Hyperbaric oxygen therapy for sudden hearing loss in Jordan
علاج فقدان السمع المفاجىء بالأكسجين المضغوط
Sudden sensorineural hearing loss is a drop in hearing that appears over hours or a few days, usually in one ear and without an obvious cause, sometimes with tinnitus, a feeling of fullness in the ear, or vertigo. Treating it with hyperbaric oxygen means adding sessions of breathing high-concentration oxygen inside a pressurised chamber to the primary treatment, in order to raise the oxygen reaching the inner ear, whose fine blood supply feeds cells that are highly sensitive to oxygen shortage. This is a medically accepted use, but an adjunctive one rather than the mainstay. The mainstay is corticosteroid treatment, given by mouth, injected into the middle ear, or both, according to the decision of the ear, nose and throat specialist. Hyperbaric oxygen is added to that and does not replace it, and its addition is most defensible when started early after the loss appears and when the loss is severe. Timing is the decisive factor. Sudden hearing loss is an urgent problem that deserves assessment within the first days rather than a period of waiting, because the chance of recovery falls as time passes. The first step is not the chamber but an ENT examination with an audiogram, to distinguish sensorineural loss from a simple conductive cause such as impacted wax, fluid behind the eardrum, or a perforation, since management differs completely. An MRI scan may be requested to exclude causes affecting the hearing nerve. The limits are explicit. Hyperbaric oxygen does not treat chronic hearing loss or age-related hearing loss, nor hearing loss from long-term noise exposure, nor tinnitus alone without hearing loss, nor conductive hearing loss, and it does not restore hearing lost months earlier. It is not a substitute for corticosteroids or for ENT follow-up, and no guaranteed outcome can be promised: some patients recover substantially, some partially, and some not at all. In this condition in particular it is worth noting that the ear itself is the commonest site of trouble inside a chamber, so equalisation is explained carefully, and **severe ear pain that will not settle, or bleeding from the ear, stops the session**. Anyone unable to equalise ear pressure is offered a simple medical solution to vent the pressure before the programme continues.
Procedure steps
- 1
Urgent examination and audiogram
The first step is an ENT examination as soon as possible, with an audiogram to define the type and degree of loss. The ear canal and eardrum are inspected to exclude impacted wax, fluid behind the drum, a perforation or infection, and you are asked about vertigo, tinnitus, your medications and any recent infection or injury. This step is what prevents a simple conductive problem being treated with a course of sessions that does not fit it.
- 2
Starting corticosteroid treatment
Corticosteroid treatment is started as early as possible, by mouth, by injection into the middle ear, or both, according to your condition, your chronic illnesses and your doctor's judgement. This step is never delayed while waiting for a chamber appointment. Blood sugar and blood pressure are monitored during it if you have either problem, because steroids raise both in many patients.
- 3
Assessing eligibility for hyperbaric oxygen
Adding sessions is decided according to how long the loss has been present, how severe it is, and the response to steroids. Before entry, the barriers to chamber use are assessed: lungs, heart, sinuses and the other ear, together with a medication review, especially chemotherapy. Eligibility is a medical decision; not everyone with sudden hearing loss is a candidate, and the programme is not prescribed merely on request.
- 4
Preparation and ear equalisation
You are shown in practice how to equalise ear pressure by swallowing or moving the jaw before pressurisation, and this is the most important skill to practise here. Fire-safety rules apply: designated clothing, no oils, greasy ointments or perfumes, and no lighters, phones or any electronic device. For anyone who cannot equalise, a simple procedure to vent middle-ear pressure is discussed.
- 5
Sessions and repeat audiometry
Sessions repeat over a relatively short programme, and audiometry is repeated at intervals to measure what has actually changed in numbers rather than in impressions. Objective improvement is what justifies continuing, and if nothing has changed by the end of the programme the plan is reviewed with the ENT specialist, and options such as hearing rehabilitation, hearing aids or tinnitus management are discussed.
Before the procedure
Do not wait. Tell the doctor exactly when the hearing loss began and how it progressed, whether one ear or both are affected, and whether there is tinnitus, vertigo, fullness, pain or discharge. Report any recent cold, ear or sinus infection, any injury to the head or ear, exposure to loud noise, or recent diving or air travel. Report all medications, especially any chemotherapy, and any epilepsy or seizures, chronic lung disease, previous collapsed lung, ear surgery or perforated eardrum, and say if you are pregnant or might be. If you have diabetes or high blood pressure, mention it before steroids are started and monitor your readings during treatment. Bring your audiogram and any earlier reports. Learn and practise ear equalisation before entry, and tell the centre if your nose becomes blocked or your sinuses inflamed so the session can be postponed. Wear no oil, greasy ointment, perfume or deodorant, and bring no lighter, phone or smart watch into the chamber, as this is a fire-safety rule. If closed spaces frighten you, say so in advance.
After the procedure
Complete the corticosteroid course exactly as prescribed, never stopping or reducing it on your own, and monitor your blood sugar and blood pressure during it if either applies to you. Complete the programme of sessions and the audiometry appointments, since the result is judged by numbers rather than by impression alone. Avoid loud noise, high-volume headphones, diving and unnecessary air travel during treatment or until your doctor allows them. Expect passing fullness in the ears after sessions, and anyone completing many sessions may notice a temporary shift in vision that usually reverses after the programme ends. If tinnitus or hearing loss persists, ask your doctor about hearing rehabilitation and hearing-aid options, which improve daily life even when hearing does not return to normal. **Seek care immediately for severe ear pain, bleeding or discharge from the ear, a sudden further drop in hearing or loss spreading to the other ear, severe vertigo with vomiting or loss of balance, severe headache or weakness of the face or limbs or difficulty speaking, shortness of breath or chest pain, or a seizure or twitching.**
Expected duration
A single session usually lasts sixty to one hundred and twenty minutes, plus preparation and observation. Treatment is a programme rather than one visit, typically running from about ten to twenty sessions at roughly one per weekday, with audiometry repeated at intervals. More important than the number of sessions is starting early after the loss appears.
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