Hyperbaric Oxygen Therapy

My experience with HBOT:

Initial cause tinnitus:

1. 10/2018 - car accident - bilateral "head tinnitus" (=T1)
2. 04/04/2020 - Acoustic trauma (cummulative) - unitlateral Left ear (=T2)
3. late april 2020 - worsening due to prednisone/piracetam - bilateral shifting from L to R (=T3)

Treatment description:
Location: HBO centrum Aachen
Marx schedule: 2,4 ata and 90 mins of 100% oxygen. The measured partial oxygen pressure was in the range of 980 to 1280 mg. -> copied this directly from the description of I received.
Total duration of dive: 2,5 hrs (incl. 15 mins descent + 15 mins ascent)
HBO chamber: tank for 12 people
Medical evaluation: before and after every session ears were check on signs of barotrauma with otoscope (no signs of barotraume detected in my ears).
HBOT itself is not loud, i think max 70/75 dBs + I was allowed to wear hearing protection all the time except during the ascent and descent.

Start HBOT treatment :
Session 1: 15/05/2020

• During Therapy: immidiate sizzling in Left ear immediatly after pressure started to build.
• After therapy: Slight spike in T2 which subsided, no adverse effect

Session 2: 16/05/2020

• During therapy: immidiate sizzling in Left ear immediatly after pressure started to build.
• After therapy:
  • Slight spike in T2 which subsided,
    
  • noticed that a new sound was manifsting in Left ear which did not subside during the weekend, but was less intense than the sound I heard during the dive (=T4).
  • morning of the 18th: first time I woke-up without T2, but it was fluctuating very hard in the days before so difficult to say if HBOT had anything to do with it. However, this sadly made me decide to try another session.

Session 3: 18/05/2020

• During therapy: immidiate sizzling in Left ear immediatly after pressure started to build.
• After therapy:
  • Immediatly after: T4 was more profound was closer to the sizzling I heared during therapy
  • Several hours after therapy: suddenly started to hear high pitched random "blinks" -> made me freak out completely and decided to stop the therapy.
  • Two weeks after therarpy: T4 became even more profound and sometimes was completly the same as the sound I heard in the chamber. I also had a painfull feeling in my ear and a feeling of having fluid in my ear.

Today (09/06/2020)
- Devoped a popping/crackling + feeling of fluid in in both left and right ear (right ear started only last week friday)
- Left ear still sizzles on and off, sometimes stops, but no real difference in the last 3 weeks
- Right ear also started to develop a similar sizling tone as the right ear (=T5!?). It's still less frequent and intens, but I have the impression that it is getting worse every few days.

My conclusion

• HBOT did not do anything for T1 to -3 and gave me (at least temporarily) T4 & T5 + ETD/barotrauma.
• I think it's good to be cautious with HBOT if you experience any noise induced directly by the increase in pressure, as this might indicate that you are sensitive to ETD/barotrauma.
  
• A spike in your T seems to be a normal side effect and appears to go away for almost everyone.

-> I'm now left with a multitude of sounds due to TBI, NIHL and ETD/barotrauma . Still hoping for T4&5 to go away, but tinnitus seems to have a way of sticking into my ears.
I will never forget these legendary words of the ENT: "it is not possible that HBOT will make your tinnitus any worse.".

Additional Remark
I also wanted to share this link, because I wish I would have decided differently to start the HBOT having this information:
Hyperbaric Oxygen Therapy: Effect on Middle Ear and Eustachian Tube Function
"The results show 15 of the 33 patients (45%) had evidence of eustachian tube dysfunction after treatment was initiated. Of these, 15 (100%) developed the sensation of fullness, 13 (87%) developed serous otitis media, and 7 (47%) required tympanostomy tubes."
-> So please be aware that the 2/3% ratio of people having an adverse reaction to HBOT they often throw around MIGHT be a gross underestimation.

 

I did 5 HBOT sessions after my acute acoustic trauma, and it didn't really help with my hearing loss but it seemed to help with my hyperacusis and tinnitus. Who knows, maybe it would be the same without it but I noticed a benefit right after the 3rd session. I wanted to do more but I couldn't afford it. I had no trouble with my ears inside a hard chamber but I know some people do.

 

I'm considering HBOT but feel I must be missing something here? There are three studies noting such cases where barotrauma was so severe that tympanostomy tubes were required. This can lead to all sorts of complications.

https://pubmed.ncbi.nlm.nih.gov/1731157/ - "(24%) requiring tympanostomy tubes"

https://onlinelibrary.wiley.com/doi/abs/10.1288/00005537-199411000-00011 - "53 (21.3%) required tympanostomy tubes."

https://www.otopa.org/uploads/1/0/3/7/103751734/cohn_jason_-_hbot_poster_12.pdf - "23 (28.4%) eventually required tympanotomy tube placement"

If it was really this common then I would expect to be reading about these issues on here, but there are next to no reports on this?

 

I never had HBOT so take this with a grain of salt. But, logically thinking if your ears are damaged and becomes sensitive, and since HBOT has high pressure difference compared to your inner ear, it might very well negatively impact your ears. You have low pressure in your inner ear (because it's poorly ventilated) and then suddenly you're exposed to high pressure HBOT. Obviously, that's going to concave your ear drum when you're suddenly exposed to it. Do you think that's a good idea? I have no idea how much this can do to your ears.

But I can imagine that if your eardrums are really weak (from infection, rupture ear drums, inflammation etc), then it might do damage to your ear drum. So really, who knows. If you're ready to accept these risks, then it's your own decision. If not, then I wouldn't do it, especially since a lot of people say it's ineffective.

 

I am nearly 5 weeks out from acoustic trauma. Constant loud hissing in my ear.

Is HBOT recommended at this point? Has it helped anyone on this thread?

 

I had acoustic trauma. A loud sound came through headphones for 1-2 seconds. One month has passed since the acoustic trauma. My only complaint is ringing. I have no hearing loss.

Does HBOT work? The cost is high, my salary is low. Is it worth a try?

 

@SadMan -- As someone with extensive experience with HBOT, and believe it has great value for a number of conditions... I'd say the probability of it helping your tinnitus is relatively low, and probably not worth the expense.

 

I did HBOT.

I cannot stress this enough, it is NOT worth the risk of making tinnitus worse.

It's forcibly giving you oxidative stress - maybe effective right after the onset of your tinnitus (within a couple of days), but, anything later, don't bother...

You could end up killing auditory nerves and, like me, become, much, much worse off.

If you MUST try... keep it under 5 sessions back to back, and then never again.

 

I read an article saying that oxygen chambers can actually reverse aging.

It Sure Looks Like Humans Have Found a Way to Reverse Aging

No paywall:
In a First, Scientists Say They've Partially Reversed a Cellular Aging Process in Humans

I'm surprised to see people suggesting it will destroy nerves, etc...

 

I started HBOT treatment. I had the 3rd session today.

Before the HBOT treatment, my tinnitus sometimes decreased and sometimes increased.

I cannot say that the HBOT is helping me. Should I quit?

I started the HBOT treatment on the 33rd day (i.e. approximately 4.5 weeks after my tinnitus onset). Am I too late?

After how many sessions should I see some effect from the treatment?

 

I respect your experience, but don't share your opinion.

The research that I've read, and I've tried to read as much as I can find, indicates that HBOT, when provided early enough and with sufficient sessions, can potentially help and has very little risk. Furthermore, while the earlier the better, research suggests it's been helpful within 3 months.

I've done it myself (over 20 sessions), and am inclined to believe it helped, at least in one ear. It didn't "fix" me by any means, but it might have helped.

I say that without being more certain, because it's almost impossible to know for sure what would've happened if I didn't undergo these sessions. Maybe I'd be at just the same place. Or maybe it helped drive incremental improvement.

In any case, the part of the ear that gets damaged has limited blood supply, so by increasing oxygenation through HBOT, you get more oxygen to the damaged area and improve its ability to heal - the same idea that works with many other injuries and wounds regularly prescribed HBOT.

I'd also add that following protocols used in the research, of having sufficient pressure and number of sessions, may be essential to getting some kind of improvement, if any improvement might be possible at all.

 

No one can decide if you should quit or not other than you! If it were me, I wouldn't quit (I didn't quit in my own journey) only because if there is a chance it could help, it's worth taking that chance.

If I were you, I'd read some of the research and get a sense of what the protocols have been - the pressures used, the number of sessions provided.

Some people experience improvements earlier than others, some people report improvements later that *might* be related to HBOT (although impossible to say, maybe they would've improved anyway), and some report no improvement.

But the research, such as it is, suggests slightly better outcomes for some people with HBOT than without.

Offhand, I recall reading a study that suggests within 3 months is OK, although, of course, the earlier the better.

 

After the 3rd HBOT session, I noticed a very slight ringing in my right ear. I hear it when I cover my right ear. It used to not exist.

 

Agree. Just 2 sessions of HBOT damaged my eustachian tubes to the point of needing surgery to repair them. No number of sessions is without risk.

 

What happened to your eustachian tubes?

 

They became patulous, or patulous eustachian tubes. Your eustachian tube stays open most of the time. You have something called autophony (hearing your own voice in your ears), and aerophony (hearing your breathing in your ears).

 

I understand the basic premise of ischemia and how HBOT can help that. THAT said, doing it for a few sessions early on I firmly believe is the only help you're going to get, and a day or so after the incident.

My experience might be confounded with steroid use, or is a potential fistula which developed from the pressure change. But simply put it isn't opinion, it's what I went through, and 110% I'm worse off than I'd have been not going (or going for 5 sessions and stopping when it was seemingly worsening).

What I went through was nothing short of a nightmare. They say HBOT can cause seizures, or it was a pressure change which damaged my inner ear... regardless right now it is a nightmare. If you want new additions to your high pitched static or Eeeeee, as in an orchestra of brand new sound effects, distortion, low frequency hums and what sounds like your auditory cortex is having a seizure than by all means do it.

Add to that the safety concerns at private clinics amount to "sometimes it gets worse before it gets better!"... (pro tip: that's almost never true, you're being had).
Given I had been taking benzos to sleep, I'm sure my seizure threshold when "off" them was probably a lot lower... and I had gone the day after a spike... it may have contributed...

I hate to have learned the hard way but maybe I can save someone else, as my original tinnitus has long faded...

You don't want to do HBOT... it's expensive and a last ditch effort if you are truly going deaf... and if you still really want to, limit your sessions (like 5) and do NOT go until a couple days after your "spike".

Barotrauma is not joke, I'm hoping it isn't permanent, but it's been about 2 months now...

Stick to Betahistine and normal oxygen, if you get an effect then maybe consider going for a few HBOTs. Be extremely careful, don't go for more than a week, and don't be on any thing other than tons of anti-oxidants.

 

Hello everyone.

I developed tinnitus and hyperacusis (which has slowly been getting better) after acoustic trauma through my headphones. I heard a loud noise through my headphones twice within an hour and after a few days I developed tinnitus and hyperacusis. I was given a 12 day dose of Prednisone on the 5th day which I am finishing tomorrow. 60mg 4 days, 40mg 4 days, 20mg 4 days. I have been feeling a little better since starting the steroids but I am unsure.

I have an appointment for HBOT tomorrow and I am feeling a little nervous. At first I was all in for it but now I am uneasy. I don't want to live with this for the rest of my life, so I am trying to do everything I can to fix it.

I have read through the entire Hyperbaric Oxygen Therapy thread on this forum and I am worried about barotrauma to my ear. Does anyone else have any experience with this that they can share? I am worried about not being able to release the pressure in my ear.

I'm a 20-year-old male.

 

Welcome to the forum. I am not sure why you need HBOT just for acoustic trauma and hyperacusis. That is generally for people with sudden sensorineural hearing loss or SSHL, and for other health reasons. I have just gone through 20 sessions of HBOT and luckily I was OK without barotrauma like most patients are. They ask you to spray your nostrils with nasal spray to make sure your ear drums can flex by swallowing, yawning and by blowing with the nostrils closed by your fingers. You do that continuously every few seconds as the pressure builds up. That seemed to go well until the last day when I saw a 90-year-old having trouble balancing the pressure and had his ear drum ruptured. What is strange is that he had been attending these sessions longer than most of us and yet on that day he had trouble. I am not scaring anyone from going to HBOT as it can help some people and most of us have no problem except in this very old patient.

For your case, why was HBOT suggested to you for just acoustic trauma?

I don't think HBOT is dangerous if you do the routine right following the instructions from the attendant nurse. Perhaps the old guy had gone so many times before he didn't follow the instructions as attentively as some of us newer guys. It must not be dangerous for younger folks as those nurses are in the chamber every or every other day to run the chamber and to help us.

 

Thank you for the reply. I did not have this recommended to me, in fact my ENT did not think it would help in my case. I mostly considered it because I read that this is one of the few treatments that can help at the onset of tinnitus besides steroids. I decided against going today and I am deciding to wait a few more days.

I read through this thread again and noted that barely anyone has noticed any improvements, with more experiencing complications.

If anyone else has input that would be nice.

 

All the studies done involve intratympanic steroids AND HBOT. I wouldn't do it unless you were getting both and only 5 sessions before stopping if you don't notice anything substantial (like tones cut in half).

It has to be within 3 days (my personal experience) of onset for any tones to go away. When I had my 2nd acoustic trauma this was the case and hearing them disappear was almost like magic. I was on 50mg Prednisone at the time.

The kicker though is you honestly don't know if simply diving in the ocean would be better, it could be the pressure or the oxygen, you just don't know... Given how oxygen can be toxic and the limited benefit of oxygen to dying cells 3 days later, I'd go with pressure.

Any private clinic will tout a lot of crap about it stimulating hair cells, how it heals, etc.

This is all garbage. If anything routine oxygen is toxic, the only benefit is if there are cells dying without oxygen, like a stroke or in this case the theory being hair cells.

There can be a large risk of barotrauma which would leave you worse off!

For me, a complication may be that I did not use steroids and was previously using benzos for a month, but it was not worth the risk and especially the money. If I could do it again I'd have done the above.

 

Thank you for your reply. I noted that you were one of the people that had major complications with HBOT and that was one of the reasons that led me to cancel my appointment today. It is really interesting because if you read through this entire thread there's maybe only one or two people who have benefitted from this. I thought it would be a much larger amount.

 

The fact is, if you can't follow a journal article's methods to the letter you are plain and simple gambling.

I didn't have intratympanic steroids. I also didn't notice any changes but continued. My bad reaction could have been a complication from benzos or a prior ear trauma.
Regardless, barotrauma is no joke, if you injure your inner ear with pressure it might not recover.

I would do it again if I knew what I know now, would've asked for VERY slow pressurization, would not have been taking any benzos and especially not coming "OFF" of them, and would've quit within 5 sessions if nothing changed.

I also had a terrible reaction coming off prednisone. So obviously your mileage will vary, everything has risk... that's why if you do it, just do it once. Risk compounds each time you do something inherently risky.

 

It may be that people with good experiences aren't here in the first place. Also, given the financial and logistical challenges of HBOT, it's probably not all that common. Hard to say.

In my situation, my ENT prescribed it immediately, and I'm grateful for that.

The research tells us that treatment is best when started as early as possible, but seems to show improvements can occur if started within 3 months (not that improvement isn't possible beyond that, or might not happen at all even if started immediately).

Through my experience, I have come to learn that HBOT is widely used in hospitals for a variety of wounds, particularly ones that aren't otherwise healing, the extra oxygen goosing the body's own healing process. Because the areas of the ear that can be damaged may not have a great deal of blood flow to them, by increasing blood oxygen through HBOT, you're theoretically maximizing whatever healing process can take place.

Indeed, the research seems to show that tinnitus patients who added HBOT to their other therapies seem to do a little better.

Here are some links:

1. Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis
2. The Clinical Efficacy of Hyperbaric Oxygen Therapy in Idiopathic Sudden Sensorineural Hearing Loss and Tinnitus
3. Hyperbaric oxygen therapy for acute acoustic trauma
4. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss
5. Hyperbaric Oxygen Therapy for Sudden Sensorineural Hearing Loss after Failure from Oral and Intratympanic Corticosteroid
6. Hyperbaric oxygen therapy in tinnitus with normal hearing in association with combined treatment
7. Hyperbaric oxygen therapy seems to enhance recovery from acute acoustic trauma

A few things that jump out at me from the research is that HBOT may require a sufficient number of treatments and at sufficient pressure to be effective. While some people might be helped with fewer sessions, or might not be helped at all, if you're just going to dabble in it, you may be wasting your time and money.

I would also emphasize that I made sure to go to a high quality facility with a lot of experience. I would not want to be trapped in a pressurized tube at a place that didn't know what they were doing. The place had lots of happy customers and I never saw a bad reaction. How many of them were helped? Couldn't tell you.

But overall I would say my own experience was positive. Even though it didn't "cure" me, it likely helped, and with so few legitimate treatment options, I wanted to do everything I possibly could.

Best, of course, is to get guidance from health care professionals you trust.

 

I really appreciate your detailed response. This is pretty much the route I am thinking about going, I want to do everything I possibly can before it's too late. I'm at a loss at what to do right now. The window of time to do Hyperbaric Oxygen is slowly closing for me but I am not sure if I want to do it because of the risk. The ENTs I talked to were clueless about the effectiveness of HBOT for this so they did not recommend it, they said it is only for hearing loss which as far as I know I do not have.

I am probably going to wait until this Monday to see where I stand with tinnitus, which will be my 3 week mark. I will figure out what to do from there. Damn this is so stressful.

 

The funny thing is I find myself in the same situation you were. I am coming off Prednisone and some Benzos today after a stressful two weeks. Today is going to be my first day off both of them so I will see how that goes. I am going to see where I stand on Monday which is my 3 week mark to consider if I still should do HBOT.

 

All I can say is use earmuffs, not earplugs, go slowly with the pressure, and that if you start hearing sound effects of any kind other than your tinnitus tones, take off the mask immediately and signal that it's time to leave. If the tones disappear, it'll likely be temporary but I'm sure will be nice. Just keep your ears out for intermittent new sounds.

 

Thank you for your informative responses. I really appreciate it.

 

Sorry to bump this topic again but I am wondering if anyone else has recently tried HBOT and had a good response to it?

I am going to be on my 6th week next week and I'm curious to see if it is still worth it to try HBOT at that point.

My tinnitus and hyperacusis are changing everyday for the better and worse (goes back and forth).

Thanks for any input!

 

The only positive effect I had was on ringing 3 days after an acoustic trauma. The ringing disappeared under pressure. It stayed gone for the day. It was back the next day.

This I kept going until my accident.

I also tried several days after for ringing before my 2nd acoustic incident. It had no effect.

Not worth it.