A novel technique of otic barotrauma management using modified intravenous cannulae

Abstract

This article provides the first detailed description and systematic evaluation of the management of otic barotrauma using modified intravenous cannulae. A 24-gauge IC cannula was modified as a tool for tympanostomy tube placement and middle ear ventilation. The medical records of 271 ears of 156 adult patients (median age 49 years) who underwent this procedure were reviewed retrospectively. Hundred and ninty-one tubes were placed for otalgia because of hyperbaric oxygen therapy, 58 tubes were inserted for air travel prophylaxis and 22 tubes were placed for management of otic barotrauma post-flight. All the patients who had this procedure for prophylaxis experienced regular otic barotrauma symptoms during air travel prior to tube placement. All patients were reviewed 6 weeks (range 2-9 weeks) post-procedure. This technique of otic barotrauma management worked effectively in 99 % of treated patients. On follow-up, 88 % of tubes were found to be extruded and non-extruded tubes were removed in clinic without any anaesthesia. 99.6 % of tympanic membrane had healed completely and spontaneously without sequelae. Given the safety, effectiveness, low risk of complications associated with this novel tympanostomy technique, it provided a simple yet effective therapeutic option for the management of otic barotrauma. Finally, this technique can be easily applied in all health settings as it only requires medical supplies readily available in hospitals, therefore there is no additional cost.

Middle Ear Barotraumas in Commercial Aircrew

“…As the means currently in use for prediction, such as tympanometry, tubomanometry 11 , the 9-step inflation/deflation test 10,29 and others 19,21,27 aren't applicable for everyday use in aircrew, better options to assess one's ET function before flying are needed. Moreover, preventive measures have been found either ineffective (e.g., pressure-regulating earplugs 12,15 and external ear canal moisturization 22 ) or effective 4,26,32 but unsuitable for routine use in aviation staff (e.g., nasal balloon inflation 30 or modified tympanostomy tubes 33 ), leaving the community with no tools to fight the problem. It is our suggestion that the Valsalva and/or Toynbee maneuvers might be used both in predicting the problems and, with appropriate training, preventing them as well.…”

Barotrauma inducido por vuelo en otorrinolaringología: Una revisión de la literatura

“…En un estudio piloto más reciente (n = 156) se propuso evaluar la eficacia preventiva y terapéutica de un catéter calibre 24G modifi-cado como herramienta de timpanostomía y ventilación del oído medio para el barotrauma ótico por vuelo. La terapia fue efectiva en un 99% de los casos, el 88% de los tubos fue expulsado de forma espontánea y un 99,6% de las membranas timpánicas cicatrizaron, completamente, en un tiempo promedio de 6 semanas 34 . Aunque aún faltan estudios para recomendar el uso rutinario de esta técnica, factores como la seguridad y eficacia, el menor riesgo de complicaciones en comparación con la timpanostomía convencional [35][36][37] y el hecho de ser un procedimiento ambulatorio sencillo que requiere insumos usualmente asequibles, la convierten en una opción viable, especialmente, en casos recurrentes leves a moderados.…”

Ventilation tubes and indications

“…Tek sefer uçak yolculuğunda erişkinlerin % 20'sinde, çocukların % 55'inde otik barotravma görülebilir. Hiperbarik oksijen tedavisinde ise bu oran % 90'lar seviyesindedir (39). Orta kulak barotravması, hiperbarik oksijen tedavisinin en sık görülen yan etkisidir.…”

“…Hiperbarik oksijen tedavisi sonrası VT takılan hastalarda komplikasyonların daha çok görüldüğü ve diabetes mellitusun komplikasyonlar için predispozan faktör olduğunu bildirilmiştir (40). Hiperbarik oksijen tedavisinin VT'nün timpanik membranda kalma süresinden daha önce bitmesinden dolayı, hem VT tatbikinden daha kısa süreli etkili bir yöntem bulmak hem de otore gibi komplikasyonları azaltmak amacıyla; termal yöntemle miringotomi ve intravenöz kanülün modifiye edilerek kısa süreli tatbiki gibi yön-temler uygulayan yazarlar mevcuttur (39,43).…”