Hyperbaric Oxygen Therapy

[Jan64]

It keeps me busy... See: https://www.ncbi.nlm.nih.gov/pubmed/25558548

It is important to note that a vast majority of MEB (Middle ear barotrauma) was minor. This supports HBO2 as a safe treatment modality with minimal overall risk. The current study supports standardization of most treatment protocols to a ROC (rate of compression) of 2 psi/minute.

1 psi = 6.7 kPascal Pressure difference = 1,5 ATA 1 ATA = 101.3 kPa 1.5 ATA = 152 kPa
So time of compression has to be 152 / ( 2 * 6.7) = 11.3 minutes
Next tuesday I get a HBOT treatment, I will monitor the speed of compression.



atm = 1ATA = 1.01325 bar = 14.70 psi
1bar = 100,000 N/m^2 = 100,000 pascal = 14.50 psi

 

[Codaz]

How is the pressure / how does it feel on your body anyway?
What happens in an emergency if you cannot handle the treatment?

Let us know the results please.

 

[Jan64]

Yesterday I had an HBOT session again. Went from 1 ATA to 2.5 ATA in 10 minutes. So a bit quicker than 2 psi / minute.

Questions of Codaz:
How is the pressure / how does it feel on your body anyway?
I actually feel nothing special, have no problem at all with equalizing the pressure. My experience is that only a small part of the people attending have problems in the first one or two treatments.

What happens in an emergency if you cannot handle the treatment?
Then they stop pressurising, they can also revert the pressure. During the first treatment a nurse will help you.

When you can't handle it, and you want to leave... then a small room next to the main room will be pressurized. When the pressure is equal the door to the small room can be opened. Then walk to the small room, close the door. And then the small room will be decompressed. Other patients will continue the treatment in the main room.

Let us know the results please.
On 4 August I had a noise trauma (2 h of 95 dB), started HBOT on 25 September (after 7 weeks...). Till now I had 17 treatments. I think 50-60% of the aggravation is solved. But I also used low level laser (1 h / day, 808 nm, 90 mW (Konftec), pentoxifillin, prednison/corticoid, ginkgo biloba and magnesium.

 

[Codaz]

How was this aggravation noticeable?

 

[Shem]

I'll add a data point as well. I'm 7 treatments in (scheduled for 30) to address profound hearing loss. I started 21 days after idiopathic sudden single sided profound hearing loss (80-100db loss). I am seeing some hearing gains after starting treatment, exclusively in the lower frequency ranges so far. It's not obvious whether it is the HBOT that is helping, or simply things coming back naturally over time, but either way, things are moving slowly in the right direction so I will continue treatment.

As far as the treatment itself, it's pretty straightforward. At the facility I am at, you basically are put into a glass tube - fairly large, but not large enough to sit up in. Pressurization up to 2 ATM and pure O2 happens over roughly 15 minutes. During that time I get a few ear blockages, exactly like when you are taking off in an airplane, which easily resolves by swallowing or yawning. No big deal (for me anyway). You then stay in the pressurized atmosphere for 2 hours. During that time, I don't feel any different than being in normal ATM. Once you are done, they depressurize, again, over roughly 15 minutes (not sure of the exact timing). Again, you get some similar ear phenomenon. There is a nurse that stays with you the entire time. You can't bring any type of electronics into the chamber, so it's pretty boring, but they have a TV playing.

Couple of extra notes:
1) This is to treat the hearing loss, not the tinnitus directly. My hope is that if the hearing comes back then the tinnitus will go away. To this point I have not seen any difference in the T, although my T is in the high frequence range, where I have not yet seen much hearing improvement, still about 85db hearing threshold. Since starting treatment, I have seen about 20db improvement in the lower frequency ranges. (.5, 1K, 2K).

2) To be effective in treating hearing loss, many studies suggest that the timing is critical. You need to start treatment in the first two weeks after hearing loss to get the most significant gains.

 

[Codaz]

I'll add a data point as well. I'm 7 treatments in (scheduled for 30) to address profound hearing loss. I started 21 days after idiopathic sudden single sided profound hearing loss (80-100db loss). I am seeing some hearing gains after starting treatment, exclusively in the lower frequency ranges so far. It's not obvious whether it is the HBOT that is helping, or simply things coming back naturally over time, but either way, things are moving slowly in the right direction so I will continue treatment.

As far as the treatment itself, it's pretty straightforward. At the facility I am at, you basically are put into a glass tube - fairly large, but not large enough to sit up in. Pressurization up to 2 ATM and pure O2 happens over roughly 15 minutes. During that time I get a few ear blockages, exactly like when you are taking off in an airplane, which easily resolves by swallowing or yawning. No big deal (for me anyway). You then stay in the pressurized atmosphere for 2 hours. During that time, I don't feel any different than being in normal ATM. Once you are done, they depressurize, again, over roughly 15 minutes (not sure of the exact timing). Again, you get some similar ear phenomenon. There is a nurse that stays with you the entire time. You can't bring any type of electronics into the chamber, so it's pretty boring, but they have a TV playing.

Couple of extra notes:
1) This is to treat the hearing loss, not the tinnitus directly. My hope is that if the hearing comes back then the tinnitus will go away. To this point I have not seen any difference in the T, although my T is in the high frequence range, where I have not yet seen much hearing improvement, still about 85db hearing threshold. Since starting treatment, I have seen about 20db improvement in the lower frequency ranges. (.5, 1K, 2K).

2) To be effective in treating hearing loss, many studies suggest that the timing is critical. You need to start treatment in the first two weeks after hearing loss to get the most significant gains.

Thanks for sharing. It must be extremely hard this sudden hearing loss. A famous Dutch pianist had such hearing loss as well and from what I have read it was treated with cortisone.

 

[Shem]

Thanks Codaz. Honestly, while the hearing loss is annoying, it's not that big a deal. The resulting tinnitus is far more annoying. And we did try the oral prednisone and intratympanic dexamethasone injections with not much success, which is why the whole hyperbaric oxygen treatment thing came up.

 

[Jan64]

@Codaz How was this aggravation noticeable?
Loudness of my 'tinnitus sound' (high tone of 12-13 kHz, semi broadband) doubled. VAS-score before 2.2 (out of 10,) after acoustic trauma 4.0. It is subjective ('in Dutch: subjectief, gewoon luisteren naar de luidheid, ene dag wat luider dan de andere dag').

 

[Codaz]

@Codaz How was this aggravation noticeable?
Loudness of my 'tinnitus sound' (high tone of 12-13 kHz, semi broadband) doubled. VAS-score before 2.2 (out of 10,) after acoustic trauma 4.0. It is subjective ('in Dutch: subjectief, gewoon luisteren naar de luidheid, ene dag wat luider dan de andere dag').

In Antwerp UZA hospital they do the VAS score analysis as well. It's the only place that does this. UZ Ghent apparently don't have this questionnaire. All it gives as result is how severe is your T, which in my case varies day by day and week by week.

 

[Benoves]

@Codaz How was this aggravation noticeable?
Loudness of my 'tinnitus sound' (high tone of 12-13 kHz, semi broadband) doubled. VAS-score before 2.2 (out of 10,) after acoustic trauma 4.0. It is subjective ('in Dutch: subjectief, gewoon luisteren naar de luidheid, ene dag wat luider dan de andere dag').

Jan, ik heb een vraag m.b.t. de hyperbare zuurstof techniek en tinnitus. Zou u contact met mij op kunnen/willen nemen?

BVD

 

[Jan64]

Dear Benoves, maybe your question is also relevant/interesting for other members of Tinnitustalk... If so please state your question here, otherwise sent me a pm (personal message).
Regards,
Jan

 

[yahoo888]

Hi all, got tinnitus two weeks ago, after reading throughout this thread, I have decided to take HBOT therapy, but I didn't find any HBOT providing tinnitus treatment in Sydney.

Anyone knows where I can get HBOT tinnitus therapy in SYDNEY?

 

[Jan64]

Unfortunately I can not provide you with a HBO facility near Sydney.

You have to be certain that the cochlea (organ of Corti, 'hair cells / steriocilia') has been recently damaged. Have your ears been exposed by loud noise lately? Or is the exposure over the cause of years...? A gun shot next to your ear (like the prime minister of Belgium), and then tinnitus: --> HBOT might be beneficial.

Years of noise exposure, years of using ototoxic medicine then tinnitus without a pointable event --> hair cells are hardly recoverable (maybe with low level laser therapy??). HBOT will not be beneficial.

Did you already try corticoid/prednison (starting with 60 mg 3 days and then taper with 10 mg (60,60,60,50,40,30,20,10,10,10,10)? Pentoxifillin (1200 mg daily 14 days)? You can also combine HBOT with prednison/pentoxifillin. Just ask your GP or ENT.

 

[yahoo888]

No ototoxic medicine at all.

My GP didn't help much，she said it's difficult to cure and just live with it. I will see a ENT 20th Nov, don't expect much. I did a hearing test which is very simple. No hearing loss from 0.5k to 4k.

I believe I have hearing loss in higher frequencies cos I found the bird chirping sounds totally different sharper and thinner.

 

[Jan64]

By excessive use of ear plugs (every day, while sleeping etc.) you limit the stimulation of the auditory cortex which can cause tinnitus...

0.5-4 kHz is only 20% of the total 'hearing range'. A high chirping sound can indicate a hearing loss in the high frequency range. Best is to get an extended hearing test reaching till 16 kHz.

 

[Tinker Bell]

Thanks Codaz. Honestly, while the hearing loss is annoying, it's not that big a deal. The resulting tinnitus is far more annoying. And we did try the oral prednisone and intratympanic dexamethasone injections with not much success, which is why the whole hyperbaric oxygen treatment thing came up.

How long ago did you do the steroids? I underwent those as well, and my ear specialist provided research indicating that intratympanic injections can make improvements over the course of two months. He also had studies that showed most often improvements occur with lower frequencies.

If you did both steroids and HBOT within a close timeframe, it might be difficult to conclude which actually impacted your hearing. I wish you luck and better hearing!

 

[Codaz]

By excessive use of ear plugs (every day, while sleeping etc.) you limit the stimulation of the auditory cortex which can cause tinnitus...

0.5-4 kHz is only 20% of the total 'hearing range'. A high chirping sound can indicate a hearing loss in the high frequency range. Best is to get an extended hearing test reaching till 16 kHz.

Excessive use of plugs is not adviced if you want to get used to sound again, AFAIK this is what I have read on various topics. Overprotection is also not adviseable.

 

[Codaz]

Thanks Codaz. Honestly, while the hearing loss is annoying, it's not that big a deal. The resulting tinnitus is far more annoying. And we did try the oral prednisone and intratympanic dexamethasone injections with not much success, which is why the whole hyperbaric oxygen treatment thing came up.

How is losing a part of your senses not a big deal? And yes, T can be so loud that it overstates all other sounds. But hearing less is a big issue.

 

[GregCA]

0.5-4 kHz is only 20% of the total 'hearing range'

Keep in mind that hearing doesn't work linearly. There are 3 octaves in the 0.5-4 kHz range, and only 2 octaves in the 4-16 kHz range...
If you accept (for the purpose of math simplification) that a human hearing range starts at ~16 Hz and ends at 16 kHz (vs 20 Hz - 20 kHz which is the accepted normal range), then we have 8 octaves before 4 kHz, and only 2 after... Which means that the hearing before 4 kHz accounts for 80% of the "full hearing range" (quite a difference from 20%).

One octave in the high frequencies spans across a very large frequency range.
To put it more "visually": losing all hearing above 10 kHz is like taking out that rightmost octave on a piano (just 12 keys). It's not like we take half of the keys out.

 

[TimeWorks]

tried it, did zip...did it for 2 weeks. In fact I tried virtually everything...you name it I did. Went to see supposedly the world's #1 authority on "T"....did zip...but yeah I "cured" myself. How? Go do stuff, don't visit any sites, don't read anything about it and very soon you won't even know you have it. If you just got it. Take some valium for the first few days, weeks to relax you and STOP visiting any sites and discussing it with anyone. T is a a wild tiger that wants out of his cage...anyone that has habituated doesn't come to any site to report. They are too busy leading good lives.

 

[Jan64]

Most relevant: what did you do in the first 3 month... in the acute phase of tinnitus? And what did you do after an aggravation? Did you get HBOT within 8? weeks after onset...? Let's get on topic again...

 

[Jan64]

One octave in the high frequencies spans across a very large frequency range.
To put it more "visually": losing all hearing above 10 kHz is like taking out that rightmost octave on a piano (just 12 keys). It's not like we take half of the keys out.

Thank you! I did not know.. You actually say that So when I can't hear > 15 kHz only a small part of my cochlea is damaged... not 25% but maybe 2-5%...

 

[yahoo888]

By excessive use of ear plugs (every day, while sleeping etc.) you limit the stimulation of the auditory cortex which can cause tinnitus...

0.5-4 kHz is only 20% of the total 'hearing range'. A high chirping sound can indicate a hearing loss in the high frequency range. Best is to get an extended hearing test reaching till 16 kHz.

I know but there is no above 8kHz testing in Sydney, I've decided to go back to CHINA to take tinnitus treatment in three days. At least they provide Steroid and HBOT treantment. Australia is just hopeless in this field.

 

[Jan64]

I know but there is no above 8kHz testing in Sydney, I've decided to go back to CHINA to take tinnitus treatment in three days. At least they provide Steroid and HBOT treantment. Australia is just hopeless in this field.

What HBOT protocol do they use in China? Pressure? Costs and where to do?

 

[Jan64]

2) To be effective in treating hearing loss, many studies suggest that the timing is critical. You need to start treatment in the first two weeks after hearing loss to get the most significant gains.

Ideally start as soon as possible... but in practice not every one is that quick... Getting an GP of ENT appointment also costs time. As mentioned in several posts the first 3 month period is critical. Then tinnitus (or the aggravation) is in the acute phase. Big question how is the 'shape' of success after 4, 5, 6, 7 etc weeks. Is the shape linair?

 

[yahoo888]

What HBOT protocol do they use in China? Pressure? Costs and where to do?

Same protocol here 2.0ATA. Don't know the cost yet, should be 100-400 RMB per session, several public hospitals provide HBOT treatment in my hometown.

And they have in depth experience cos they have seen too many tinnitus patients due to the population. It is difficult to cure but at least they have standard treatment in the acute tinnitus stage...

 

[Jan64]

Same protocol here 2.0ATA. Don't know the cost yet, should be 100-400 RMB per session, several public hospitals provide HBOT treatment in my hometown.

And they have in depth experience cos they have seen too many tinnitus patients due to the population. It is difficult to cure but at least they have standard treatment in the acute tinnitus stage...

Thanks for the information! So 1 RMB = $0.15 RMB 100-400 = $15-60 a session.
2.0 ATA is oke since there is a paper which states that there is no difference between efficacy with pressures of 2.2 and 2.5 ATA.

 

[GregCA]

Thank you! I did not know.. You actually say that So when I can't hear > 15 kHz only a small part of my cochlea is damaged... not 25% but maybe 2-5%...

Kind of, yes.
I say "kind of" because there's a difference between the logical damage (ie impairment in the hearing range on an octave basis) and physical damage (the amount of surface/volume of cochlea that is damaged), due to the fact that the cochlea's physical "sensors" aren't linearly distributed and with even density across it.

The latter doesn't matter: it's the former that matters to you, since that's what makes up the perception. In that respect, losing > 15 kHz is a pretty small loss (your estimate of 2-5% is probably a good ballpark).

 

[Jan64]

Kind of, yes.
The latter doesn't matter: it's the former that matters to you, since that's what makes up the perception. In that respect, losing > 15 kHz is a pretty small loss (your estimate of 2-5% is probably a good ballpark).

In my not so accurate perception 30% of my cochlea was damaged... Now being 2-5%... With this new knowledge it feels much better... Thanks!

 

[Shem]

Update for those interested: 18 treatments in. Significant improvement in hearing loss (idiopathic single sided profound hearing loss), no difference in tinnitus, although it bothers me less and less each day.