Appeal type: Experimental/Investigational
Decision: Upheld

Diagnosis: Hearing Loss
Treatment: Hyperbaric Oxygen treatment
The health plan denied the requested treatment. The health plan's determination is upheld.

This is a female who developed difficulty hearing from her left ear with the sound of static, but no dizziness. She denied dizziness and had received a COVID vaccine. Her ear exam was normal and a magnetic resonance imaging (MRI) was negative. An audiogram demonstrated a profound left sensorineural hearing loss with normal hearing in the right ear. She was treated with oral steroids and underwent three trans tympanic steroid injections with no response. 

The patient underwent her first hyperbaric oxygen dive, which is the service under review.

The health plan's determination is upheld, in whole.

The proposed treatment, hyperbaric oxygen under pressure, full body chamber, per 30-minute interval and a physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session is not likely to be more beneficial than any standard treatment or treatment of her left sudden idiopathic sudden sensorineural hearing loss. No, hyperbaric oxygen therapy has not shown to be more beneficial in combination with steroids or steroids alone [this is referenced in the report]. Based upon the peer reviewed medical literature, there is no preferred treatment regimen for sudden hearing loss which has in the past included vasodilators, diuretics, antivirals, and rheologic agents. Studies are fraught with methodological flaws, small cohorts and an absence of long term follow up.

This is a treatment that is not approved by the Food and Drug Administration (FDA). According to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS), hyperbaric oxygen in sudden hearing loss is considered an "option" when combined with steroids as a primary therapy within the first two weeks of onset of symptoms. The treatment date is outside this window. The AAO-HNS states that despite this recommendation, results leading to this should be interpreted with caution due to studies with small numbers in clinical trials, methodological shortcomings and poor reporting. In a Hayes report of the literature, the quality of evidence of hyperbaric oxygen with steroids was low in overall quality and with use of hyperbaric oxygen alone was very low with studies that were limited by short term follow up, small patient populations, poor reporting of data protocols and/or demographics. In a Cochrane review by Bennet, application of hyperbaric oxygen therapy in idiopathic sudden hearing loss significantly improved hearing, but the clinical significance remains unclear. The authors concluded that they could not assess the effect of hyperbaric oxygen therapy on tinnitus by pooled analysis. Due to the modest number of patients, methodological shortcomings and poor reporting, the results should be interpreted cautiously. In review by Rhee, the authors conclude that optimal criteria for patient selection and a standardized regimen for hyperbaric oxygen therapy should be applied in routine practice, which is not delineated, with future trials to investigate maximal treatment benefit.