Inner ear disease

Inner ear disease 

Sound, acoustic pressure and its effect on the ear

Sound in the physical sense is produced by wave-like, minute changes in pressure in the air. The energy transmitted by these changes in pressure is referred to as acoustic pressure.

Our ear picks up the sound and makes it audible for us in the form of sounds or noises: These minute pressure changes cause the eardrum to vibrate. The auditory ossicles relay the vibrations to the inner ear where the pitch (i.e. frequency) is registered accordingly by very sensitive nerve cells (so-called auditory hair cells). After being processed in the brain, we are able to hear them as higher or lower pitched tones. 

Symptoms of inner ear diseases

  • Feeling of pressure in ear
  • Hearing loss (sudden deafness)
  • Tinnitus (ringing in the ears)
  • pain
  • Hyperacusis (over sensitivity to noise)

What is Tinnitus?

Tinnitus is experienced as noise when there is no such external physical noise present. There are many causes of tinnitus (ear disease, infections, stress, noise, accidents, tumours or psychosomatic). Nowadays, tinnitus is considered a national disease and not without consequences (insomnia, anxiety, depression and inability to work).

Impact of HBO therapy

HBO therapy is a form of treatment, whereby the patient inhales medically pure oxygen (HBO = hyperbaric oxygenation) under increased pressure (hyperbaric). In a hermetically sealed chamber the pressure is increased from 1.5- to 3-times the normal atmospheric pressure. 

Normally, the oxygen in the air binds itself to the red blood cells and is transported from the blood stream to the tissues. The diseased or injured organism can only maintain this oxygen supply to a limited extent and the oxygen is unable to penetrate the tissues sufficiently.

HBO significantly improves the metabolic status of the inner ear, to the extent of providing up to a 20 times higher oxygen supply. This is because oxygen is not only transported by the red blood cells (which is normally the way) but also via the physical solution in body fluids where the oxygen is able to reach all areas of the body through HBO therapy.

Based on an optimal metabolism, the inner ear is able to regenerate and can gradually resume its function.

Treatment options

Currently, the following procedures are recommended in the treatment of noise-related inner ear damage:

  • Infusion with cortisone / rheological treatment                    (to improve blood circulation)
  • HBOT (hyperbolic oxygen therapy)

Starting the therapy at the earliest opportunity will ensure the best chance for improvement!
After the appearance of tinnitus, spontaneous healing sometimes occur and the noise disappears again.

Should this not be the case, you should see a specialist doctor as soon as possible (between 48 hours and 3 months). Usually, an infusion with cortisone will be recommended. If this is combined with a HBO therapy, the patient will have the best possible chance of improvement.
Under no circumstances should you simply wait it out!  

Contraindications / side effects

With a thorough examination and medical history of the patient, the physician can eliminate any possible contraindications and determine the patient’s personal suitability for the therapy.

The effects can be read about in the following studies.

Equivalent success in HBO & Infusion therapy

A prospective randomised study in Hannover confirmed the therapeutic equivalence of the two methods. This means if an infusion therapy is not available or ineffective, HBO is indicated.

Acute stage (< 3 months)

Treatment / Procedure

Chances of success

Medication to improve blood flow i.e.tablets


Infusions with medication to improve blood flow


Infusions with medication to improve blood flow plus cortisone


hyperbaric oxygen therapy (HBO)


hyperbaric oxygen therapy at early onset


Subacute stage (3-12 months)

Treatment  / Procedure

Chances of success

Medication, i.e. tablets







  • European Manual of Medicine
    Editors: M. Anniko, M. Bernal-Sprekelsen, V. Bonkowsky, P. Bradley, S.Iurato
    Otorhinolaryngology, Head & Neck Surgery
    Springer-Verlag Berlin Heidelberg 2010
    ISBN 978-3-540-68940-9
  • P1 principles of Tinnitus sudden deafness from 01/2014

Summary: Contradictory statements on the usage of the therapy due to poor quality studies. However, the collective observations point to a “significant improvement in hearing ability”.

  • Four therapies used to treat acute sudden deafness were assessed:
    • Corticosteroids
      • Unclear clinical significance 
      • Vasodilatator drugs/ Vasoactive substances
      • Efficacy remains unproven
    • Intratympanic steroids
      • equivalent to oral steroids and of unclear clinical significance 
    • HBO therapy
      • Meta-analysis 2005: HBO improves hearing
      • Update 2007: HBO improves hearing significantly at an early stage
      • Update 2010 und 2012: same positive statement

Reimbursement of costs

  • is based on a statutory scale of medical fees for physicians (GOÄ).
  • HBO is usually reimbursed by private health insurance; eligibility is only when the following medical condition is presented (“with tinnitus disorders associated with perception impairment of the inner ear„).
  • with statutory health insurance, the assumption of costs is based upon the individual case.

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