RESUMEN
Hyperbaric oxygen therapy (HBQ) has been used for several years as a treatment for Ménière's disease, particularly in Sweden. In this study continuous variations in pressure (from 1.7 to 2.2 ATA; alternobaric oxygen therapy: ABOT) were used to decrease endolymphatic hydrops, the typical histopathological substrate of Ménière's disease by increasing hydrostatic pressure and mechanical stimulation of the endolymphatic flow toward the duct and the endolymphatic sac, which produces a consequent increase in the dissolved O2 content in the labyrinth liquid, which should contribute to recovering cell metabolism and restoring cochlear electrophysiological function to normal. An experimental group of 20 patients suffering from unilateral Ménière's disease received a total of 15 ABOT treatment sessions during the acute episodes. Treatment foresaw two days without therapy every five days of application. Maintenance treatment consisted of one session per day for five consecutive days every month for one year. Thereafter, during the second, third, and fourth years of treatment, patients were submitted to one session per day for five consecutive days every three months. A control group of 18 patients suffering from Ménière's disease was treated with 10% glycerol i.v. (during the acute episodes) and with betahistine (8 mg x 3/day) in the periods in between. Mean pure tone average (PTA in dBHL) hearing thresholds at octave frequencies from 500 to 3,000Hz, and frequency of episodes of vertigo and tinnitus, both after 15 days of treatment and at the end of a four-year follow-up, were compared for both groups according to the 1995 Committee on Hearing and Equilibrium criteria. No statistically significant differences were found between the two groups at the end of the first 15 days of treatment. However, at the end of the follow-up period, patients treated with ABOT had significantly fewer vertiginous episodes and improved PTAs and tinnitus compared to the controls. The results support the use of ABOT as a valid alternative to drugs in the long-term treatment of Ménière's disease.
Asunto(s)
Oxigenoterapia Hiperbárica/métodos , Enfermedad de Meniere/terapia , Adulto , Edad de Inicio , Endolinfa/fisiología , Femenino , Estudios de Seguimiento , Pérdida Auditiva Sensorineural/etiología , Humanos , Masculino , Enfermedad de Meniere/complicaciones , Persona de Mediana Edad , Análisis de Regresión , Acúfeno/terapia , Vértigo/terapiaRESUMEN
The term sudden hypoacusis describes a hearing loss of rapid onset and unknown origin that can progress to severe deafness. Of the many therapeutic protocols that have been proposed for treating sudden hypoacusis, hyperbaric oxygen therapy (HOT) plays a leading role. We studied 50 patients who had been referred to our ENT unit within 48 hours of the onset of sudden hypoacusis. We randomly assigned 30 of these patients to undergo once-daily administration of HOT for 10 days; the other 20 patients were treated for 10 days with an intravenous vasodilator. Response to therapy in all patients was evaluated by calculating the mean hearing threshold at frequencies between 500 and 4,000 Hz and by assessing liminal tonal audiometry results recorded at baseline and 10 days after the cessation of treatment. These results, plus the findings of other audiologic and otoneurologic examinations, revealed that the patients in the HOT group experienced a significantly greater response to treatment than did those in the vasodilator group, regardless of age and sex variables. Significantly more patients in the HOT group experienced a good or significant response. In both groups, patients with pantonal hypoacusis responded significantly better than did those with a milder condition. Based on our findings, coupled with the fact that oxygen therapy is well tolerated and produces no side effects, we conclude that HOT should be considered the preferred treatment for patients with sudden hypoacusis.
Asunto(s)
Pérdida Auditiva/terapia , Oxigenoterapia Hiperbárica/métodos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Endolymphatic hydrops is the hystopathological substrate characteristic of Ménière's disease. Besides the classical treatment with diuretics and/or osmotic drugs for some time, now treatment in a "pressure chamber" (OTI) has also been applied. The oxygen administered in the hyperbaric chamber can reduce the hydrops both by increasing the hydrostatic pressure and by mechanically stimulating the flow of endolymph toward the duct and endolymphatic sac. In addition, an increase is seen in the amount of O2 dissolved in the labyrinthine fluids and this contributes to recovering cell metabolism and restoring normal cochlear electrophysiological functions. Between 1992 and 1996 40 patients with monolateral Ménière's disease were studied: 15 underwent oxygen therapy at a constant pressure (2.2 ATA) (HOT), 25 with a continuous variation in pressure (from 1.7 to 2.2 ATA) (Alternobaric therapy, AOT). During the acute phase the patients underwent daily OTI treatment for 15 days in a row. The maintenance treatment called for one treatment cycle (one session a day for 5 days in a row) a month for 1 year, followed by for one treatment cycle (one session a day for 5 days in a row) every three months during the 2nd, 3rd and 4th years. The controls consisted of a group of 18 patients treated with 10% glycerol i.v. (during the acute phase) and betahystine (8 mg x 3/die) between episodes. A comparison was made of the average hearing threshold for the frequencies 500-3000 Hz (PTA), how frequently episodes of dizziness arose and extent of hearing loss in the three groups after the initial 15 days of treatment and at the end of the 4-year follow-up, in compliance with the criteria laid down by the Committee on Hearing and Equilibrium in 1995. At the end of the first 15 days of treatment, there were no statistically significant differences between the three groups. At the end of the follow-up, on the other hand, hyperbaric treatment, and in particular alternobaric therapy, enabled a significant reduction in the episodes of dizziness as compared to the control group. PTA and deafness also improved significantly in the patients who had undergone hyperbaric treatment. The results of the present work show that HOT, and in particular AOT, offer a valid alternative to drugs in the treatment of Ménière's disease.
Asunto(s)
Oxigenoterapia Hiperbárica/métodos , Enfermedad de Meniere/terapia , Oxígeno/uso terapéutico , Enfermedad Aguda , Adulto , Anciano , Hidropesía Endolinfática/fisiopatología , Hidropesía Endolinfática/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enfermedad de Meniere/fisiopatología , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Forty-five patients suffering from Menière's disease were submitted to pressure chamber therapy: 20 with constant pressure (2.2 ATA, hyperbaric treatment) and 25 with continuous variations in pressure levels (from 1.7 to 2.2 ATA, alternobaric treatment). Oxygenation therapy consisted of one session per day lasting 90 minutes for 15 days during the acute attacks followed by five consecutive sessions per month during a follow-up of two years. For a control group we used 18 patients treated with 10 per cent intravenous glycerol during the acute episode and 8 mg tid of betahistine thereafter. We compared hearing loss, vertigo and tinnitus in the three groups 15 days after starting treatment and at the end of the follow-up, according to the criteria suggested by the 1995 Committee on Hearing and Equilibrium. We found no statistically significant differences in recovery from the cochlear-vestibular symptoms in the three groups at the end of the first 15 days of therapy, whereas hyperbaric and, in particular, alternobaric treatment permitted a significant control of the principal attacks of vertigo during the follow-up period. Hearing loss also showed a more significant and more persistent improvement in the patients treated with alternobaric oxygenation compared to the patients in the other two groups.