What should I do about the persistent echo sensation after Hyperbaric Oxygen Therapy (HBOT) and completion of high-dose steroid therapy, now that I'm back on my baseline 7.5mg prednisone (Prednisone) for Systemic Lupus Erythematosus (SLE) management?

Management of Persistent Echo Sensation After HBOT

You need urgent ENT evaluation with audiometry to assess for middle ear barotrauma or eustachian tube dysfunction, which are the most common complications of HBOT occurring in 6-17% of patients. 1

Immediate Assessment Required

The "echo sensation" you're experiencing is most likely middle ear barotrauma or persistent eustachian tube dysfunction from the hyperbaric oxygen therapy. 1 This is the primary complication of HBOT, occurring in approximately 17% of patients receiving HBOT across various indications, though only 6.25% in sudden sensorineural hearing loss patients specifically. 1

Critical Next Steps

• Schedule audiometry within 24-48 hours to document any changes in hearing thresholds and compare to your post-HBOT baseline. 2
• Obtain otoscopic examination to evaluate for tympanic membrane perforation, middle ear effusion, or signs of barotrauma. 1
• Document the specific characteristics of your echo sensation: Is it autophony (hearing your own voice loudly)? Does it change with head position? Is there associated fullness or pressure? 1

Most Likely Diagnoses

Eustachian tube dysfunction is the leading concern, presenting as:

• Autophony (echo of your own voice)
• Aural fullness
• Difficulty equalizing pressure
• May persist for days to weeks after HBOT completion 1

Middle ear barotrauma can cause:

• Persistent pressure sensation
• Conductive hearing changes
• Tympanic membrane changes visible on exam 1

Treatment Algorithm

If Eustachian Tube Dysfunction Confirmed:

• Nasal decongestants (oxymetazoline spray for 3-5 days maximum) to reduce mucosal edema 1
• Oral decongestants (pseudoephedrine 30-60mg every 4-6 hours) if no contraindications 1
• Valsalva maneuvers performed gently several times daily 1
• Nasal steroid spray (fluticasone or mometasone) for persistent cases 1

If Middle Ear Barotrauma Confirmed:

• Observation for minor cases without perforation 1
• Avoid further pressure changes (no flying, diving, or additional HBOT) 1
• Antibiotics only if tympanic membrane perforation present to prevent otitis media 1

Important SLE-Specific Considerations

Your baseline 7.5mg prednisone for SLE does NOT increase your risk of HBOT complications. 1 The concern about steroid-related complications (osteonecrosis, fractures) is primarily with chronic high-dose use in patients with pre-existing bone/joint problems, not with your maintenance dose. 1, 3

Do not increase your prednisone dose for this complication unless specifically directed by your rheumatologist, as the echo sensation is a mechanical/pressure issue, not an inflammatory one requiring additional immunosuppression. 4, 3

Red Flags Requiring Immediate Evaluation

• Sudden worsening of hearing beyond your baseline post-HBOT status 2
• Severe vertigo or imbalance suggesting inner ear involvement 1
• Persistent tympanic membrane perforation (if confirmed) not healing after 2 weeks 1
• Signs of infection (fever, ear drainage, increasing pain) - particularly important given your immunosuppression 4

Expected Timeline

Most eustachian tube dysfunction from HBOT resolves within 2-4 weeks with conservative management. 1 If symptoms persist beyond 4 weeks, consider:

• Tympanometry to objectively assess middle ear function 1
• Referral to neurotology for specialized evaluation 1
• MRI temporal bones if concern for other pathology 1

Common Pitfall to Avoid

Do not assume this is related to your SLE or steroid taper. The timing (immediately after HBOT) and nature of the symptom (echo/pressure sensation) clearly point to a mechanical complication of the hyperbaric therapy itself, not lupus activity or steroid withdrawal. 1, 4 Fever would be the primary concern for infection in an SLE patient on steroids, not isolated echo sensation. 4