Appeal type: Experimental/Investigational
Decision: Upheld

Diagnosis: Hearing Loss.
Treatment: Hyperbaric Oxygen treatment.

The health plan denied the Hyperbaric Oxygen treatment. The health plan's determination is upheld.

The patient is a female who presented with sudden fullness of left ear that started six days prior to the visit while running. The patient reported the first SARS-CoV-2 (COVID) vaccine injection. Medical history was positive for miscarriage.

Otalgia and vertigo were denied. Tinnitus and hearing loss of the left ear were complained of. The physical examination was normal, and an audiogram was performed on this same day. The right ear was normal, and a left profound sensorineural hearing loss was found, with the audiogram being available in the documents.

Her treatment consisted of an appropriate course of oral steroid on that same date of service. Follow-up yielded no perceived improvement and no side effect of medicine. There were no new symptoms or physical exam findings. Audiogram this day was unchanged. An injection into the tympanic cavity with liquid-local corticosteroids was made. A magnetic resonance imaging (MRI) of the inner ears was normal.

Two more injections of steroid were made into the left ear tympanum. There was no change in hearing. Hyperbaric oxygen therapy (HBOT) was recommended as an option of treatment. 

A second opinion with a neuro-otology subspecialist agreed to continue HBOT.

According to guidelines written by the American Academy of Otolaryngology, Statements 9A and 9B list hyperbaric oxygen therapy (HBOT) to be an option of treatment. The guidelines support consideration if within one month and this time has passed as well. The health plan does not cover HBOT for the indication of sensorineural hearing loss (SNHL).

The health plan's determination is upheld, in whole. HBOT is not included in the patient's health plan and the literature supports it starting within one month of symptoms when it is indicated.

The patient had the standard treatments for the insured's condition - that being oral and injectional corticosteroids. All other therapies, including HBOT, are not considered standard. There is no evidence of a beneficial effect of HBOT on chronic idiopathic sudden sensorineural hearing loss (ISSHL) or tinnitus and we do not recommend the use of HBOT for this purpose. [2]

"The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. There is no evidence of a beneficial effect of HBOT on chronic presentation of ISSHL and/or tinnitus and we do not recommend use of HBOT for this purpose based on the single study available." [1]

For people with acute ISSHL, the application of HBOT significantly improved hearing, but the clinical significance remains unclear. We could not assess the effect of HBOT on tinnitus by pooled analysis. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously. An appropriately powered trial is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. There is no evidence of a beneficial effect of HBOT on chronic ISSHL or tinnitus and we do not recommend the use of HBOT for this purpose. [2]

One cannot make conclusions of the role of HBOT with the meta-analyses available due to the heterogeneity of the patients included in the combined studies. [3]