Review finds strongest support for HBOT plus corticosteroids in sudden hearing loss recovery

The intricate microcirculation of the inner ear is essential for hearing and balance. Vascular disruptions such as hypoperfusion are implicated in sudden sensorineural hearing loss (SSNHL) and potentially Ménière's disease (MD). This review evaluates current evidence on hemodynamic-based therapies, specifically corticosteroids, vasodilators, and hyperbaric oxygen therapy (HBOT), to target these vascular mechanisms. The findings highlight a complex evidence landscape where combining adjunctive HBOT with corticosteroid therapy showed the strongest support for enhancing hearing recovery in SSNHL. However, this combination's effectiveness was influenced by several factors such as the timing of therapy administration, initial severity of hearing loss, and specific audiogram configurations. In contrast, robust evidence backing the routine addition of vasodilators to standard SSNHL therapy was limited, and data supporting HBOT for MD was absent in the reviewed literature. This synthesis suggests that while a tailored approach using combination HBOT and corticosteroids is a promising strategy for SSNHL, significant further investigation through randomized controlled trials is needed to resolve conflicting findings, standardize protocols, and better understand the underlying hemodynamic mechanisms to develop effective evidence-based treatments, especially for MD.