What are the next best steps to manage flushing, sweating, echo sensation, and ear fullness during HBOT and IT steroid injections?

Managing Symptoms During HBOT and IT Steroid Salvage Therapy

Your symptoms of flushing, sweating, echo sensation (autophony), and ear fullness are expected side effects of your current treatment regimen and do not require discontinuation of therapy—continue with your planned 8 remaining HBOT sessions and 2 remaining IT steroid injections as these represent your best chance for hearing recovery. 1

Understanding Your Current Symptoms

Flushing and Sweating

• These are common systemic effects from the IT steroid injections, which deliver high concentrations of corticosteroids that can have systemic absorption despite being locally administered 1
• The flushing and sweating typically resolve as your body metabolizes the steroids between injection sessions and should not prompt treatment discontinuation 1

Echo Sensation (Autophony) and Ear Fullness

• Difficulty equalizing middle ear pressure occurs in 17% of patients undergoing HBOT, making this your most likely explanation for the echo sensation and fullness 1
• Eustachian tube dysfunction develops in up to 45% of patients receiving HBOT for various indications, though in SSNHL patients specifically, barotrauma rates are lower at approximately 6.25% 1
• The echo sensation you describe (hearing others' voices but not your own) is characteristic of Eustachian tube dysfunction rather than autophony, which typically involves hearing your own voice loudly 1

Immediate Management Steps

For Pressure Equalization Issues

• Perform aggressive Valsalva maneuvers before, during descent, and after each HBOT session to prevent middle ear barotrauma 1
• Consider using topical nasal decongestants (oxymetazoline) 30 minutes before each HBOT session to improve Eustachian tube function 1
• Alert your HBOT technician to slow the rate of compression if you experience difficulty equalizing—this is the single most important intervention to prevent barotrauma 1

For Systemic Steroid Effects

• The flushing and sweating require no specific intervention beyond reassurance, as these are transient effects that will resolve after your IT steroid series is complete 1
• Ensure adequate hydration during this period 1

Why You Must Continue Treatment

Critical Timing Window

• You are within the optimal 4-week window for salvage therapy, and discontinuing now would eliminate your best opportunity for hearing recovery 1
• The American Academy of Otolaryngology-Head and Neck Surgery specifically recommends HBOT as salvage therapy within 1 month of onset when combined with steroid therapy 1
• Early treatment within 4 weeks is associated with significantly better outcomes compared to delayed treatment beyond this window 1

Evidence for Combined Therapy

• Combined HBOT and IT steroids show superior outcomes compared to either therapy alone, with full hearing recovery occurring in 42.6% of patients receiving combined therapy versus 17.5% with HBOT alone or 11.6% with IT steroids alone 1
• Patients with severe to profound hearing loss (which appears to be your situation) benefit more from HBOT than those with mild losses 1, 2
• The combination accelerates recovery, particularly in the initial treatment period 3

Monitoring for Serious Complications

Red Flags Requiring Immediate Evaluation

• Severe, persistent ear pain (beyond transient discomfort during IT injections) 1
• New-onset severe vertigo or imbalance (beyond transient dizziness immediately post-injection) 1
• Persistent tympanic membrane perforation with drainage 1
• Signs of middle ear infection (fever, purulent drainage) 1

Expected vs. Concerning Symptoms

• Expected and manageable: Transient dizziness after IT injections, mild ear fullness, difficulty equalizing pressure, flushing, sweating 1
• Concerning: Severe pain, persistent vertigo lasting hours, fever, purulent drainage, sudden worsening of hearing 1

Optimizing Your Remaining Sessions

For Your 8 Remaining HBOT Sessions

• Continue the standard protocol of 100% oxygen at >1 atmosphere absolute pressure for the prescribed duration 2
• Focus on aggressive pressure equalization techniques throughout each session 1
• Report any difficulty equalizing to your HBOT technician immediately so they can adjust compression rates 1

For Your 2 Remaining IT Steroid Injections

• The steroids should be instilled in the affected ear for 15-30 minutes per injection 1
• Expect transient dizziness and possible brief caloric vertigo immediately after injection—this is normal 4
• The injections are typically administered within 7 days of each other based on the evidence from salvage therapy trials 1

Prognosis and Expectations

Realistic Outcomes

• Patients with lesser degrees of hearing loss (<81 dB) and age <60 years improve more than those with profound deafness and older age 1
• Improvement rates of 44-47% are reported with combined salvage therapy in high-quality trials 1
• The greatest treatment efficacy occurs at low frequencies of hearing 3

Timeline for Recovery

• Most improvement occurs within the 2-6 week timeframe from symptom onset, which is why completing your current treatment course is critical 1
• Delay in treatment beyond 3 months results in minimal improvement (<5 dB), emphasizing the importance of not interrupting your current therapy 1