HBOT is Not Indicated for Otosclerosis
HBOT has no established role in the treatment of otosclerosis and should not be offered for this condition. The evidence provided exclusively addresses sudden sensorineural hearing loss (SSNHL), which is a completely different pathophysiologic entity from otosclerosis.
Critical Distinction Between Conditions
Otosclerosis is a primary disorder of the otic capsule bone causing progressive conductive hearing loss (and sometimes mixed hearing loss) through stapedial fixation—this is a mechanical problem requiring surgical intervention (stapedectomy/stapedotomy) 1.
SSNHL is an acute cochlear or retrocochlear event causing sudden sensorineural hearing loss, potentially related to vascular compromise, viral infection, or inflammation—this is where HBOT has been studied 1.
Why HBOT Would Not Work for Otosclerosis
The theoretical mechanism of HBOT involves increasing oxygen delivery to ischemic cochlear tissue and reducing hypoxia and edema 1. This mechanism is:
- Irrelevant to otosclerosis, where the pathology is abnormal bone remodeling causing mechanical fixation of the stapes footplate
- Not addressing the structural problem that causes hearing loss in otosclerosis
Evidence Base Limitations
All guideline recommendations and research studies in the provided evidence specifically address SSNHL, not otosclerosis:
- The American Academy of Otolaryngology-Head and Neck Surgery 2019 guidelines state clinicians "may offer" HBOT combined with steroids for SSNHL within 2 weeks of onset, but this is an option (not a recommendation) with balanced benefit and harm 1.
- Even for SSNHL, the evidence shows only modest benefit (25% improvement in hearing, not 50%), with a number needed to treat of 5 1, 2.
Appropriate Treatment for Otosclerosis
The standard of care for otosclerosis remains:
- Observation for mild cases with minimal functional impact
- Hearing amplification for those declining surgery
- Stapedectomy or stapedotomy for definitive treatment of conductive hearing loss
HBOT should not be considered, offered, or discussed as a treatment option for patients with otosclerosis, as there is no pathophysiologic rationale or clinical evidence supporting its use in this condition.