INNER AND MIDDLE-EAR HYPERBARIC OXYGEN-INDUCED BAROTRAUMA

Patients receiving hyperbaric oxygen (HBO) therapy can sustain inner a nd middle ear barotrauma. The purpose of this study is to define the i ncidence and significance of HBO-related barotrauma, in addition to es tablishing guidelines for prophylactic myringotomy or tympanostomy tub e placement. Thirty patients were stratified into two groups (those ab le to autoinflate and those unable to autoinflate the middle ear) and barotrauma was assessed by otoscopy, tympanometry, high-frequency audi ometry, and distortion product otoacoustic emission (DPOAE) testing, T en of 11 patients (91%) from the noninflater group suffered middle ear barotrauma, and seven of 19 patients (37%) from the autoinflater grou p sustained middle ear barotrauma. Patients unable to autoinflate the middle eap 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 u ndergoing 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) w as found in four of 15 autoinflaters (27%) and two of seven noninflate rs (29%). There was no significant difference between the groups. The decrease in DPOAEs was not associated with a change in conventional au diometry.