Hyperbaric oxygen combined with postauricular and intratympanic steroid injections in diabetic patients with severe or profound refractory sudden sensorineural hearing loss

Patients with type 2 diabetes mellitus (T2DM) and severe or profound refractory sudden sensorineural hearing loss (RSSNHL) urgently require more effective salvage therapies. This study aimed to evaluate the efficacy of a triple salvage therapy—combining hyperbaric oxygen (HBO), intratympanic steroids (ITS), and postauricular steroid injections (PSI)—for severe or profound RSSNHL in diabetic patients. This retrospective study analyzed 117 patients with unilateral severe or profound RSSNHL and concurrent T2DM between January 2020 and December 2024. All patients underwent salvage therapy with PSI and ITS, either with ( n = 60) or without ( n = 57) HBO. The primary efficacy endpoint was the change in hearing level, while secondary endpoints included changes in glycemic control, tinnitus and vertigo symptoms, anxiety and depression scores, and sleep quality. Compared to the No-HBO group, the HBO group achieved superior post-salvage efficacy, with significantly higher cure rates, clinical effectiveness rates, and hearing threshold gain ( P 0.05). Salvage therapy improved glycemic control, neurotological symptoms, sleep, and psychological status in both groups, with greater benefits observed in the HBO group ( P < 0.05). Shorter intervals from symptom onset to salvage therapy and shorter T2DM duration were associated with significantly greater hearing improvement ( P < 0.05). This triple salvage therapy effectively treats severe or profound RSSNHL in diabetic patients, improving auditory outcomes, glycemic control, and comorbid symptoms without increasing the incidence of adverse events. • First demonstration of triple salvage therapy (combination of HBO, ITS and PSI) for RSSNHL with T2DM. • The triple salvage therapy improved hearing outcomes and glycemic control. • The triple salvage therapy significantly improved tinnitus and psychological outcomes. • Shorter intervals from symptom onset to salvage therapy and shorter T2DM duration were associated with significantly greater hearing improvement