Should the current treatment plan be continued until completion of the planned HBOT sessions by day 22?

Continue HBOT Treatment Through Day 22

Yes, you should absolutely complete the planned HBOT sessions through day 22, as you are demonstrating significant clinical improvement (>35 dB hearing recovery) and remain within the optimal treatment window where HBOT provides maximum benefit for sudden sensorineural hearing loss. 1, 2

Evidence Supporting Treatment Continuation

Your Clinical Response Indicates Treatment Success

• You have achieved substantial hearing improvement from >120 dB loss to 85 dB loss (>35 dB improvement), which represents a clinically significant response that justifies completing the full treatment course 1
• The return of mid-tone frequencies, decreased tinnitus, and echoing sensation are positive prognostic indicators suggesting ongoing cochlear recovery 1, 2
• The American Academy of Otolaryngology-Head and Neck Surgery guidelines indicate that HBOT combined with steroids shows benefit when administered within 2 weeks of onset, and you initiated HBOT on day 12, which falls within this therapeutic window 1, 2

Optimal Treatment Protocol Alignment

• Your treatment regimen closely follows evidence-based protocols: high-dose systemic steroids initiated within 6 hours, intratympanic steroids started on day 1, and HBOT begun on day 12 1, 2, 3
• The standard HBOT protocol for sudden sensorineural hearing loss consists of 10-20 sessions of 30-90 minutes each at >1 atmosphere absolute pressure, and completing your planned course through day 22 aligns with this recommendation 1, 2, 3
• Evidence demonstrates that HBOT is more effective when performed within 2-4 weeks of acute onset, and your completion date of day 22 remains within this optimal window 1, 2

Severity-Based Treatment Justification

• Patients with moderate to severe hearing losses (≥60 dB) demonstrate greater improvement with HBOT than those with mild losses, and your initial profound loss (>120 dB) specifically indicates HBOT benefit 1, 2, 3
• The Cochrane review data showed that while 50% improvement rates were not significantly increased, 25% improvement rates were significantly better with HBOT, and you have already exceeded this threshold 1

Critical Treatment Considerations

Monitoring During Remaining Sessions

• Continue monitoring for middle ear barotrauma, which occurs in approximately 6.25% of SSNHL patients receiving HBOT, though your concurrent steroid use likely reduces this risk 1
• Watch for eustachian tube dysfunction (occurs in 17-45% of HBOT patients for various indications), though rates are lower in SSNHL patients receiving concurrent steroids 1
• Serial audiometry should be performed to document continued improvement and guide any future treatment decisions 1

Steroid Taper Coordination

• Your 10-day systemic steroid course should be coordinated with HBOT completion, as the combination therapy is more effective than either treatment alone 1, 2, 3
• The intratympanic steroid series (bi-weekly × 3 weeks) provides local high-dose steroid delivery that complements HBOT's oxygenation effects 1, 3

Rationale Against Early Discontinuation

Risk of Incomplete Recovery

• Stopping HBOT prematurely when you are demonstrating active improvement could result in suboptimal final hearing outcomes 1, 2
• The evidence suggests that completing the full treatment course maximizes the chance of achieving serviceable hearing (Class B/C: PTA 31-50 dB with discrimination 50-69%, or PTA >50 dB with discrimination 50-69%) 4

Cost-Benefit Analysis Already Favorable

• While HBOT is expensive ($600-700 per session), you have already invested in the majority of sessions and are demonstrating measurable benefit that justifies completion 1
• The documented hearing improvement you have achieved represents clinically meaningful recovery that supports continuing through the planned treatment endpoint 1, 2

Treatment Window Optimization

• Discontinuing at day 11 would leave you short of the recommended 2-4 week treatment window where HBOT demonstrates maximum efficacy 1, 2
• Completing treatment through day 22 ensures you receive the full benefit of HBOT within the optimal therapeutic timeframe 1, 2

Post-Treatment Follow-Up

• Obtain comprehensive audiometry at treatment completion (day 22) to document final hearing thresholds across all frequencies (250-8000 Hz) 4
• Schedule follow-up audiometry at 1 month and 3 months post-treatment to assess stability of hearing recovery 1
• If hearing plateaus or declines after completing HBOT, consider additional intratympanic steroid injections as salvage therapy 1, 3