Smart David
Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.
Corresponding author: Clinical Professor David Smart, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool St, Hobart, Tasmania 7000, Australia, ORCiD: 0000-0001-6769-2791,
Diving Hyperb Med. 2024 Dec 20;54(4):360-367. doi: 10.28920/dhm54.4.360-367.
This report describes the outcomes of sensorineural hearing loss (SNHL) due to cochlear inner ear barotrauma (IEBt) in five divers treated with hyperbaric oxygen (HBOT).
The case histories of five consecutive divers presenting with SNHL from IEBt due to diving, were reviewed. All divers provided written consent for their data to be included in the study. All had reference pre-injury audiograms. All noted ear problems during or post-dive. Independent audiologists confirmed SNHL in all divers prior to HBOT, then assessed outcomes after HBOT.
Three divers breathed compressed air on low risk dives, and two were breath-hold. None had symptoms or signs other than hearing loss, and none had vestibular symptoms. All could equalise their middle ears. Inner ear decompression sickness was considered unlikely for all cases. All were treated with HBOT 24 hours to 12 days after diving. Two divers received no steroid treatment, one was treated with HBOT after an unsuccessful 10-day course of steroids, and two divers received steroids two days after commencing HBOT. All divers responded positively to HBOT with substantial improvements in hearing across multiple frequencies and PTA4 measurements. Median improvement across all frequencies (for all divers) was 28 dB, and for PTA4 it was 38 dB.
This is the first case series describing use of HBOT for IEBt-induced SNHL. The variable treatment latency and use/timing of steroids affects data quality, but also reflects pragmatic reality, where steroids have minimal evidence of benefit for IEBt. HBOT may benefit diving related SNHL from IEBt with no evidence of perilymph fistula, and provided the divers can clear their ears effectively. A plausible mechanism is via correction of ischaemia within the cochlear apparatus. More study is required including data collection via national or international datasets, due to the rarity of IEBt.
本报告描述了5名接受高压氧治疗（HBOT）的潜水员因耳蜗性内耳气压伤（IEBt）导致感音神经性听力损失（SNHL）的治疗结果。
回顾了5例因潜水导致IEBt并出现SNHL的连续潜水员的病历。所有潜水员均书面同意将其数据纳入研究。所有人都有受伤前的听力图作为参考。所有人在潜水期间或潜水后都注意到了耳部问题。独立听力学家在HBOT治疗前确认所有潜水员患有SNHL，然后评估HBOT治疗后的结果。
3名潜水员在低风险潜水中呼吸压缩空气，2名潜水员屏气潜水。除听力损失外，没有人有其他症状或体征，也没有人有前庭症状。所有人都能使中耳压力平衡。所有病例均不太可能患有内耳减压病。所有患者在潜水后24小时至12天接受了HBOT治疗。2名潜水员未接受类固醇治疗，1名潜水员在为期10天的类固醇治疗失败后接受了HBOT治疗，2名潜水员在开始HBOT治疗两天后接受了类固醇治疗。所有潜水员对HBOT治疗反应良好，多个频率的听力和PTA4测量值均有显著改善。所有频率（所有潜水员）的中位改善值为28dB，PTA4的中位改善值为38dB。
这是首个描述使用HBOT治疗IEBt引起的SNHL的病例系列。治疗延迟的差异以及类固醇的使用/时机影响数据质量，但也反映了实际情况，即类固醇对IEBt的益处证据极少。对于没有外淋巴瘘证据且潜水员能够有效清理耳部的IEBt相关SNHL，HBOT可能有益。一种合理的机制是通过纠正耳蜗内的缺血。由于IEBt罕见，需要通过国家或国际数据集进行更多研究，包括数据收集。
