鼓膜穿刺术在预防 200 米水下快速浮力上升逃生引起的中耳气压伤中的作用。
Role of tympanocentesis in the prevention of middle ear barotrauma induced by fast buoyant ascent escape from 200 m underwater.
机构信息
Department of Otolaryngology - Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Otorhinolaryngology and Head and Neck Surgery, No. 905 Hospital of PLA Navy, Shanghai, China.
出版信息
Diving Hyperb Med. 2024 Sep 30;54(3):196-203. doi: 10.28920/dhm54.3.196-203.
INTRODUCTION
We aimed to study middle ear barotrauma caused by fast compression followed by buoyant ascent escape from 200 m underwater and its effect on the auditory system, and to validate the preventive effect of tympanocentesis on middle ear barotrauma.
METHODS
Twenty Sprague Dawley rats were divided into two groups: rats in group A underwent a simulated fast buoyant ascent escape from a depth of 200 m, while those in group B underwent tympanocentesis before the procedure described for group A. Ear endoscopy, acoustic conductance, and auditory brainstem response (ABR) tests were conducted before and after the procedure to evaluate the severity of middle ear barotrauma and auditory function in both groups. Additionally, histopathological examination of the middle ear in both groups was conducted to evaluate the severity of middle ear barotrauma by observing submucosal haemorrhage.
RESULTS
None of the ears in either group showed any abnormalities before the experiment. In group A, middle ear barotrauma was universally observed after the simulation procedure. The tympanograms of all ears were initially type A and became type B after the procedure. Further, after the simulation, the hearing thresholds at different frequencies (4, 8, 16, 24, and 32 kHz) assessed by ABR significantly increased compared to those before the procedure. In group B, no middle ear barotrauma was observed, and the hearing threshold at each frequency did not change significantly compared with post-puncturing. After dissecting the middle ear, gross pathological observations were consistent with the above results. Microscopically, blood accumulation and submucosal haemorrhage in the middle ear cavity were observed in group A but not in group B.
CONCLUSIONS
Fast buoyant ascent from 200 m underwater can cause middle ear barotrauma, resulting in hearing loss. Tympanic membrane puncture can effectively prevent middle ear barotrauma caused by the rapid buoyant ascent escape procedure.
引言
本研究旨在探讨 200 米水下快速减压后再进行浮力上升逃生对中耳的气压伤影响，并验证鼓膜穿刺术对中耳气压伤的预防效果。
方法
将 20 只 Sprague Dawley 大鼠随机分为两组：A 组进行模拟 200 米快速浮力上升逃生，B 组在 A 组模拟程序前进行鼓膜穿刺。分别在程序前后进行耳内镜、声导抗和听性脑干反应（ABR）测试，评估两组中耳气压伤和听觉功能的严重程度。此外，对两组中耳进行组织病理学检查，观察黏膜下出血情况评估中耳气压伤的严重程度。
结果
两组动物实验前耳部均未见异常。A 组模拟后所有动物均出现中耳气压伤，鼓膜导抗图均由 A 型变为 B 型，ABR 各频率（4、8、16、24、32 kHz）听阈较实验前显著升高。B 组未见中耳气压伤，鼓膜穿刺后各频率听阈与穿刺前比较差异无统计学意义。中耳解剖后大体观察结果与上述一致。显微镜下，A 组中耳腔可见血液积聚和黏膜下出血，B 组未见上述改变。
结论
200 米水下快速减压上浮逃生可导致中耳气压伤，引起听力损失。鼓膜穿刺可有效预防快速浮力上升逃生程序引起的中耳气压伤。
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