Susannah Sherlock1,2,3, Sharon Kelly4, Michael H Bennett5,6. 1. Hyperbaric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. 2. Senior Clinical Lecturer, University of Queensland, Brisbane, Australia. 3. Corresponding author: Dr Susannah Sherlock, Royal Brisbane and Women's Hospital, Butterfield St, Herston QLD 4029, Brisbane, Australia, susannah.sherlock@health.qld.gov.au. 4. Department of Ear Nose and Throat Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia. 5. Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney Australia. 6. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
Abstract
INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand. METHODS: Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST)). RESULTS: Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change. CONCLUSION: There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand. METHODS: Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST)). RESULTS: Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change. CONCLUSION: There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Entities:
Keywords:
ENT; General interest; Hearing loss, sudden; Hyperbaric facilities; Hyperbaric oxygen therapy; Medical society
Authors: Sujana S Chandrasekhar; Betty S Tsai Do; Seth R Schwartz; Laura J Bontempo; Erynne A Faucett; Sandra A Finestone; Deena B Hollingsworth; David M Kelley; Steven T Kmucha; Gul Moonis; Gayla L Poling; J Kirk Roberts; Robert J Stachler; Daniel M Zeitler; Maureen D Corrigan; Lorraine C Nnacheta; Lisa Satterfield Journal: Otolaryngol Head Neck Surg Date: 2019-08 Impact factor: 3.497
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