Bilateral sudden sensorineural hearing loss following indirect lightning exposure successfully treated with hyperbaric oxygen therapy: a case report

Introduction: Lightning injuries may result in a wide spectrum of neurological and otological complications. Sudden sensorineural hearing loss (SSNHL) following indirect lightning exposure is rare, and evidence regarding the role of hyperbaric oxygen therapy (HBOT) remains limited. We report a case of severe bilateral SSNHL following indirect lightning exposure with substantial recovery after HBOT. Case report: A 26-year-old man developed sudden bilateral hearing loss after a lightning strike hit a lightning rod approximately 20 m from his location. He experienced transient syncope and limb weakness consistent with keraunoparalysis. Audiometry demonstrated severe bilateral sensorineural hearing loss, with pure-tone averages (PTA) of 70 dB HL in the right ear and 75 dB HL in the left ear. Because of persistent hearing loss despite systemic corticosteroid treatment, HBOT was initiated approximately 105 days after injury. A total of 30 HBOT sessions were administered together with intratympanic steroid injections. After 20 sessions, PTAs improved to 39 dB HL and 42 dB HL. Following completion of treatment, PTAs improved to 15 dB HL and 12 dB HL, with speech discrimination scores of 96% bilaterally. Conclusions: Severe bilateral SSNHL following indirect lightning exposure is rarely reported. Proposed mechanisms include cochlear injury, microvascular compromise, and oxidative damage to inner-ear structures. This case demonstrates that indirect lightning exposure may result in both keraunoparalysis and severe bilateral SSNHL. Substantial hearing recovery was observed despite initiation of HBOT more than three months after injury, suggesting a potential role for HBOT as part of a multidisciplinary treatment approach in selected cases.