Prophylaxis against middle ear barotrauma in US hyperbaric oxygen therapy centers

The most common complication of hyperbaric oxygen (HBO) treatment is middle ear barotrauma, which can lead to permanent hearing loss and vertigo. Unconscious patients and infants present a special diagnostic challenge because of difficulties in communicating pain and equalizing pressure across the ears. This study involved a phone survey to all hospital-based HBO centers in the United States concerning routine practice for middle ear barotrauma prophylaxis. Results indicate that more than a fifth of centers always do routine prophylactic myringotomies on intubated patients (30 of 126) and infants (19 of 86). Less than half of centers never performed the procedure as routine prophylaxis. A third of centers (49 of 145) routinely administered prophylactic drugs before HBO treatment. Topical nasal decongestants, particularly oxymetazoline, were preferred to systemic oral medications (chi2 = 20.8, P<.001). These results show that there is great variance in clinical practice with regard to middle ear barotrauma prophylaxis among US HB0 centers. Many centers are using unproven therapies such as topical nasal decongestants.