[abstract] BAROTITIS MEDIA RESULTING FROM HYPERBARIC OXYGEN THERAPY. A RETROSPECTIVE STUDY OF 395 CONSECUTIVE CASES.

Abstract

Thirty-nine of 395 patients (9.8%) required otologic consultation and 32 of 395 patients (8.1.%) required myringotomies and insertion of tympanostomy tubes. The percent of otologic consultations ultimately requiring myringotomy and insertion of tyrnpanostomy tubes was 32 of 39 (82%). The average age in the otologic consultation group was 45.4 years. Of the 39 patients, 23 were nonthermal burn patients and 16 were thermal burn patients. Our department treated 81 thermal burn patients (20.5% of the total), 40 of these patients (49.3%) had head and neck involvement, and 15 of these burn patients required myringotomy and insertion of ventilating tubes (18.5% of the total thermal burn group). Eleven of the burn patients had head and neck involvement or 73% of this subset required myringotomy and insertion of ventilating tubes. Of the remaining 23 patients receiving otologic consultation, 6 of them had head and neck involvement. The 6 patients represent 26% of the 23 nonthermal burn patients receiving ventilating tubes. Of the remaining 17 patients, 11 required ventilating tube insertions and this subset did not have head and neck involvement; this represented 47.8% of the nonthermal burn group. This retrospective study demonstrated a lower than expected incidence of barotitis media as result of hyperbaric oxygen therapy. It also demonstrated that thermal burn injury, particularly when the head and neck was involved, put the patient at great risk of requiring ventilating tube insertion. It can be postulated in the thermal burn subgroup when the head and neck is involved, that the amount of edema that occurs is having a direct adverse on eustachian tube physiology with resultant barotitis media. The diagnostic categories that seem to be in the most risk for barotitis seems to be in the thermal burn cases particularly if there is head and neck involvement. There does not seem to be quite as much risk in the nonthermal burn subset of patients with head and neck involvement.