MRI Findings of Otic and Sinus Barotrauma in Patients with Carbon Monoxide Poisoning during Hyperbaric Oxygen Therapy

Abstract

Background and PurposeTo study the MRI findings of otic and sinus barotrauma in patients with carbon monoxide(CO) poisoning during hyperbaric oxygen (HBO) therapy and examine the discrepancies of otic and sinus abnormalities on MRI between barotrauma and acute otitis media with effusion.Materials and MethodsEighty patients with CO-poisoning diagnosed with otic and sinus barotrauma after HBO therapy were recruited. Brain MRI was performed to predict delayed encephalopathy. Over the same period, 88 patients with acute otitis media with effusion on MRI served as control. The abnormalities of the middle ear and paranasal sinuses on MRI were noted and were compared between groups. Nine patients with barotrauma were followed up by MRI.ResultsIn the barotrauma group, 92.5% of patients had bilateral middle ear abnormalities on MRI, and 60% of patients had both middle ear cavity and mastoid cavity abnormalities on MRI in both ears. Both rates were higher than those in the control group (p = 0.000). In the two groups, most abnormalities on MRI were observed in the mastoid cavity. The rate of sinus abnormalities of barotrauma was 66.3%, which was higher than the 50% in the control group (p = 0.033). In the nine patients with barotrauma followed up by MRI, the otic barotrauma and sinus abnormalities had worsened in 2 patients and 5 patients, respectively.ConclusionMRI is able to depict the abnormalities of otic and sinus barotrauma in patients with CO-poisoning during HBO therapy and to differentiate these from acute otitis media with effusion.

Outcome of Patients with Carbon Monoxide Poisoning at a Far-East Poison Center

“…There were many limitations regarding the findings of this study due to it being retrospective in nature, small sample size, lack of standard indications for hyperbaric oxygen therapy, lack of magnetic resonance neuroimaging studies [ 26 , 27 ], lack of plasma inflammatory biomarkers analysis [ 28 ], and short follow-up duration. For example, Hox et al [ 29 ] revealed that diffusion tensor imaging was a valuable tool for assessing the severity of brain injury and a predictor of outcome in patients with delayed encephalopathy after CO poisoning.…”