Idiopathic Sudden Sensorineural Hearing Loss (ISS) or (ISSHL)
The classical presentation of ISS is that the patient will awaken with a sudden hearing loss, usually unilateral (in one ear). They may experience tinnitus (a ringing or a noise no one else hears) in one or both ears, have an aural fullness and have vertigo (dizziness). The incidence in the U.S. is 20 out of every 100,000 adults, with 4000 new cases reported annually. Medically we suspect the actual number of cases may actually be under-reported. Fortunately, 65% of the reported cases resolve spontaneously. ISS accounts for 90% of all hearing loss reported.
Hearing loss can impose a heavy social & economic burden on individuals, families, communities & countries collectively. Hearing impairment makes it difficult for an individual to obtain, perform, & keep employment. Those suffering from hearing impairments are often stigmatized & isolated socially. According to the World Health Organization (WHO) a significant burden is the cost of special education & the loss of employment.
The onset of ISS may be associated with vascular occlusion, viral infections, immune-associated mechanisms, trauma, abnormal tissue growth, toxins & cochlear membrane damage. Cochlear pathology may include; vestibular Schwannomas, demyelinating diseases & stroke. No matter what the cause it should be investigated thoroughly.
Like most things in the medical field, there is no consensus for the treatment of ISS. Everything from oral corticosteroids to vitamins & tranquilizers has been advocated. There is good evidence to suggest the effectiveness of vasodilators in the treatment of ISS. However, the incidence of side effects & the cost of such vasodilators has yet to be determined.
There is significant evidence that suggests Hyperbaric Oxygen Therapy (HBOT) may be the safest and most effective form of treatment for ISS. The cochlea is a snail-shaped, conical chamber of bone & is the auditory portion of the inner ear. Cochlear activity is known to require high oxygen levels. Oxygen is believed to improve cochlear metabolism & intracochlear tension. HBOT is the only way to achieve an increase in the oxygen concentration in the cochlea.
Several retrospective studies have demonstrated using HBOT alone can improve hearing loss by 69%. HBOT alone demonstrated the greatest improvement however, when coupled with steroids, the percentages of recovery are even higher, especially when started within 6 days of the onset.
Some insurance companies will now cover HBOT for the treatment of ISS, acoustic trauma or Noise-induced hearing loss when HBOT is initiated within a 3-month window of the onset.
If you or a family member are suffering from ISS, talk with your EENT physician about incorporating Hyperbaric in with your treatment for a greater chance for recovery. Studies & more information are available. Please feel free to contact our office if you have any questions.
Dr. Skaggs is a member of the International Hyperbaric Medical Association (IHMA) & was recently appointed to the Executive Board of Directors. This organization is on the cutting edge of research, establishing treatment protocols, indications for treatment while establishing safety for the public & the industry. We are proud to be a part of that.