Can hyperbaric oxygen help tinnitus?

Tinnitus is common, and when it will not settle it is natural to look for anything that might switch it off. Hyperbaric oxygen therapy (HBOT) sometimes comes up in that search. The short answer is that the evidence does not support HBOT for long-standing tinnitus, and we do not offer it as a tinnitus treatment.

This guide explains what tinnitus is, what causes it, when it needs urgent care, how the NHS manages it, and exactly what the research on hyperbaric oxygen shows.

What is tinnitus?

The NHS describes tinnitus as hearing noises that do not come from an outside source. It can sound like ringing, buzzing, whooshing, humming, hissing, throbbing, or even music or singing. You may hear it in one or both ears or in your head, and it may come and go or be there all the time.

It is widespread. A Cochrane review estimates that tinnitus affects up to 21% of adults, with around 1% to 3% experiencing severe problems. The NHS says it is not usually a sign of anything serious and may get better by itself.

What causes tinnitus?

It is not always clear, but the NHS says tinnitus is often linked to:

• some form of hearing loss
• Ménière's disease
• conditions such as diabetes, thyroid disorders or multiple sclerosis
• anxiety or depression
• certain medicines, including some chemotherapy medicines, antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin

Tinnitus and hearing loss often go together. NICE says the two can co-exist, and that care for adults with both should also follow its guideline on hearing loss. A GP will usually look in your ears first, because some causes, such as an ear infection or a build-up of earwax, can be treated directly.

When is tinnitus an emergency?

Most tinnitus is not urgent, but some patterns are. The NHS advice is:

• Go to A&E or call 999 if you have tinnitus after a head injury, or tinnitus with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo).
• Ask for an urgent GP appointment if your tinnitus beats in time with your pulse.
• See a GP if you have tinnitus regularly or constantly, if it is getting worse, or if it is affecting your sleep, concentration or mood.

NICE guideline NG155 sets out referral timings for professionals:

• Immediately for tinnitus with sudden significant neurological symptoms such as facial weakness, suspected stroke, or a high risk of suicide.
• Within 24 hours for hearing loss that developed over 3 days or less in the past 30 days.
• Within 2 weeks for distress affecting mental wellbeing despite initial support, or for hearing loss that is rapidly worsening or started suddenly more than 30 days ago.

NICE also advises considering referral for persistent pulsatile tinnitus or persistent tinnitus in one ear, and offering imaging to people with pulsatile tinnitus.

How is tinnitus assessed and managed in the UK?

NICE NG155 starts with support: talking through the person's experience, its impact and their concerns, and agreeing a management plan that reflects their preferences. From there, the main options are:

• Hearing aids. NICE recommends amplification devices for people whose hearing loss affects their ability to communicate, and advises against them for tinnitus without hearing loss.
• Psychological therapies. For tinnitus that still causes distress, NICE recommends a stepped approach: digital tinnitus-related CBT first, then group-based therapy such as mindfulness-based cognitive therapy, acceptance and commitment therapy or CBT, then individual CBT.
• Sound therapy. NICE did not find enough evidence to make a recommendation for practice and called for more research. The NHS still suggests avoiding total silence, because soft background sound may help distract from tinnitus.
• What NICE advises against. It says not to offer betahistine to treat tinnitus.

The NHS adds tinnitus counselling and tinnitus retraining therapy, noting it is unclear whether retraining therapy works for everyone.

The strongest research support is for CBT. A 2020 Cochrane review of CBT for tinnitus included 28 studies with 2,733 participants. It found CBT may reduce the negative impact of tinnitus on quality of life at the end of treatment, with few adverse effects. The certainty of that evidence was low to moderate, and it is not known whether the effect lasts to 6 or 12 months.

Everyday steps the NHS suggests include relaxation or breathing exercises, a regular bedtime routine, avoiding stress and loud noise, and joining a support group.

What does the research say about hyperbaric oxygen and tinnitus?

HBOT means breathing concentrated oxygen in a pressurised chamber; our page on what HBOT is explains the basics. The idea behind using it for ear problems is that hearing loss and tinnitus may involve a shortage of oxygen in the inner ear.

The best summary of the evidence is a Cochrane systematic review of hyperbaric oxygen for sudden sensorineural hearing loss and tinnitus of unknown cause. Its most recent search was in May 2012. It found:

• Seven randomised trials, 392 participants. The studies were small and of generally poor quality. Trials were eligible if they used a chamber above 1.2 ATA for 30 to 120 minutes.
• Chronic tinnitus: no benefit shown. There were no significant improvements in hearing or tinnitus for problems that had been present for around six months.
• A clear conclusion. The authors found no evidence of a beneficial effect of HBOT on chronic hearing loss or tinnitus, and did not recommend HBOT for this purpose.

The Cochrane plain language summary adds that any benefit may only apply when HBOT is used within two weeks of onset, with no evidence it helps people whose hearing has been affected for some months.

Our chamber runs at 1.5 ATA. We do not offer HBOT as a treatment for tinnitus, and nothing in this evidence would justify doing so.

Why is sudden hearing loss a different question?

Sudden hearing loss is a medical emergency, and it often comes with tinnitus. The Cochrane review notes that up to 90% of people with sudden sensorineural hearing loss also report tinnitus.

For people with recent sudden hearing loss, the same review found that HBOT improved hearing. There was a 22% greater chance of improvement and roughly one extra good outcome for every five people treated. Even so, the authors said the clinical significance was unclear and the result should be read cautiously. They could not assess the effect on tinnitus by pooling the trials.

Decisions about HBOT in that situation belong with an ENT team as part of urgent hospital care. They should never delay the urgent assessment that NHS and NICE advice calls for.

Can pressure affect your ears?

Yes, and this matters for anyone with ear symptoms. Cochrane notes that HBOT carries some risk of damage to the ears, sinuses and lungs from pressure, as well as temporary worsening of short-sightedness, claustrophobia and oxygen poisoning. The reviewers say serious adverse events are rare, but that HBOT cannot be regarded as an entirely benign intervention. Clearing your ears as pressure changes is essential, and some ear and sinus conditions make a session unwise. Our page on who HBOT is not suitable for covers this in more detail.

What we would suggest instead

If tinnitus is new, one-sided, pulsing, or comes with hearing loss, dizziness or facial weakness, get it assessed urgently. If it is long-standing and wearing you down, ask your GP about a hearing test, audiology support and the talking therapies NICE recommends. Those routes have evidence behind them.

If you have questions about HBOT for another reason, our general introduction to hyperbaric oxygen therapy and the page about our clinic explain what we do and who oversees it.