http://www.revistadechimie.ro REV.CHIM.(Bucharest)♦69♦No. 4 ♦2018 952 The Role of Hyperbaric Oxygen Therapy in the Management of Patients With Sudden Hearing Loss DRAGOS CRISTIAN STEFANESCU 1,2,3 , RAZVAN HAINAROSIE 3,4 *, VIOREL ZAINEA 3,4 , DAN CORNECI 2,3 , RADU CRISTIAN JECAN 3,5 1 Gen. Dr. Aviator Victor Anastasiu National Institute of Aeronautical and Spatial Medicine, 88th Mircea Vulcanescu Str., 010825, Bucharest,Romania 2 Carol Davila University Central Emergency Military Hospital, 88th Mircea Vulcanescu Str., 010825, Bucharest,Romania 3 Carol Davila University, Medicine and Pharmacy Faculty, 8 Eroii Sanitari Str., 050474, Bucharest, Bucharest, Romania 4 Institute of Phonoaudiology and Functional ENT surgery Prof. Dr. Dorin Hociota, 21th Mihail Cioranu Str., Bucharest, Romania 5 Agripa Ionescu Emergency Clinical Hospital Bucharest, 7 Ion Mincu Str., 011356, Bucharest, Romania The therapeutic approach in sensorineural hearing loss (ISSNHL) is far from a consensual protocol among ENT (ear, nose and throat) doctors. The present paper describes our experience with Hyperbaric Oxygen Therapy (HBOT) as salvage treatment for selected patients with the sudden sensorineural hearing loss. The HBOT method has shown an efficacy of 50% in our study, as salvage treatment in ISSNHL after initially corticoids therapy. Thus, we can assert without doubt that HBOT represents a viable option for those patients who want to continue the effort to regain hearing. Under the auspices of the national ENT society, through a collective effort, can be achieved a therapeutic consensus in the sensorineural hearing loss. In this consensual document, HBOT can be found both as initial and salvage therapy, alone or in the multimodal therapeutical variant. Further, the National Health Insurance House should introduce the reimbursement of HBOT sessions in the methodological norms, in order to offer this new therapeutic solution to all patients. Keywords: hyperbaric oxygen therapy, salvage treatment, sudden sensorineural hearing loss *email: razvan@riaclinic.com: Phone: 0727224447 All authors have contributed equally to this papaer According to the American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) guideline- 2012, presumptive idiopathic sudden sensori- neural hearing loss ( ISSNHL) is diagnosed if audiometry confirms a 30-decibel (dB) hearing loss at three consecutive frequencies, with a sudden onset (within 72 hours) and no underlying condition has been identified [1]. The authors of the mentioned guideline have proposed to improve the management of ISSNHL, reducing unnecessary tests and procedures. Thus, although there is no consensus on effectiveness of corticosteroids (local - intratympanic, oral or systemic) as initial therapy to patients with ISSNHL, the AAO-HNSF guidelines give physicians this option. In a situation where the first-line treatment did not have the expected result, additional treatments may be used. It is very important that the recommendation for hyperbaric oxygen therapy (HBOT), as salvage/additional treatment, to be done within 3 months of diagnosis of ISSNHL. Recently (April 2016), during the Tenth European Consensus Conference on Hyperbaric Medicine, the recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment have been established [2]. Referring to ISSNHL, the hyperbaric oxygen therapy recommendation is considered appropriate by the large majority of experts (Type 1, Level B evidence). The time elapsed from onset to initiation of hyperbaric oxygen therapy seems to be very important. Thus, the combined therapy (corticosteroids and hyperbaric oxygen) can be applied in patients with ISSNHL, provided they present themselves within 2 weeks of disease onset (Type 1, Level B evidence). The maximum time limit from the onset of the disease to the initiation of hyperbaric oxygen therapy (alone or combined with medical treatment) is considered to be 6 months (Type 1, Level C evidence). Especially in patients with severe or profound hearing loss, the hyperbaric oxygen therapy as salvage treatment can be accomplished provided that their presentation is between 2 weeks and 4 weeks of disease onset (Type 3, Level C evidence). In Romania, the Ministry of Health established in 2010 through the specialized commission, the Therapeutic Guide in Otorhinolaryngology - Head and Neck Surgery. The therapeutic recommendations for the patients with ISSNHL are much less well defined and refers to measures that are taken to improve microcirculation and inner ear oxygenation as well as steroid treatment. It is also mentioned that there is no proven effective therapy [3]. Synthesising the views of the three groups of experts (AAO-HNSF, Consensus Conference on Hyperbaric Medicine and Romanian Therapeutic Guide in Otorhino- laryngology) outlined above and taking into account that between 35-60% of patients with ISSNHL have experienced a spontaneous remission, we decided to make our own therapeutic algorithm. The present paper describes our experience with hyperbaric oxygen therapy as salvage treatment for patients with the sudden sensorineural hearing loss. Experimental part Has been achieved a retrospective and nonrandomized study, involving 6 patients with idiopathic unilateral sensorineural hearing loss presented at 3-6 weeks after onset, with 60 dB or higher of pure tone average (PTA) hearing threshold. The study was conducted from December 2009 through January 2016, at the National Institute of Aeronautical and Spatial Medicine and the Institute. Participants were followed up for 6 months. All patients were first treated with corticosteroids, given orally or intravenously, by different physicians in different doses.