an increased exposure to impulse noises from firearms. Aim of this study: 1. We wanted to demonstrate whether early treatment of AAT means a higher chance for the patient to improve hearing after trauma. 2. We find the answer to the question of whether hyperbaric oxygen therapy (HBO2) has a positive effect in the treatment of AAT. Methods: We retrospectively analyzed data for the period 2004–2019 in patients with AAT. We evaluated the therapeutic success of corticosteroids and HBO2 in a cohort of patients with AAT n = 108 patients/n = 141 affected ears. Results: Hearing improvement after treatment was recorded in a total of 111 ears (79%). In terms of the data analysis we were able to ascertain, utilizing success of treatment versus timing: within 24 h following the onset of therapy in 56 (40%) ears—54 (96%) ears had improved; within seven days following the onset the therapy was used in 55 (39%) ears—41 (74%) ears had improved; after seven days the therapy started in 30 (21%) ears—16 (53%) ears had improved. Parameter latency of the beginning of the treatment of AAT was statistically significant (p = 0.001 and 0.017, respectively). The success of the medical protocols was apparent in both groups—group I (treated without HBO2): n = 61 ears, of which 50 (82%) improved, group II (treated with HBO2): n = 73 ears, of which 56 (77%) improved. Group II shows improvement at most frequencies (500–2000 Hz). The most serious sensorineural hearing loss after AAT was at a frequency of 6000 Hz. Conclusion: Analysis of our data shows that there is a statistically significant higher rate of improvement if AAT treatment was initiated within the first seven days after acoustic trauma. Early treatment of AAT leads to better treatment success. HBO2 is considered a rescue therapy for the treatment of AAT. According to our recommendation, it is desirable to start corticosteroid therapy immediately after acoustic trauma. If hearing does not improve during the first seven days of corticosteroid therapy, then HBO2 treatment should be initiated.

Noise-Induced Hearing Loss Treatment: Systematic Review and Meta-analysis

OBJECTIVE

To determine the efficacy of steroid and hyperbaric oxygen therapy (HBOT) in the setting of acute noise-induced hearing loss.

METHODS

Systematic review and meta-analysis of noise-induced hearing loss treatment studies that reported on patients who (1) reported individual frequencies up to 8,000 Hz with mean and SDs; (2) were treated only with steroids ± HBOT; and (3) sustained acute acoustic trauma. The Newcastle-Ottawa Scale was used to assess risk of bias across cohorts. Data sources were Embase, Web of Science, Cochrane Databases (via Ovid EBM Reviews), and PubMed.

RESULTS

Four studies were of retrospective cohorts and one of a prospective cohort. Only one study examined blast acoustic trauma, and the remaining four examined gunfire acoustic trauma. This meta-analysis used a random-effects model for pure tone average (PTA) (0.5, 1, and 2 kHz) and "high-frequency" PTA (HPTA) (4, 6, and 8 kHz) for the five studies included. Steroid therapy demonstrated a 6.55-dB (95% CI, 0.08-13.17 dB) PTA (n = 55) improvement and a 9.02-dB (95% CI, 1.45-16.59 dB) HPTA (n = 71) improvement. Steroid with HBOT demonstrated a 7.00-dB (95% CI, 0.84-13.17 dB) PTA (n = 133) improvement and a 12.41-dB (95% CI, 3.97-20.86 dB) HPTA (n = 150) improvement. According to our statistical analysis of the pooled studies' heterogeneity, there was moderate inconsistency in the cross-study results of both treatment groups.

CONCLUSION

Steroids with or without HBOT appear to improve both low and high hearing thresholds following acoustic trauma. Future studies will require inclusion of control groups, precise definition of acoustic trauma intensity and duration, and genetic polymorphisms.