Varughese L, O'Neill O J, Marker J, Smykowski E, Dayya D
Phelps Hospital, Department of Family Medicine, Sleepy Hollow, New York U.S.
Phelps Hospital, Department of Undersea and Hyperbaric Medicine, Sleepy Hollow, New York U.S.
Undersea Hyperb Med. 2019;46(2):95-100.
Symptomatic Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common reported complications during hyperbaric oxygen (HBO2) treatment. There is no standardized rate of compression (ROC) reported to decrease the incidence rates of ETD and MEB during hyperbaric treatments. Few studies actually demonstrate that the ROC decreases the incidence of ETD or MEB.
Our study was designed to determine an optimal hyperbaric chamber compression rate that might reduce the incidence of symptomatic ETD leading to MEB during the compression phase of treatment in a multiplace hyperbaric chamber. Data was collected prospectively over 2,807 elective patient treatments compressed using a U.S. Navy Treatment Table 9 (USN TT9) with a modified ROC. ROC was assigned using two variables, time (10 vs.15 minutes) and slope (linear vs. non-linear compression). Patients were exposed to all four compression schedules in a consecutive daily fashion. We recorded any patient requiring a stop during initial compression due to ear discomfort. Anyone requiring a stop was evaluated post treatment for MEB. Findings were compared to our standard 10-minute linear ROC. Evaluation of the tympanic membrane was accomplished using video otoscopy. Barotrauma when present was classified using both the Teed and O'Neill grading systems. Data was analyzed using basic statistical methods.
When comparing four different rates of compression during an elective USN TT9 in a multiplace (Class A) chamber there is a decreased incidence for symptomatic ETD when using a 15-minute linear compression schedule (p-value ⟨0.05).
Using a 15-minute linear compression schedule is associated with less symptomatic ETD and less MEB when performing an elective 45 fsw (USN TT9) hyperbaric treatment in a Class A chamber. Asymptomatic ETD and MEB were not considered in this study.
症状性咽鼓管功能障碍（ETD）和中耳气压伤（MEB）是高压氧（HBO2）治疗期间报告的最常见并发症。目前尚无标准化的加压速率（ROC）可降低高压治疗期间ETD和MEB的发生率。很少有研究实际证明ROC能降低ETD或MEB的发生率。
我们的研究旨在确定一种最佳的高压舱加压速率，该速率可能会降低在多人高压舱治疗的加压阶段导致MEB的症状性ETD的发生率。前瞻性收集了2807例使用美国海军治疗表9（USN TT9）并采用改良ROC进行加压的择期患者治疗的数据。ROC通过两个变量来确定，即时间（10分钟与15分钟）和斜率（线性与非线性加压）。患者以连续每日的方式接受所有四种加压方案。我们记录了任何在初始加压期间因耳部不适而需要暂停的患者。任何需要暂停的患者在治疗后均接受MEB评估。研究结果与我们标准的10分钟线性ROC进行比较。使用视频耳镜检查对鼓膜进行评估。出现气压伤时，使用Teed和O'Neill分级系统进行分类。使用基本统计方法对数据进行分析。
在多人（A类）舱中对择期USN TT9进行四种不同加压速率比较时，使用15分钟线性加压方案时症状性ETD的发生率降低（p值＜0.05）。
在A类舱中进行择期45英尺海水深度（USN TT9）高压治疗时，使用15分钟线性加压方案与较少的症状性ETD和较少的MEB相关。本研究未考虑无症状ETD和MEB。
