Bayoumy A B, Weenink R P, van der Veen E L, Besseling-Hansen F S, Hoedemaeker A D M, de Jong F J M, van der Laan M H, Swenker R, van Hulst R A, de Ru J A
Department of Otolaryngology, Central Military Hospital, Ministry of Defense, Utrecht, the Netherlands.
Department of Anesthesiology and Department of Hyperbaric Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
J Otol. 2021 Oct;16(4):237-241. doi: 10.1016/j.joto.2021.05.001. Epub 2021 May 11.
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.
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.
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.
Our analysis shows results in favor of early initiation (≤2 days) of the combination treatment of HBOT and corticosteroids in patients with AAT.
急性声创伤（AAT）是由强烈噪声冲击导致的急性听力损伤。荷兰军队中针对伴有严重听力损失的AAT的当前治疗策略是皮质类固醇与高压氧治疗（HBOT）联合治疗。在之前的一项研究中，联合治疗的早期启动与更好的治疗效果相关。因此，我们进行了一项新的分析，以评估在两天内开始联合治疗的患者与两天后开始联合治疗的患者在听力结果上的差异。
对2018年2月至2020年3月期间诊断为伴有严重听力损失的AAT的军事患者进行回顾性分析。计算所有受影响频率（定义为初始听力图上损失≥20 dB）首次和最后听力图之间的绝对和相对听力改善情况。我们还确定了恢复到荷兰军队要求水平的患者数量，并进行了言语辨别测试。
在该分析中，纳入了30例患有AAT的男性患者（49耳）。中位年龄为24.5岁（四分位间距23 - 29岁）。开始使用皮质类固醇和HBOT治疗的中位时间分别为1天和2天。31耳在两天内开始HBOT治疗，18耳在两天后开始。所有受影响频率的平均绝对和相对听力增益分别为18.8 dB（标准差14.6）和46.8%（标准差31.3）。100%辨别/言语感知水平从64.0 dB提高到51.7 dB（增益12.3 dB±14.1）。与两天后开始相比，在≤2天开始HBOT治疗时，绝对和相对听力改善明显更多。
我们的分析结果表明，对于AAT患者，早期（≤2天）启动HBOT和皮质类固醇联合治疗是有益的。
