Incidence Of Middle Ear Barotrauma Research Articles

Middle Ear Barotrauma in Military Aircrew: Analysis of Risk Factors

Introduction: Middle ear barotrauma is a common medical problem related to aviation; because the aviation environment exposes the aviator to a rapidly changing ambient pressure. Middle ear barotrauma occurs when the Eustachian tube failed to equalize middle ear pressure with ambient pressure during flight. Objective: To determine the prevalence of middle ear barotraumas among aircrew on Bangladesh Air Force (BAF) and to find the risk factors of middle ear barotrauma. Materials and Methods: This cross-sectional study was carried out on middle ear barotrauma in aircrew of BAF from February 2018 to January 2019. Aircrew who experienced fullness in the ear or ear pain during flight and visited the flight surgeon was enrolled in this study. Modified TEED scale used for grading of middle ear barotrauma. Results: The study revealed middle ear barotrauma in the aircrew was 12.0% with a higher prevalence among the student pilots (14.2%) compared with trained pilots (5.9%), the mean age of aircrew was 23.2 ± 3.6 years. The right ear (43.5%) was affected in most of the cases than the left ear (34.8%). Most of the symptoms developed at a stage of descending (60.9%). The duration (mean± SD) of sickness was 7.6±3.7 days. Conclusion: Middle ear barotrauma or ear block is common in trainee aircrew but it is also seen in the experienced pilots who fly with upper respiratory tract infection (URTI) or a common cold. Appropriate training on ear physiology related to pressure changes inside the hypobaric altitude chamber can prevent the incidence of middle ear barotrauma. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 14-17

Effect of antiplatelet and/or anticoagulation medication on the risk of tympanic barotrauma in hyperbaric oxygen treatment patients, and development of a predictive model.

Middle ear barotrauma (MEBt) is a common side effect of hyperbaric oxygen treatment (HBOT) and can result in pain, hearing loss, tinnitus and otorrhagia. The use of antiplatelet/anticoagulant drugs is thought to increase the risk and severity of MEBt during HBOT. Single centre, retrospective observational cohort study of all patients treated with HBOT over a 4-year period (between 01 January 2015 to 31 December 2018) looking at the incidence of MEBt and the concurrent use of antiplatelet and/or anticoagulant drugs. MEBt was assessed by direct otoscopy of the tympanic membrane post-HBOT and scored using the modified Teed classification. Multivariate modelling assessed the relationship between antiplatelet and/or anticoagulation drug use, age, sex, and MEBt during HBOT. There was no evidence that antiplatelet and/or anticoagulation drugs increase the risk of tympanic barotrauma in HBOT patients. The prevalence of MEBt was higher in female patients than in males (χ2 P = 0.004), and increased with age (χ2 P = 0.048). No MEBt was recorded in patients undergoing recompression therapy for decompression sickness or cerebral arterial gas embolism. In this retrospective single-centre study, antiplatelet and/or anticoagulation drugs did not affect the risk of MEBt, but both age and sex did, with greater prevalence of MEBt among older patients and females compared with younger patients and males. A predictive model, requiring further validation, may be helpful in assessing the likelihood of MEBt in patients undergoing HBOT.

HUBUNGAN FREKUENSI PENYELAMAN, LAMA MENYELAM, PILEK, DAN MEROKOK, TERHADAP KEJADIAN BAROTRAUMA TELINGA TENGAH PENYELAM TRADISIONAL

Inability to equate middle ear space pressure with the surrounding environment can cause tissue damage or barotrauma. Factors influencing the incidence of middle ear barotrauma in traditional divers are colds, smoking, frequency of diving and length of diving. The purpose of explaining the factors related to the occurrence of barotrauma in the middle ear of traditional breath-resistant divers. The analytic observational research design with cross sectional approach is supported by in-depth interviews, by conducting interviews using questionnaires and otoscopy examinations of respondents to determine the events of middle ear barotrauma. The study population was traditional divers, totaling 78 respondents. The dependent variable is the occurrence of barotrauma in the middle ear of traditional divers, the independent variable with colds, smoking habits, frequency of diving and length of diving, data analysis using bivariate and multivariate. Results as many as 32 people (41.0%) of 78 respondents experienced middle ear barotrauma. Bivariate analysis showed a correlation between the frequency of diving with the events of the middle ear barotrauama p = 0.012. Logistic regression test showed the significance value of the frequency of diving ≥ 4 days / week (p = 0.0106; PR = 5.310; 95% CI = 1.619-17.413). Conclusion of factors related to the incidence of middle ear barotrauma in traditional divers is the frequency of diving hari 4 days / week, with a probability of 38.13%.

Tympanometric evaluation of Eustachian tube function in Polish scuba divers

Scuba divers are subjected to relatively high ambient pressures while descending. Equalizing maneuvers (e.g., Valsalva) are necessary to open the Eustachian tube (ET) and allow air into the middle ear (ME) cavity. Insufficient opening of the ET leads to ME barotrauma, which is the most common injury related to scuba diving. The study aims were to assess the incidence of ME barotrauma and to compare tympanometric parameters and stapedial reflexes in scuba divers and non-diving individuals. 60 scuba divers participated in the study; control consisted of 90 non-diving volunteers without a history of otolaryngologic problems. All participants were examined with the use of otoscopy and tympanometry with evaluation of ipsilateral stapedial reflexes. The group studied was surveyed regarding occurrence of ME barotrauma and diving competence. 51.7% of the divers experienced ME barotrauma, the most common symptoms being earache and hearing loss. Comparison of the group studied and control revealed significantly lower ME pressure and compliance in scuba divers. In scuba divers with ME barotrauma, longer time from injury correlates directly with greater ME pressure and compliance, indicating tissue recovery. At 4,000Hz 100dB percentage of present stapedial reflexes among scuba divers was significantly lower than in controls; moreover, a greater number of dives correlated inversely with percentage of present stapedial reflexes at 4000Hz 100dB. The reduced thresholds at high intensities suggest a negative effect of scuba diving on hearing. ME pressure and compliance, however still within the norm, are significantly lower in scuba divers than in non-diving healthy volunteers. This may be attributed to a subclinical form of barotrauma.

Analysis of factors related to failure in the pressure test: a six-year experience in Taiwan

The Republic of China Navy instituted the pressure test as one of the selection tools for diving troops and submarine crews. We analyzed factors associated with failure in the pressure test. This was a retrospective cohort study designed to investigate pressure test failure in Navy recruits between January 2010 and August 2015. The recruits received pressurization in a hyperbaric chamber to a simulated depth of 112 feet of seawater (fsw) at a rate of 25 fsw/minute. Data describing trainee demographics, disease history, causes and depth of failure, as well as type of injury, were extracted from case notes and facility databases for statistical analysis. Of 3,608 trial cohorts, there were 435 failures, with an overall failure rate of 12.06%. About 95% of these failure trials were within a simulated depth of 60 fsw. Fifty-seven (57) failures did not record causes of failure. Among the other 378 failures, the most commonly identified causes were ear barotrauma (365 trials, 96.56%) and sinus barotrauma (10 trials, 2.65%). Statistical analysis revealed that recent upper respiratory tract infection, allergic rhinitis, and cigarette smoking were all significantly associated with higher incidence of middle ear barotrauma. Our results suggest that pressure testing to a depth of 60 fsw is effective in disqualifying personnel entering diving and submarine service. Recent infection of the upper respiratory tract, allergic rhinitis and cigarette smoking are risk factors for middle ear barotrauma, resulting in failure of the pressure test.

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

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. To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols. Double-blinded, randomized controlled trial. Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014. 100 participants undergoing their first hyperbaric oxygen therapy session. 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 barotrauma was defined as an increase of at least one grade on a modified TEED scale. 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). 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.

Study of " Health Education Atlas" reducing hyperbaric oxygen therapy induced middle ear barotrauma

Objective To investigate the incidence of middle ear barotrauma due to hybaric oxygen therapy by using Health Education Atlas . Methods 100 patients were divided into two groups by random number table.The research group(49 patients) was educated by Health Education Atlas. The control group(51 patients) was educated by traditional education approach.During the first three days, we observed and recorded the eardrum injury and asked patients ear discomfort everyday. Results The incidence rate of middle ear barotrauma of the research group was 6.1%, which of the control group was 19.6%.The eardrum injury of the research group was milder than the control group(χ2=4.02, P<0.05). Conclusion Education using Health Education Atlas can reduce the incidence of middle ear barotrauma due to hybaric oxygen therapy. Key words: Barotrauma; Ear, middle; Hyperbaric oxygenation; Health education

169 Do Higher Rates of Compression Result in Higher Rates of Middle Ear Barotrauma in Patients Undergoing Hyperbaric Oxygen Therapy?

Study Objectives: Undersea and Hyperbaric Medicine is a sub-specialty of emergency medicine and involves oversight of hyperbaric oxygen therapy. Middle ear barotrauma is the most common complication of hyperbaric oxygen therapy. The incidence of reported middle ear barotrauma has varied dramatically between treatment centers from 15%-65%, and previous studies suggested that slower rates of compression might decrease the incidence of middle ear barotrauma. Various rates of compression are used in treatment centers nationwide.

Middle Ear Barotrauma with Hyperbaric Oxygen Therapy: Incidence and the Predictive Value of the Nine-step Inflation/Deflation Test and Otoscopy

We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearing loss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.

Middle ear barotrauma in scuba divers

Middle ear barotrauma is the most common health hazard of scuba diving. To investigate the overall incidence of middle ear barotrauma, a prospective incidence study of 51 novice divers and 46 experienced divers was conducted. Otoscopy was performed on the divers before and immediately following a single dive. The overall incidence of mild barotrauma was 40%, and the incidence of severe barotrauma was 27%. No tympanic membrane perforations were found. The most common presenting symptoms were difficulty clearing ears during descent, ear pressure, and ear pain. Barotrauma was not associated with diver age, sex, experience, otolaryngologic history, or medications. Barotrauma was associated with poor underwater visibility, difficulty clearing ears during ascent, and hearing loss after surfacing.

Efficacy of Pseudoephedrine for the Prevention of Barotrauma During Air Travel

Study objective: To determine the efficacy of decongestant prophylaxis in the prevention of symptoms of middle ear barotrauma (aerotitis media) during air travel. Design: Prospective, parallel, double-blind, randomized trial. Setting: Two commercial airports in Michigan. Type of participants: Two hundred fifty volunteers with a history of recurrent ear discomfort during air travel. Interventions: Following randomization, each subject received 120 mg pseudoephedrine or placebo 30 minutes before flight departure. Recorded data included subject demographics, history of ear discomfort, and otologic examination. After arrival at their final destinations, volunteers were asked to complete a questionnaire and return it by mail to the investigators. Questions included the intensity and duration of otologic symptoms experienced while flying and possible drug side effects. Measurements and main results: One hundred ninety subjects completed the study; 96 received 120 mg of pseudoephedrine and 94 received a placebo. The two treatment groups were similar with regard to age, sex, weight, and flight profile ( P > .1). Ear discomfort was present in 32% (31 of 96) of those receiving pseudoephedrine versus 62% (58 of 94) of the control group (χ 2 = 15.34; P = .0001). Adverse effects were minimal; seven patients experienced drowsiness. Conclusion: Our results suggest that use of an oral decongestant before flying decreases the incidence of middle ear barotrauma associated with ambient pressure changes during air travel. [Csortan E, Jones J, Haan M, Brown M: Efficacy of pseudoephedrine for the prevention of barotrauma during air travel. Ann Emerg Med June 1994;23:1324-1327.]

Middle Ear Barotrauma Associated with Hyperbaric Oxygenation Treatment

We investigated the signs and symptoms of middle ear barotrauma in 67 patients with hyperbaric oxygenation treatment as well as the influence of predisposing factors. Ear damage was classified into 5 grades on the basis of objective findings at otoscopic examination. The incidence of middle ear barotrauma assessed by objective criteria was 68.7%, and showed little variation with age or primary disease. On the other hand, the incidence assessed by subjective symptoms was lower than the objectively-based incidence in aged patients, those with severe neurological diseases, and those who had difficulties speaking. Patients with a trauma grade of 2 or more complained of severe symptoms and were appropriate candidates for treatment. It is considered that otoscopic examination should be performed in patients who undergo hyperbaric oxygenation treatment and that prior management of nasal and paranasal diseases is beneficial in the prevention and treatment of middle ear barotrauma.

高圧酸素治療による中耳圧力損傷

Middle ear barotrauma is a major side effect of hyperbaric oxygenation therapy (OHP) which may develop such clinical symptoms as otalgia and ear fullness.The purpose of this study is to observe patients with side effects during OHP and examine the factors predisposing to middle ear barotrauma.OHP was used in 94 patients (64 males and 30 females) at Shakaihoken Takaoka Hospital. Their subjective symptoms were correlated with sex, age, primary diseases and the incidence of middle ear barotrauma.In 12 patients with middle ear barotrauma, the incidence of eustachian tube stenosis, and of nasal and paranasal diseases were determined. Eustachian tube stenosis was evaluated by the measurement of opening pressure by catheter inflation. Nasal and paranasal diseases were evaluated by anterior rhinoscopy and plain X-rays.1. The incidence of middle ear barotrauma was 37.2%, higher in males (45.3%) than in females (20.0%).2. Aged patients and those with severe disease had a low incidence of middle ear barotrauma, but some of them might not have mentioned symptoms.3. In patients with middle ear barotrauma, a high incidence of nasal and paranasal diseases and a low incidence of eustachian tube stenosis were observed.These results suggest that otorhinolaryngological examinations should be performed in all patients treated with OHP. Treatment of nasal and paranasal diseases is important to prevent middle ear barotrauma.