Inner and middle ear hyperbaric oxygen-induced barotrauma

Area of Science:

• Otolaryngology
• Diving Medicine
• Hyperbaric Medicine

Background:

• Hyperbaric oxygen (HBO) therapy is crucial for treating various conditions.
• Inner and middle ear barotrauma are known complications of HBO therapy.
• Understanding the incidence and risk factors for HBO-related barotrauma is essential.

Purpose of the Study:

• To determine the incidence and significance of ear barotrauma in patients undergoing HBO therapy.
• To establish guidelines for prophylactic myringotomy or tympanostomy tube placement in at-risk patients.
• To evaluate the relationship between middle ear barotrauma and autoinflation ability.

Main Methods:

• Thirty patients undergoing HBO therapy were divided into two groups: those able to autoinflate their middle ear and those unable to.
• Barotrauma was assessed using otoscopy, tympanometry, high-frequency audiometry, and distortion product otoacoustic emission (DPOAE) testing.
• Audiological assessments were performed to evaluate hearing function and inner ear status.

Main Results:

• A significantly higher incidence of middle ear barotrauma was observed in patients unable to autoinflate (91%) compared to those who could (37%).
• Patients unable to autoinflate exhibited greater severity of barotrauma.
• Significant changes in DPOAEs were noted in both groups, but without a significant difference between them or correlation with conventional audiometry.

Conclusions:

• The ability to autoinflate the middle ear is a critical factor in preventing HBO-related barotrauma.
• Prophylactic pressure-equalizing tubes or myringotomies should be considered for patients with Eustachian tube dysfunction or artificial airways undergoing HBO therapy.
• While DPOAEs showed changes, their association with conventional hearing loss in HBO barotrauma requires further investigation.