PROPHYLAXIS AGAINST MIDDLE-EAR BAROTRAUMA IN US HYPERBARIC-OXYGEN THERAPY CENTERS

The most common complication of hyperbaric oxygen (HBO) treatment is m iddle ear barotrauma, which can lead to permanent hearing loss and ver tigo, Unconscious patients and infants present a special diagnostic ch allenge because of difficulties in communicating pain and equalizing p ressure across the ears, This study involved a phone survey to all hos pital based HBO centers in the United States concerning routine practi ce for middle ear barotrauma prophylaxis. Results indicate that more t han 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 th ird of centers (49 of 145) routinely administered prophylactic drugs b efore HBO treatment, Topical nasal decongestants, particularly oxy met azoline, were preferred to systemic oral medications (chi(2) = 20.8, P < .001). These results show that there is great variance in clinical practice with regard to middle ear barotrauma prophylaxis among US HBO centers, Many centers are using unproven therapies such as topical na sal decongestants. Copyright (C) 1996 by W.B. Saunders Company