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assess the effect of HBOT on tinnitus by pooled data analysis. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powe- red trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT.There is no evidence of a beneficial effect of HBOT on chronic presen- tation of ISSHL and/or tinnitus and we do not recommend use of HBOT for this purpose based on the single study available.

Hyperbaric oxygen in tinnitus: influence of psychological factors on treatment results? ORL J Otorhinolaryngol Relat Spec. 2007;69(2):107-12. Porubsky C, Stiegler P, Matzi V, Lipp C, Kontaxis A, Klemen H, Walch C, Smolle-Juttner F Division of Thoracic Surgery and Hyperbaric Medicine, University of Medicine, Graz, Austria. christian. porubsky@klinikum-graz.at

Introduction: The standard treatment of subjective tinnitus hardly reaches the level of placebo controls. Though the effectiveness of hyperbaric oxygenation (HBO) for subjective tinnitus has never been objecti- fied, it is still advocated by some institutions. We analyzed the effectiveness of hyperbaric oxygen treat- ment in the context of accompanying factors. Patients and methods: We randomized 360 patients suffering from tinnitus into 2 HBO treatment proto- cols (group A: 2.2 bar for 60 min bottom time and group B: 2.5 bar for 60 min bottom time once a day for 15 days). All patients were asked to fill in a questionnaire (social and medical history, tinnitus characteri- stics, pre-HBO duration of tinnitus, prior therapy, pretreatment expectation, accompanying symptoms). A subjective assessment of the therapeutic effect was obtained. Results: Twelve patients (3.3%) experienced complete remission of tinnitus, in 122 (33.9) the intensity lessened, and 44 (12.2%) had a subjectively agreeable change of noise characteristics. No change was found in 157 cases (43.6%) and 25 (6.9%) experienced deterioration. There was no statistically signi- ficant difference between groups A and B (p > 0.05). Out of 68 patients with a positive expectation of HBO effects, 60.3% stated that the tinnitus had improved whereas only 47.2 and 19%, respectively, out of patients who underwent therapy with an indifferent (n = 271) or negative expectation (n = 21) reported an improvement. The influence of subjective expectation on the outcome was statistically significant (p < 0.05). Conclusion: The therapeutic effects of HBO on subjective tinnitus may be substantially influenced by psychological mechanisms.

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