Therapeutic effect optimization and influencing factors of hyperbaric oxygen in the treatment of sudden sensorineural hearing loss

Background The best course of hyperbaric oxygen (HBO) therapy for sudden sensorineural hearing loss (SSNHL) and the difference of curative effect on different degrees of hearing loss are not clear in the existing studies. There is an urgent need to optimize HBO treatment strategies through standardized protocols. Methods The multicenter retrospective cohort study (n = 1309) was conducted to explore the efficacy optimization and influencing factors of HBO in the treatment of SSNHL. From January 2022 to September 2024, patients who met the 2019 American Academy of Otolaryngology Head and Neck Surgery Clinical Practice Guidelines for sudden deafness were enrolled in the study. HBO group (n = 991) received 2.2 ATA hyperbaric oxygen combined with hormone therapy, while non-HBO group (n = 318) received only corticosteroid therapy. The primary outcome was the rate of hearing recovery at the end of treatment, and the secondary outcome was the rate of hearing recovery 90 days after treatment. Results 11–20 times of HBO significantly increased the slight recovery rate (OR = 2.205,95% CI: 1.399–3.474, P = 0.001) and the partial recovery (OR = 2.236,95% CI: 1.429-3.500, P < 0.001), but had no significant effect on complete recovery. The 90-day follow-up results showed no heterogeneity with respect to the effect at completion of treatment, but the efficacy of 11–20 HBO sessions extended over time from improving only slight and partial recovery to significantly promoting complete recovery (OR = 0.422, 95% CI: 0.224–0.793, P = 0.007). The degree of hearing loss significantly affected the efficacy. Compared with the patients with total deafness, the partial recovery of patients with mild/moderate to severe deafness was significantly lower (92.5%, 91.6%, 67.0%), while the partial recovery of patients with very severe deafness was significantly higher (125.3%). Multivariate regression analysis showed that age, delayed treatment, vertigo and high initial pure tone threshold were independent prognostic factors (P < 0.05). No serious adverse events occurred. Conclusion HBO combined with corticosteroids can improve hearing recovery.It is recommended to implement 10–20 times of HBO therapy as early as possible morbidity 2 weeks, especially for patients with extremely severe and total deafness.In the future, it is necessary to unify the efficacy criteria to promote individualized treatment.