Sudden for ISSHL. There are up to 20

Sudden sensorineural hearing loss (SSHL) has been defined as anidiopathic loss of hearing of at least 30 dB over at least three testfrequencies. The disease develops within a timeframe of three days from onset.The incidence ranges from 5 to 20 per 100.

000 persons per year. As it is anidiopathic disease, the etiological factors contributing towards developingthis disease are still unknown. Although there are various proposed etiologicfactors, such as infections, immunological, toxic, neurological, circulatoryand other disorders. Although viral diseases and circulatory impairment of thecochlea would seem to be etiological factors of ISSHL, definitive proof islacking.

4 None of these factors have evidence supporting its role in the onset ofthe disease. The assessment of prognosis in ISSHL is even more difficult if we takeon account of the possibility of spontaneous recovery. This phenomenon seems tooccur in 29-78% of patients affected by ISSHL, depending on the shape of theaudiogram at onset of the disease. 3 The spontaneous recovery rate, defined as a hearinggain of at least 30 dB, typically develops within 2 weeks in 73% of patients(2).

Numerous proposed factors inevitably bring many treatment regimens forISSHL. There are up to 20 different types of treatment procedures reported.Wilson et al., demonstrated that oral steroid therapy had a higher impact onhearing improvement, in comparison to severe and profound hearing loss. In clinical practices the more frequent treatment utilised for ISSHL hasbeen systemic steroid treatment. More recently, IT steroid treatment has beenemerging and becoming more popular with otolaryngologists.

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This rise has mostly been caused by the high risks ofunfavourable side-effects a systemic approach. These effects can be endocrineproblems, osteoporosis or weight gain 5.  Hyperbaric oxygen therapy has been common for a longer period of time.

It was first used in the late 1970 by Goto and Vincey in the treatment of ISSHL.Goto stated that the treatment wouldincrease perilymph oxygenation. The same was reported by Lamm et al, whoreported that HBO therapy would increase the oxygen tension of the perilymphaticand improve the microcirculation of the inner ear. In theory, a combination of treatmentsshould provide a better outcome for patients with sudden sensorineural hearingloss.

This study is a trial to see whether combination of some of the commonlypreferred modalities together yield better results than the traditionalapproach.