You woke up deaf in one ear. The clock started last night.

I started this hyperbaric practice about a year and a half ago now, and it's been going pretty strong. And one of the things that I found extremely exciting about the hyperbarics and related to ear, nose, and throat is the amazing efficacy in sudden hearing loss. It's kind of an unusual phenomenon, but about 30 to maybe 60 people a year in South Dakota will all of a sudden lose their hearing.

Like, bam, it's just gone. They wake up and it's gone. Now, about half of those people will have a dizziness along with it. And so you hear about people getting labyrinthitis. They think they're gonna die, and the room is spinning. Well, the balance part of the inner ear and the hearing part of the inner ear are all in the same otic capsule, and about half of people have a competent valve between the balance center and the hearing center.

Some people will get just a dizziness. They get vertigo, and they say, "What the heck?" They're spinning and dizzy, puking, no hearing loss. And half the people, all of a sudden, they just get hearing loss, and they're not dizzy, and then half the people get both. It's a labyrinthitis either way, but one time it's just hearing, one time it's just balance, or it's both.

The frustrating thing is that people go in to see their doctor or urgent care, and they think they're having a stroke or something, and then people look in their ear, and it's late, and they're like, "Oh, I think you have fluid there," or, "There's wax there."

And they don't have any other neurologic symptoms. They don't have any weakness or stroke-like symptoms. They just can't hear. And so they get put off as fluid behind the eardrum, which happens, or maybe there's wax in there. They can't see, and it's late, and you're working. I know how it is working late.

Emergency room care was moonlighting when I was in residency. It's just like whatever it takes to get them out of the urgent care center. The diagnosis gets delayed, and it's very, very common. Then they come in and see me a month later, and we do a hearing test, and it's like, "Oh, you have a sensorineural hearing loss."

It's like going blind in one eye. You know, if you go blind in one eye, everybody freaks out, and you get treated right away. But if you go deaf in one ear, it's like almost all the time they just get kinda, "Ah, you know, you got fluid, or you got wax," or, "Do these ear drops," or, "Take this antibiotic," or something like that.

If we catch those people early, what happens invariably is it's some kind of a viral infection, or it's something that caused inflammation. And whenever it causes inflammation in those tight spaces, those cells get inflamed, and blood can't get to them, and so oxygen can't get to them. And the nerve is, like, holding its breath.

So we put them on steroids. We've shown that if we put them on high-dose steroids to lessen the inflammation, they get better. We put them on oral steroids. You could put them on IV steroids, or sometimes we put steroids right through the eardrum and soak high-dose steroids right in. It soaks in through the oval window and the round window in particular to get into the inner ear, into the labyrinth.

They get dramatically better. So we've shown over and over again that steroids, topically or systemically through the IV or through the digestive tract, are dramatically helpful. The other thing we've shown is that if you put them in a hyperbaric oxygen chamber, it literally pushes the oxygen right to that nerve immediately.

And that nerve's just sitting there holding its breath because it's all inflamed, and it can feed that nerve, and it can make a dramatic return, especially if you get those people in early. One of the things that happened recently: I had a patient, and she had had this exact same thing happen in her left ear, so she knew what happened.

Profound hearing loss. Nerve's gone. She went through this rigmarole. "Oh, you have fluid." Yeah, then they put her on steroids and then nothing, nothing. And then a few weeks ago, she had it happen in her other ear. So she comes into the clinic with her husband. Well, they knew it happened then because she's had it happen to her before.

She's kinda crying, and she's in the clinic. She's completely deaf. And she knows what's going on. We do a hearing test. She's got bilateral profound hearing loss. And so I had my medical student write up the case. And as ENTs and audiologists well know, a lot of the recovery on hearing loss is really based on how bad it is when you get it.

And her hearing — we do an audiogram. People don't understand all the time what an audiogram is, but if you're in the field, you'll say, "Well, everything is way down at the bottom." So this is how loud it has to be. So both her ears are way down here in the profound hearing loss, and usually that's a terrible prognosis.

Put her on prednisone, a milligram per kilo, high dose of prednisone, put steroids behind her eardrum in the clinic, have them sit there and let it soak in for 20 minutes, and we got her in the chamber at a pretty high dose, 100% oxygen, and she made an absolutely incredible recovery, almost up to normal in her ear.

Now, the other ear that was dead was holding its breath for five years, so obviously that nerve is dead. So she had no recovery in the first ear, but she made almost a complete recovery — which is unheard of in that degree of hearing loss — in her other ear. And so I've had more and more patients.

And I used to say, "If you can get people in within two weeks, you're gonna get some response." I say, "If you get them in within two hours." I mean, for sure two days. My goal now is, if I can get all the people in South Dakota, maybe in eastern South Dakota, in within 48 hours, it's a really huge difference in their life.

Even a unilateral hearing loss can really negatively affect you. If you're in the car, and you can't hear, and your husband's over there — it just makes everything hard. I had a surgeon friend who had the same thing. He was dizzy and had labyrinthitis. And his whole career, they say, "Oh, yeah, if you're on that side of him, he can't hear you, and he gets annoyed because he didn't hear what you said."

But it makes a big difference in people's lives if you can save that hearing. So I found that to be absolutely incredible. So I'm really kind of trying to get a system where all the ENTs and all the audiologists have my personal cell phone number, because they'll know if it's real or not.

I don't want all the people in the state calling me for wax, but if they could get ahold of me, I said I could get them started. I could put the steroids behind their eardrum. We have, right here in our hyperbaric clinic, a microscope and a chair, and I have high-strength Decadron to put behind the eardrum with special needles, and you can put that in.

Or if they can't pop their ears, I do little myringotomies all the time anyway. But if we can get them in, it makes a real big difference. So it's kind of my latest passion, to try to almost have a sudden hearing loss hotline and get people in right away. And it's very rewarding, 'cause the people know it.

I just saw another patient. We have two people in here getting hyperbarics just for that now, and they come in and they're like, "Wow, it's back." And so that's been a real privilege. The problem with hearing loss is, very clearly, you just don't get people in that fast.

The insurance company won't pay anything unless it's been proven over and above any statistical significance, and it's not just kinda like, eh, maybe. It's gotta be really high-level proof. So the insurance companies generally will pay for sudden sensorineural hearing loss because they know the data is so robust.

And the American Academy of Otolaryngology has said that if you can get hyperbarics, it's amazing. It's a great idea, especially if you can get hyperbarics right away. They've said for sure steroids. I mean, everybody recommends steroids. A high dose of steroids if you can.

Some people can't handle oral steroids. I dunno if you've been on prednisone. Some people go crazy. Some people are diabetic and they can't quite get their sugars under control. It can make your sugars go crazy. You can't sleep. It makes people super hungry. And so some people just can't tolerate systemic steroids.

And so they said, if not, you can put it behind the ear. Now, there's some studies that show putting it behind the ear is actually better than oral steroids. I like to do both, because this has really no side effects other than it's a little uncomfortable while you're doing it.

The hyperbaric oxygen, in all the studies, has shown efficacy. The problem is doing double-blinded, randomized, prospective studies — finding the patients and then saying, "Okay, how do you not give hyperbarics?" And then they put them in hyperbaric chambers with normal room air or with 100% oxygen, and they both get benefit.

Well, we know that pressure will drive even room-air oxygen into your system, too. And so people have gotten benefit on both of those things. And so there's a lot of studies that are kinda eh. Even this patient I had with the five years ago, she had steroids. She got no benefit. And then their second ear, you say, "Well, maybe it was worse."

Maybe it was worse, but she got complete resolution with the hyperbarics. Now, I know that's anecdotal. It's one patient, but there's so much robust data that it's been a recommendation by the academy based on the literature. And if you go do a literature review — as a matter of fact, I'm having my medical student write a paper on her, and it's gonna be in the South Dakota Medical Journal.

And so he's done a literature review on the hyperbarics and all the studies, but it's definitely indicated, and it's not some willy-nilly, like, you know, drink apple cider vinegar or do something. It's robust data that's really helpful. And it makes a lot of sense, too.

Most people are probably gonna not be too excited if it's two months. And sometimes people say one month. But no matter what, the sooner the better. As a matter of fact, that lady, when I met her in the clinic that day, I had her in here that evening, just because I knew it was important — and I own the place, so I'm like, "Let's get her in there. Get it going."

And so anytime you have an ischemic episode, whether it's a stroke or heart attack or anything, it's ischemia, meaning you don't have blood flow, meaning you don't have oxygen supply, and all the damage is coming from anoxia. You just don't have enough oxygen to get there, whether it's a hemorrhagic stroke or a blocked stroke, or you get a heart attack and a blocked heart valve, and all the damage is being done.

If you get it treated early — people that have heart attacks, they breathe oxygen. If you get them in a chamber, it's actually a great thing, if you don't have contraindications. But the sooner the better. Two months is probably not gonna help if it's been more than two months.

Earlier than two weeks, we're pretty excited, and I'd like to get them in within two days, 'cause I think you'll see a huge difference. In other places it's inpatient, or it's expensive. And they have soft chambers.

Is that really — is it legit? Is it 100% oxygen? Are they going up to two and a half, two, three atmospheres, getting the high pressures? And it's hard to find that place, but we have that here, and so we can get those people in. This patient of mine was a 47-year-old lady, and it's really kind of piqued my interest in this.

So she lost her hearing five years ago in her left ear. Stone deaf. Profound loss. Got steroids. That was it. Never came back. No response. She just is deaf in that ear. She comes in to see me, and she loses her hearing in her right ear. Same thing, profound deafness. She's stoic. She's crying, tearful.

She's with her husband. She can't hear a thing. She's just stone deaf, comes into the clinic crying. She knows what's going on because she had that. So we do an audiogram. There it is. That proves it's a nerve loss. It's not — 'cause the eardrums look perfect. We were able to start her on oral prednisone and put high-dose Decadron behind her eardrum under a microscope.

I put that in there, let it soak in the oval and round window, get that in there, and I got her into this chamber that same evening. And she started hearing, like, the day after. She can hear stuff. Now, it's anecdotal, but she came back from a profound loss all the way down here at the very bottom of our charts — she bounced back to basically normal hearing in her ear.

Now, the other ear was beyond repair because it happened so long ago. So her other ear is still deaf, and her right ear is perfect. She's got perfectly normal hearing, 100% speech understanding, and she's within normal limits on that ear, and I cannot attest that to just the steroids.

I'm sure it was the hyperbaric, and I'm sure it was getting her in quickly. It just happened that she came into my clinic and saw me. But if I can get other audiologists or other ENTs to say, "Let's get them in" — if we can get them into the chamber immediately, the same day even or the day after, it makes a huge difference in their recovery.

Suppose you're somewhere and you lose your hearing, and you're just like, "What the heck is going on?" One of the things I tell people is that we use tuning forks sometimes. We put tuning forks: "And you hear this? Is it louder here or there?" Suppose you lose your hearing because you have wax or fluid or a hole in your eardrum — let's say you had a lot of wax and all of a sudden the wax blocks your hearing.

If you take your finger and you stick it in your ear and then you hum — try that. Just go, mm, and then hum up and down. Open your mouth and hum. It's louder in that ear, isn't it? Try that. It's louder in the ear that's plugged. And so if you have a wax impaction or fluid and you say, "I can't hear out of this ear," and then you say, "Well, hum," and it's louder in the ear you're complaining about, you're fine.

It's not a nerve deafness. It's wax or fluid. But if you do that and it's not louder and you can't hear it in that ear, then uh-oh, you probably have a nerve deafness. You probably have a sudden nerve deafness, and then you wanna get after that and get on steroids and then get in the chamber.

Taking out the tuning forks, too: if you took out a tuning fork and you put it on your forehead and it's louder in the ear they're complaining about, it's a conductive hearing loss due to fluid or wax or something in the canal — something that we can fix the day after, or with antibiotics or steroids or cleaning the ear or whatever.

That's just kind of a rule of thumb that says, hey, if it's a conductive loss, whew, take a breath, it's gonna be fine. But if it's a nerve loss, get them on steroids at the very least, and then get them to an audiologist or get them to ENT — or call that Todd guy and get them in the chambers, is what I'd like to do.

In order to get them in for a sudden hearing loss, we'd wanna establish it with at least one formal audiogram by an audiologist. It could be other things, too, and then you also wanna make sure they're somewhat screened. Make sure they don't come in with a pneumothorax or some kind of condition that contraindicates them from getting in. When we give them oxygen, some people that are prone to seizures — it can actually make that worse, and so you don't wanna put a poorly controlled epileptic patient in the chamber.

So there's a little bit of medical clearance to get in here as well. So nobody's getting in the chamber for hearing loss without a formal audiogram by an audiologist. Even if the ENT or the audiologist can get them to me, I'll take care of the intratympanic dexamethasone. I will do that, and I'll take care of the steroids too, and manage their sugars or whatever.

And so to me — sometimes I'll have a patient, like a thyroid patient. They have a goiter and they have calcium issues, and I say, "Okay, I'm gonna give it to my partner," and I just know they're gonna take care of the thyroid and the TSH and the calciums.

And so if they can get ahold of me, and I'm in town, I'll just take care of it all. Or if they said, "No, I like to do this medication, the intratympanic dexamethasone," and put them on the steroid regimen, then I'd just do the hyperbarics and get them in there and then send them back for their audios.

We like to get 20 treatments, and usually insurance will approve 20. Each treatment lasts two hours, but 90 minutes at a pretty high pressure — 2.85 even. Breathing 100% oxygen, and they just watch TV or take a nap. But that might be a month of treatments, four weeks or so of treatments.

And then they probably have an audiogram after two weeks, and probably have an audiogram after four to six weeks, and they could follow it through. That's all you can do, in essence. If they had a virus, sometimes they'll have chickenpox — if you've seen people that have zoster on their face or something.

If they had chickenpox coming out on the ear, then we put them on antivirals, too. That's called Ramsay Hunt syndrome, and sometimes you can get a chickenpox virus in the geniculate ganglion, and they have a facial paralysis and they lose their hearing. That's a pretty ominous diagnosis. But I'd definitely have them in the chamber for that, and I'd put them on Valtrex, which is an antiviral.

The thing that struck me just from a personal nature was how grateful they were that we had this, and how life-changing it would have been to be deaf. And even if you had a cochlear implant, it's not great. It's not as good as hearing aids.

And to actually be back where she was was pretty dramatic. And that's maybe why — it's very rare in medicine that we can actually do things to fix people. A lot of times we're like, "Oh, I can't fix that." You know, they got ringing in their ears.

"Well, sorry, so does everybody." There's so many things in medicine where I used to think that surgeons and doctors could fix everything. We fix very little. And this is something that, through a series of pretty simple treatments that's very healthy — it's just oxygen and pressure and steroids and diminishing inflammation — it's so dramatic.

And it was so nice to see that, and to see how happy she was that she was not deaf. Maybe that's what really turned me on to the whole thing. It was really nice to be able to do something awesome like that, or be part of it at least.

It's more in adults. Very rarely do I ever see it in kids. It's almost always adults. Like this lady was 47. I think it's probably more middle-aged — maybe more things go wrong with us when we get a little older. The other thing I would say, as a caveat, is that it helps neuropathies, right? So here the nerve is holding its breath.

It needs to be restored. What else would be totally benefited? Well, any cranial neuropathy. Have you ever seen somebody — we had a young lady, we know this is true too — her face gets paralyzed. They have what we call a Bell's palsy. No, that's just a diagnosis of exclusion. We don't know what the heck it is.

They get an MRI, it's normal. Face is totally paralyzed. And if it's a House-Brackmann grade VI, and they're a young healthy lady, and they can't move their face, that's like a medical emergency. And so what do we do? We put them on the same thing, steroids, and get an MRI.

We put them on Valtrex. Well, this would for sure help. There's no question about it. Now, it's much more rare to have a sudden acute dense complete facial paralysis, but it happens. I get one every two years maybe. Now, usually they have a little bit of movement, and that usually almost always comes back with just steroids.

But this would help it get better faster. And some people get it where they don't get it all back, and they have a little bit of a weakness for the rest of their life.

But it would work for any cranial neuropathy, including sometimes we'll get the vocal cords don't work. But the facial paralysis is just an obvious one. And maybe anosmia.

You know, you can't smell — which we had a ton of that with COVID. So maybe, in theory, maybe this would help for anosmia, or not being able to smell or taste, which happens a lot with these weird viruses, especially COVID. And so it's a viral infection of the geniculate ganglion and the facial nerve.

And both the facial nerve and the audiovestibular nerve go through the same little tiny canal from in the brain out to outside the skull. So it's a canal that's so tight in the skull, and inflammation in that tight little bony canal gets so swollen that they can't —

It's like the nerve's holding its breath. It can't breathe. And so steroids, steroids, steroids. We actually went so far as to drill into the mastoid and then try to drill the facial nerve off and pick the bone off it and let it swell up. You know, like when someone has a stroke and their brain swells, they take part of their skull off to let the brain swell, hoping it'll recover.

And so that's what we do with the nerve that's swollen and ischemic — you try to let it breathe. But hyperbarics would help all that, if they're not so sick they can't get in the chamber. But any cranial neuropathy, any post-stroke patient, any post-heart-attack patient — if they can get them in right away, you're gonna fix some of that tissue.

Nerve tissue, I think, lasts a little longer than muscle tissue. But if you have a heart attack, how much heart tissue damage did you have? It's muscular heart damage, and the last thing people are thinking about when they've had a heart attack is sitting in a chamber like that. But in theory it would work.

Especially — but I think especially strokes. If you can get those people in and they don't have a contraindication, you can get a stroke patient in, they'll get a lot of benefit.