Peran Terapi Oksigen Hiperbarik

pada Tuli Mendadak

dr. Kees de Roode

WEBINAR PRINSIP PENANGANAN TULI MENDADAK – 14 MARET 2021

APA ITU HBOT ?
Hyperbaric Oxygen Therapy

• First reported in The Lancet in 1887 and is best known for

the treatment of decompression sickness.
• A treatment modality in which a patient intermittently
breathes 100% O2 while the treatment chamber is
pressurized to a pressure greater than sea level pressure
(SHUMEC 2013, Thom 2013)
• ICD-9-CM Procedure → 93.95 (Hyperbaric oxygenation) /
ICD-10-PCS Procedure Code → 5A05121 (Extracorporeal
Hyperbaric Oxygenation, Intermittent)
• Treatment may be carried out either in a mono-place
chamber pressurized with oxygen 100 % or in multi-place
chamber with compressed air, which case the patient
receives oxygen by mask, head tent (hood), or
endotracheal tube (Thom 2013)
• Breathing 100% O2 at 1 ATA or exposing isolated parts of the
body to 100% O2 (even if pressurized) doesn’t constitute
HBOT (UHMS 2005)
Pressure
Main Theurapetic Effects of HBO
• Gas volume effects
• A reduction in the volume of gas-filled spaces according
to Boyle’s law (Thom 2013)
• Relevance to treating pathological condition in which
gas bubbles are present in the body, such as arterial gas
embolism and decompression sickness (Thom 2013)
• Increases the partial pressure of oxygen in the tissues
• The majority of patients who undergo HBO Therapy are
not treated for bubble-induced injuries hence
therapeutic mechanism are related to an elevated O2
partial pressure (Thom 2013)
• Increased dissolved O2 content in plasma
• ≈ 0,3 ml per dl whole blood at sea level pressure
• ≈ 2,1 ml per dl if breathing 100% O2 at sea level pressure
• ≈ 4,4 ml per dl if breathing 100% O2 at 2 ATA
• ≈ 6,8 ml per dl if breathing 100% O2 at 3 ATA
• Sufficient dissolved O2 content in plasma if breathing 100% O2
at 2.8 ATA to meet tissue’s basal metabolic requirement.
Plasma Oxygen Content
 INDIKASI
1. Air or Gas Embolism
2. CO Poisoning (CO Poisoning Complicated By Cyanide Poisoning)
3. Clostridial Myositis and Myonecrosis (Gas Gangrene)
4. Crush Injury, Compartment Syndrome & Other Acute Traumatic Ischemias
5. Decompression Sickness
6. Arterial Insufficiencies: Central Retinal Artery Occlusion, Enhancement of
Healing In Selected Problem Wounds
7. Severe Anemia
8. Intracranial Abscess
9. Necrotizing Soft Tissue Infections
10. Osteomyelitis (Refractory)
11. Delayed Radiation Injury (Soft Tissue & BonyNecrosis)
12. Compromised Grafts and Flaps
13. Acute Thermal Burn Injury
14. Idiopathic Sudden Sensorineural Hearing Loss
15. Stroke
Role of HBOT
Angiogenesis- progressive improvement of tissue oxygenation
Improve local host immune response
Clearance of infection
Enhance tissue growth

Enhancement of healing in selected problem

wounds
 Tn. S 63 Thn (1 MO)

DEBRIDEMENT(D-6) (2 MO)

AFTER HBOT 5 X (D-9) ( 3 MO )

AFTER HBOT 10 X (D-14) (5 MO)

(4 MO)

Courtesy of dr.ARIE ZAKARIA Sp.OT, Sp.KL

KONTRAINDIKASI Absolut KONTRAINDIKASI Relatif
Untreated Pneumothorax Demam
Pacemakers ISPA
Selected Medication: Kehamilan
1. Dexorubicin
2. Bleomycin
3. Disulfiram
4. Cis Platinum
5. Mafenide Acetate
Covid-19
EFEK SAMPING
• Barotrauma
• Oxygen Toxicity
• Hypoglycemia (Patient with DM)
• Anxiety
• Decompression Sickness (Attendants)
Peran TOHB pada Tuli Mendadak?
SSNHL
Rapid onset
Over 72 hour
Decrease in hearing of ≥ 30 dB
At least 3 consecutives frequencies

(Otolaryngology-Head and Neck Surgery, 2012)

Etiology
Reduced blood flow and oxygen delivery to the cochlea.
(JS Kim et al, 1999)

Cochlea is highly dependent on blood and oxygen supply to maintain its function.
(K. Tabuchi, 2010)

Significant injury in the blood-endolymph and blood-vestibulocochlear nerve barriers.

(Case report-J. Zou, Journal of Otology, 2020)

Acoustic trauma can lead to reduced cochlear blood flow and inner ear hypoxia.
(Lamm and Arnold, 1999)
Rationale
Vascular compromise and associated cochlear ischemia are thought to be
contributory to SSHL could be a final common pathway to hearing loss.

HBOT allows for delivery of greatly increased partial pressure of oxygen to the
tissue, in this case the cochlea, which is very sensitive to ischemia.
Furthermore HBOT is thought to have complex effects on immunity, oxygen
transport, hemodynamics, reducing hypoxia-edema and potentiating normal host
responses to infection and ischemia.
Early initiation of treatment
• Statement 9. Hyperbaric Oxygen Therapy: Clinicians may offer
hyperbaric oxygen therapy within 3 months of diagnosis of ISSHL
(American Academy of Otolaryngology-Head and Neck Surgery, 2012).
• Younger patients respond better to HBOT than older patients
(cutoffs varied 50-60 years).
• Early HBOT is better than late (defined from 2 weeks to 3 months).

Our Experience
• Bad : If in 2 weeks no improvement or late medication; complain of
vertigo; loss in high frequencies & old age.
• Good : early treatment; loss in low frequencies.
 RECOMMENDED HBOT PROFILE:

100% O2 at 2.0 to 2.5 ATA

for 90 minutes daily
for 10 to 20 treatments. 

(The 2.4 ATA treatment pressure is probably

most practical, especially for facilities with
multiplace chamber operations)

UHMS http://membership.uhms.org/?page=ISSHL
KESIMPULAN
The cochlea has a high oxygen requirement and so is sensitive to
disruptions of its blood supply (Thalmann et al, 1972).

HBOT is started as early as possible (Bayoumy et al, 2019).

 ...and HYPERBARIC

INSTALASI HIPERBARIK RS KHUSUS THT-BEDAH KL PROKLAMASI – 14 MARET 2021