Prevention of hyperbaric-associated middle ear barotrauma

Carlson, Scott A.; Jones, J. Stephen; Brown, Michael D.; Hess, C. L. Von

doi:10.1016/s0196-0644(05)80063-0

Cited by 28 publications

(15 citation statements)

References 4 publications

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“…patients unable to autoinflate owing to the presence of an endotracheal tube or anatomic alteration of the airway, (i.e., laryngectomized patients); and 2 . patients who began HBO therapy and had continued pain and/or hemotympanum even after receiving decongestants 9,10 . The benefit of medical therapy in patients with artificial airways undergoing HBO therapy has not been studied, but given the primary problem of an inability to propel airflow toward the eustachian tubes, it would seem unlikely that simply decongesting these patients would offer significant benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these authors emphasized inherent inaccuracies with methods of evaluation of eustachian tube function. In evaluating preventive measures, Carlson et al 9 found that topical decongestants did not alter subjective or objective barotrauma during HBO therapy. However, predive oral pseudoephedrine more reliably decreased the incidence and severity of barotitis media 10 …”

Section: Introductionmentioning

confidence: 99%

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Inner and Middle Ear Hyperbaric Oxygen‐Induced Barotrauma

1997

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Patients receiving hyperbaric oxygen (HBO) therapy can sustain inner and middle ear barotrauma. The purpose of this study is to define the incidence and significance of HBO-related barotrauma, in addition to establishing guidelines for prophylactic myringotomy or tympanostomy tube placement. Thirty patients were stratified into two groups (those able to autoinflate and those unable to autoinflate the middle ear) and barotrauma was assessed by otoscopy, tympanometry, high-frequency audiometry, and distortion product otoacoustic emission (DPOAE) testing. Ten of 11 patients (91%) from the noninflater group suffered middle ear barotrauma, and seven of 19 patients (37%) from the autoinflater group sustained middle ear barotrauma. Patients unable to autoinflate the middle ear were shown to have a higher incidence and greater severity of barotrauma than patients able to autoinflate. Pretreatment pressure-equalizing tubes or myringotomies should be considered for patients undergoing HBO therapy who have an artificial airway or have eustachian tube dysfunction and have failed conservative medical intervention. A significant change in DPOAEs (loss of emissions over a 1-kHz range) was found in four of 15 autoinflaters (27%) and two of seven noninflaters (29%). There was no significant difference between the groups. The decrease in DPOAEs was not associated with a change in conventional audiometry.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inner and Middle Ear Hyperbaric Oxygen‐Induced Barotrauma

1997

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“…5 Middle ear barotrauma is the most common adverse effect of HBO. 6 As the ambient pressure within the chamber is increased to 2 atmospheres, a patient must be able to equalize the pressure within the middle ear by autoinsufflation. If a significant pressure gradient is allowed to develop, severe otalgia may occur, followed by hemorrhage or serous effusion.…”

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confidence: 99%

Complications of Tympanostomy Tubes Inserted for Facilitation of Hyperbaric Oxygen Therapy

Clements

Vrabec²,

Mader³

1998

Arch Otolaryngol Head Neck Surg

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“…Thus, not surprisingly a slower compression will allow time for patients to perform the active maneuvers and reduce the rate of MEB as demonstrated by Vahidova, et al [3]. As the pressure gradient increases, these active maneuvers become increasingly difficult to perform [4,5]. In a linear compression, a patient may be too slow in performing these active maneuvers, and MEB may have occurred before any intervention such as interrupting the compression.…”

Section: Discussionmentioning

confidence: 99%

Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

Ng¹,

Müller²,

Orton³

2017

UHM

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Context: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB.Objective: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols.Design: Double-blinded, randomized controlled trial. Setting: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014.Patients: 100 participants undergoing their first hyperbaric oxygen therapy session.Intervention: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre-and post-treatment and then graded. Middle ear _____________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________ KEYWORDS: ear barotrauma; hyperbaric oxygen therapy; middle ear; side effects barotrauma was defined as an increase of at least one grade on a modified TEED scale.Results: The observed MEB incidence under the staged protocol was 48% compared to 62% using the linear protocol (P=0.12, exact one-sided binomial test), and thus the staged protocol did not show a significant improvement in MEB. However, the staged protocol resulted in significantly less severe deteriorations in MEB grades when compared to the linear protocol (P=0.028, exact one-sided Mann-Whitney type test).Conclusion: The use of the assessed staged compression protocol for the first hyperbaric oxygen treatment showed no significant effect on the overall incidence of MEB when compared to the gold standard linear protocol but resulted in a significant improvement in the severity of the experienced MEBs. Further studies are needed to elucidate an optimal compression protocol to minimize middle ear barotrauma. INTRODUCTIONMiddle ear barotrauma (MEB) remains a common complication of hyperbaric oxygen (HBO 2 ) therapy, with the incidence ranging from 8%-68.7% [1,2]. Currently, three concurrent practices are used to reduce the incidence of MEB: i) assessment to identify patient at risk of MEB; ii) teaching patients correct ear equalization techniques; iii) slow chamber compression. Vahidova et al demonstrated that the use of a slow compression technique (1.1 meters/minute vs. 2.8 meters/

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Prevention of hyperbaric-associated middle ear barotrauma

Cited by 28 publications

References 4 publications

Inner and Middle Ear Hyperbaric Oxygen‐Induced Barotrauma

Inner and Middle Ear Hyperbaric Oxygen‐Induced Barotrauma

Complications of Tympanostomy Tubes Inserted for Facilitation of Hyperbaric Oxygen Therapy

Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

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