Download PDF
Int Arch Otorhinolaryngol 2014; 18(02): 204-209
DOI: 10.1055/s-0034-1366974
Update Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Update on Middle Ear Barotrauma after Hyperbaric Oxygen Therapy—Insights on Pathophysiology

Marco Antônio Rios Lima
1   Health Science School, Universidade de Brasília, Brasilia, Distrito Federal, Brazil
,
Luciano Farage
1   Health Science School, Universidade de Brasília, Brasilia, Distrito Federal, Brazil
,
Maria Cristina Lancia Cury
2   Department of Hyperbaric Medicine, Armed Force Hospital, Brasilia, Distrito Federal, Brazil
,
Fayez Bahamad Júnior
1   Health Science School, Universidade de Brasília, Brasilia, Distrito Federal, Brazil
› Author Affiliations
Further Information

Publication History

27 August 2013

02 December 2013

Publication Date:
10 February 2014 (online)

   Permissions and Reprints

Abstract

Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention.

Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear.

Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma.

Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation.

 

  • References

  • 1 Carlson S, Jones J, Brown M, Hess C. Prevention of hyperbaric-associated middle ear barotrauma. Ann Emerg Med 1992; 21 (12) 1468-1471
    CrossrefGoogle Scholar
  • 2 Sadé J, Ar A. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck Surg 1997; 116 (4) 499-524
    CrossrefGoogle Scholar
  • 3 Karahatay S, Yilmaz YF, Birkent H, Ay H, Satar B. Middle ear barotrauma with hyperbaric oxygen therapy: incidence and the predictive value of the nine-step inflation/deflation test and otoscopy. Ear Nose Throat J 2008; 87 (12) 684-688
    Google Scholar
  • 4 Vahidova D, Sen P, Papesch M, Zein-Sanchez MP, Mueller PH. Does the slow compression technique of hyperbaric oxygen therapy decrease the incidence of middle-ear barotrauma?. J Laryngol Otol 2006; 120 (6) 446-449
    Google Scholar
  • 5 Ars B, Dirckx J, Ars-Piret N, Buytaert J. Insights in the physiology of the human mastoid: message to the surgeon int. J Int Adv Otol 2012; 8 (2) 296-310
    Google Scholar
  • 6 Neuman TS, Thoom SR. Physiology and Medicine of Hyperbaric Oxygen Therapy. Philadelphia, PA: Elsevier; 2008
    CrossrefGoogle Scholar
  • 7 Sadé J. On the function of the pars flaccida: retraction of the pars flaccida and buffering of negative middle ear pressure. Acta Otolaryngol 1997; 117 (2) 289-292
    CrossrefGoogle Scholar
  • 8 Magnuson B. Functions of the mastoid cell system: auto-regulation of temperature and gas pressure. J Laryngol Otol 2003; 117 (2) 99-103
    Google Scholar
  • 9 Csakanyi Z, Katona G, Josvai E, Mohos F, Sziklai I. Volume and surface of the mastoid cell system in otitis media with effusion in children: a case-control study by three-dimensional reconstruction of computed tomographic images. Otol Neurotol 2011; 32 (1) 64-70
    CrossrefGoogle Scholar
  • 10 Sadé J. The buffering effect of middle ear negative pressure by retraction of the pars tensa. Am J Otol 2000; 21 (1) 20-23
    CrossrefGoogle Scholar
  • 11 Yokobori Jr AT, Yoshinari H, Kowata I. Mechanical test methods of biomedical membranes such as used for otolaryngology. Biomed Mater Eng 1991; 1 (2) 137-142
    Google Scholar
  • 12 Hidir Y, Ulus S, Karahatay S, Satar B. A comparative study on efficiency of middle ear pressure equalization techniques in healthy volunteers. Auris Nasus Larynx 2011; 38 (4) 450-455
    CrossrefGoogle Scholar
  • 13 Miyazawa T, Ueda H, Yanagita N. Eustachian tube function and middle ear barotrauma associated with extremes in atmospheric pressure. Ann Otol Rhinol Laryngol 1996; 105 (11) 887-892
    Google Scholar
  • 14 Kumazawa T, Iwano T, Ushiro K, Kinoshita T, Hamada E, Kaneko A. Eustachian tube function tests and their diagnostic potential in normal and diseased ears. Acta Otolaryngol Suppl 1993; 500: 10-13
    Google Scholar
  • 15 Lacey JP, Amedee RG. The otologic manifestations of barotrauma. J La State Med Soc 2000; 152 (3) 107-111
    Google Scholar
  • 16 García ML, Guinart DG, Castellanos RG. Barotraumatismos de Oído y otros trastornos otológicos relacionados com el buceo. Revista Virtual de Medicina Hiperbárica. January 2004. Available at: www.cccmh.com/REVISTA-OHB/Revista-OHB.htm . Accessed in Aug 8, 2013
    Google Scholar
  • 17 Doyle WJ. The mastoid as a functional rate-limiter of middle ear pressure change. Int J Pediatr Otorhinolaryngol 2007; 71 (3) 393-402
    CrossrefGoogle Scholar
  • 18 Gaihede M, Dirckx JJJ, Jacobsen H, Aernouts J, Søvsø M, Tveterås K. Middle ear pressure regulation—complementary active actions of the mastoid and the eustachian tube. Otol Neurotol 2010; 31 (4) 603-611
    Google Scholar
  • 19 Alper CM, Kitsko DJ, Swarts JD , et al. Role of the mastoid in middle ear pressure regulation. Laryngoscope 2011; 121 (2) 404-408
    CrossrefGoogle Scholar
  • 20 Cinamon U, Sadé J. Mastoid and tympanic membrane as pressure buffers: a quantitative study in a middle ear cleft model. Otol Neurotol 2003; 24 (6) 839-842
    CrossrefGoogle Scholar
  • 21 Alicandri-Ciufelli M, Gioacchini FM, Marchioni D, Genovese E, Monzani D, Presutti L. Mastoid: a vestigial function in humans?. Med Hypotheses 2012; 78 (3) 364-366
    CrossrefGoogle Scholar
  • 22 Doyle WJ. Experimental results do not support a gas reserve function for the mastoid. Int J Pediatr Otorhinolaryngol 2000; 52 (3) 229-238
    CrossrefGoogle Scholar
  • 23 Swarts JD, Cullen Doyle BM, Alper CM, Doyle WJ. Surface area-volume relationships for the mastoid air cell system and tympanum in adult humans: implications for mastoid function. Acta Otolaryngol 2010; 130 (11) 1230-1236
    CrossrefGoogle Scholar
  • 24 Koç A, Ekinci G, Bilgili AM, Akpinar IN, Yakut H, Han T. Evaluation of the mastoid air cell system by high resolution computed tomography: three-dimensional multiplanar volume rendering technique. J Laryngol Otol 2003; 117 (8) 595-598
    Google Scholar
  • 25 Pau HW, Sievert U, Just T, Sadé J. Pressure changes in the human middle ear without opening the eustachian tube. Acta Otolaryngol 2009; 129 (11) 1182-1186
    CrossrefGoogle Scholar
  • 26 Ars B, Wuyts F, Van de Heyning P, Miled I, Bogers J, Van Marck E. Histomorphometric study of the normal middle ear mucosa. Preliminary results supporting the gas-exchange function in the postero-superior part of the middle ear cleft. Acta Otolaryngol 1997; 117 (5) 704-707
    CrossrefGoogle Scholar
  • 27 Kanemaru S, Umeda H, Yamashita M , et al. Improvement of eustachian tube function by tissue-engineered regeneration of mastoid air cells. Laryngoscope 2013; 123 (2) 472-476
    CrossrefGoogle Scholar
  • 28 Flint PW, Haughey BH, Lund VJ , et al. Cummings Otolaryngology Head and Neck Surgery. 5th ed. Philadelphia, PA: Elsevier; 2010
    CrossrefGoogle Scholar
  • 29 Beuerlein M, Nelson RN, Welling DB. Inner and middle ear hyperbaric oxygen-induced barotrauma. Laryngoscope 1997; 107 (10) 1350-1356
    CrossrefGoogle Scholar
  • 30 Shupak A, Sharoni Z, Ostfeld E, Doweck I. Pressure chamber tympanometry in diving candidates. Ann Otol Rhinol Laryngol 1991; 100 (8) 658-660
    Google Scholar
  • 31 Shupak A, Attias J, Aviv J, Melamed Y. Oxygen diving-induced middle ear under-aeration. Acta Otolaryngol 1995; 115 (3) 422-426
    CrossrefGoogle Scholar
  • 32 Shupak A, Tabari R, Swarts JD, Bluestone CD, Doyle WJ. Effects of middle ear oxygen and carbon dioxide tensions on eustachian tube ventilatory function. Laryngoscope 1996; 106 (2 Pt 1) 221-224
    CrossrefGoogle Scholar
  • 33 Shupak A, Tabari R, Swarts JD, Bluestone CD, Doyle WJ. Effects of systemic hyperoxia on eustachian tube ventilatory function. Laryngoscope 1997; 107 (10) 1409-1413
    CrossrefGoogle Scholar
  • 34 Buckingham RA, Stuart DR, Geick MR, Girgis SJ, McGee TJ. Experimental evidence against middle ear oxygen absorption. Laryngoscope 1985; 95 (4) 437-442
    Google Scholar
  • 35 Eden AR, Gannon PJ. Neural control of middle ear aeration. Arch Otolaryngol Head Neck Surg 1987; 113 (2) 133-137
    CrossrefGoogle Scholar
  • 36 Blanshard J, Toma A, Bryson P, Williamson P. Middle ear barotrauma in patients undergoing hyperbaric oxygen therapy. Clin Otolaryngol Allied Sci 1996; 21 (5) 400-403
    CrossrefGoogle Scholar
  • 37 Uzun C, Adali MK, Tas A, Koten M, Karasalihoglu AR, Devren M. Use of the nine-step inflation/deflation test as a predictor of middle ear barotrauma in sports scuba divers. Br J Audiol 2000; 34 (3) 153-163
    CrossrefGoogle Scholar
  • 38 Matos A. Middle Ear Barotrauma in Divers [doctoral thesis]. Rio de Janeiro, Brazil: Brazilian Academy of Military Medicine; 1975
    Google Scholar
  • 39 Ornhagen HC, Tallberg P. Pressure equilibration of the middle ear during ascent. Undersea Biomed Res 1981; 8 (4) 219-227
    Google Scholar
  • 40 Landolfi A, Autore A, Torchia F, Ciniglio Appiani M, Morgagni F, Ciniglio Appiani G. Ear pain after breathing oxygen at altitude: prevalence and prevention of delayed barotrauma. Aviat Space Environ Med 2010; 81 (2) 130-132
    CrossrefGoogle Scholar