Hyperbaric Oxygen Therapy

HBOT had no effect on me after a handful of sessions.

 

May I ask you how long after the onset of tinnitus did you have HBOT? And what caused the tinnitus for you?

 

Within a couple of months.

Acoustic trauma.

 

I started HBOT a few days ago. I have completed 3 sessions so far. I haven't noticed any change in tinnitus - maybe a small spike but that's it. Ears seem to be clicking a bit more when I swallow if that makes sense.

At first I was really scared I would damage my ears during the dives and get barotrauma, but I seem to be good so far. I plan to do two more sessions tomorrow and the day after and see where I'm at, currently planning to stop at 5. I found a Private Clinic in the Bay Area that does it at around $200 per session. All out of pocket by me. I will be at 8 since my Acoustic Trauma on Monday. I will report back soon.

 

I have decided to stop HBOT after 5 sessions. I haven't noticed much change at all and my tinnitus might've gotten a little worse since I first started.

I reasoned that at 8 weeks there probably isn't much room for improvement with HBOT and that it is probably not worth the cost at this point for me.

 

I recently developed ISSNHL and tinnitus immediately following COVID-19 vaccination leaving me with 30-50 dB loss above 750 Hz in one ear. After a week on Prednisone I had recovered the lower ranges but still missing above 6 kHz and tinnitus. My doctor, Daniel Zeitler, is one of the co-authors of the 2019 Clinical Practice Guidelines to treat Sudden Hearing Loss. This guideline was updated in 2019 from the previous 2012 version after reviewing all the latest literature. It is critical for the HBOT discussion to note that much of the RCTs of HBOT have taken place in the last 10 years, so this is a major review of HBOT trials. The bottom line is that HBOT is one of the few treatment options to have shown effectiveness, but still not enough to be a recommendation.

This document gives the full list of recommendations to all doctors on how to treat SSHL including a helpful flowchart. While tinnitus is different from SSHL, almost all SSHL is accompanied by tinnitus, so it may be useful to people even without SSHL. Their list of "recommendations" is largely diagnostic - get an audiogram, rule out tumors with MRI, educate. There are only 4 "optional" treatments for SSHL - primary oral steroids like Prednisone, primary HBOT, salvage HBOT, and salvage Intratympanic steroids.

Speaking of MRIs, the research showed about 10% of SSHL revealed tumors in the MRI which were otherwise undetected and did not correlate with whether the SSHL improved or not. But there's a 10x price difference. At Virginia Mason Hospital in Seattle my insurance through Premera would have cost me almost $2000, but Premera's website helped me find Bellevue Medical Imaging which did the same procedure for $600. It was awful - literally 75 minutes lying absolutely still with a jackhammer going on. That itself is a traumatic experience for anyone, especially if you're claustrophobic.

CPG recommends HBOT if it's done early, and while this document doesn't show it, this study which I think is referenced shows that when used as salvage treatment, 1.5 ATM is barely any better (but some) than doing nothing compared to dramatic improvements at 2.5 ATM. The studies also show that it's more effective on "younger" patients of under 50 or 60. The gains are mostly for higher hearing loss like >70 dB. If you really like to read, then check out this meta-study of 160 HBOT trials. Actually I found reading all of those easier than reading the 40-page history of this 10-year-old thread!

Since I did read all 10 years of this thread as well as the excellent 5000 person survey I would say the experience here is less than would be indicated by the studies. I was particularly struck that 70% of people who had tried HBOT found no change. And I saw a summary by a member showing that most anecdotal users here did not improve. But there's likely a huge variation in how long people have had tinnitus before undergoing HBOT, what pressure (which apparently makes a huge world of difference), and whether it was primary or salvage HBOT. These RCTs in the studies incorporated into the CPG do take these into account and while not stellar, the analysis supported HBOT. I take away that HBOT is not recommended by the CPG and is only an option. Also, realize this is for treating hearing loss, not tinnitus.

In my particular case, Dr. Zeitler told me that my improvement already put me beyond the recommendations for HBOT. If I had not responded to steroids or still had a large 70 dB loss, then HBOT would have been his recommendation. But he left it up to me to try or not, and I decided to be aggressive. I didn't want to regret having tinnitus forever over a few thousand $. The doctor was very clear that the guidelines are to try 10 sessions, then have hearing re-measured, and if there is improvement, do another 10 sessions. This goes against most of this thread recommending 15 minutes, and up to 40 sessions. Guidelines also don't recommend HBOT after 1 month.

I've been on 4 dives so far starting at 1.3 ATM working up to 2.0 ATM today which is as far as they want to take me. Virginia Mason Seattle offers 10 sessions / $20k to insurance but Premera denied. VM also offered 10 sessions / $6k, uninsured price. I found the Pro Club in Bellevue, WA offered 2.0 ATM for $300/session. But I then found Washington Hyperbarics using the Fortius 420 hard chamber at 2.0 ATM for $219/session but I stumbled upon a special for $179/session. So far I have found no changes, but no problems either. I'm a diver so diving at 40 feet is no big deal and I know how to clear my ears. I actually love doing it in this small 1 person chamber because they let me bring in any electronics I want although I limit it to my Apple iPhone and AirPods to reduce the chances of a battery problem and I bring in a hard metal case just in the remote case of a fire. I wear an oxygen helmet and remove it for 5 minutes which any diver will tell you is necessary to avoid oxygen toxicity. I liked reading that many people found improvement towards the end of the 10 sessions and remain hopeful. I test my hearing each day using iOS MD Health app with AirPods Pro. I found that closely matched the professional audiogram and at $420 for Virginia Mason audiograms I can buy a lot of AirPods Pros for that much. BTW, AirPods Pro are excellent for the chamber & helmet because they have active noise cancellation but can be controlled from the iPhone while the helmet is on! It cuts the noise way down to a very relaxing amount and with music it's easy.

I'm also taking Ginkgo Biloba and just ordered NAC after reading this thread.

I will update after my 10 sessions are up.

 

HBOT seems very much all or nothing and needs to be done early.

 

I completed my 10 dives but unfortunately there was no effect on either my hearing loss or tinnitus. I used Washington Hyperbaric Therapy Center in Redmond, WA. They are a standalone clinic but they operate pretty professionally with comfortable Fortius 420 chambers and oxygen helmets.

My next stop is the Costco hearing aid center. I hear there are hearing aids with sound generators for tinnitus.

 

How were your dives? Any side effects? I feel like I was dealing with a good amount of side effects after 5 dives at 2.4 ATM.