Hyperbaric Oxygen Therapy for Sudden Hearing Loss
HBOT is an FDA-approved adjunct treatment for sudden sensorineural hearing loss. Learn how it works, what research shows, and when to act.
Hyperbaric Oxygen Therapy for Sudden Hearing Loss
Sudden sensorineural hearing loss is a medical emergency. It strikes fast, often overnight or within hours, and the window for effective treatment is narrow. HBOT is an FDA-covered adjunct that can improve hearing outcomes when started early alongside standard steroid therapy.
What Sudden Sensorineural Hearing Loss Is
Sudden sensorineural hearing loss (SSNHL) means losing 30 or more decibels of hearing across three consecutive frequencies within 72 hours or less. It almost always affects one ear. Most cases have no identified cause — doctors call this idiopathic.
The standard first-line treatment is high-dose oral corticosteroids, started immediately. Every day without treatment increases the risk of permanent loss.
HBOT is an adjunct to steroids, not a replacement. It addresses a different part of the problem: oxygen deprivation in the inner ear.
How HBOT Treats Sudden Hearing Loss
The cochlea — the spiral structure in the inner ear — is one of the most oxygen-sensitive organs in the body. When blood supply to the cochlea is disrupted, the hair cells that convert sound waves into nerve signals begin to die. Once gone, they don’t grow back.
HBOT supersaturates blood plasma with dissolved oxygen. That oxygen reaches the cochlea through diffusion, even when normal circulation is impaired. This may preserve hair cells that are damaged but not yet permanently lost.
Timing matters more than almost anything else here. Treatment started within the first two weeks of hearing loss has a meaningful impact. After three months, the research shows benefit is minimal at best. If you’ve been diagnosed with SSNHL, ask your ENT about a referral to a hyperbaric center the same day.
What the Research Shows
The strongest evidence comes from a 2021 Cochrane systematic review by Sherlock and colleagues. The review analyzed randomized controlled trials of HBOT for sudden hearing loss and found that adding HBOT to steroid therapy significantly improved pure-tone average hearing compared to steroids alone. This is the highest level of evidence available in clinical research.
Medicare covers HBOT for sudden sensorineural hearing loss under National Coverage Determination 20.29. Private insurance coverage varies. Your insurer may cover HBOT for this indication, but confirm coverage and prior authorization requirements before scheduling sessions.
Treatment Timeline and Protocol
Speed is the most important factor in treatment. The sooner HBOT starts after onset, the better the chances of meaningful recovery.
A typical protocol runs 10 to 20 sessions over two to four weeks, at pressures between 2.0 and 2.4 ATA. Sessions run about 90 minutes each. Treatment usually runs alongside a course of corticosteroids.
Ask your otolaryngologist for a referral to a hyperbaric medicine center as soon as SSNHL is diagnosed. Don’t wait to see if hearing improves on its own. The treatment window closes faster than most patients realize.
You can read more about what HBOT is and how sessions work and check insurance coverage basics before your appointment. To find a certified hyperbaric center, visit the providers directory.
FAQ
Is hyperbaric oxygen therapy FDA-approved for sudden hearing loss?
Yes. Medicare covers HBOT for sudden sensorineural hearing loss under National Coverage Determination 20.29. The Undersea and Hyperbaric Medical Society also lists it as an approved indication.
How soon after sudden hearing loss should HBOT start?
As soon as possible. HBOT is most effective within the first two weeks of onset. After three months, research shows little to no benefit. Treating SSNHL as a medical emergency gives you the best chance of recovery.
Does HBOT replace steroids for sudden hearing loss?
No. HBOT is used alongside high-dose corticosteroids, not instead of them. Steroids reduce inflammation. HBOT delivers oxygen to the damaged cochlea to help preserve hair cells. Both treatments work together.
How many HBOT sessions are needed for sudden hearing loss?
Typical protocols run 10 to 20 sessions over two to four weeks at 2.0 to 2.4 ATA. Your hyperbaric physician will determine the right number based on your response to treatment.
References
Sherlock, L.G. et al. (2021). Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss. Cochrane systematic review found HBOT improved hearing outcomes as adjunct to steroids. PMID: 34699060. https://pubmed.ncbi.nlm.nih.gov/34699060/
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.