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OTITIC BAROTRAUMA

OTITIC BAROTRAUMA. Aero-otitis media / Aviation pressure deafness 1783 - Charles  Hydrogen Balloon World War I - Sidney Scott World War II - Increase of Air power. Mention anatomy of ET. Boyle’s law. Volume is inversely proportional to pressure in fixed mass of gas.

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OTITIC BAROTRAUMA

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  1. OTITIC BAROTRAUMA • Aero-otitis media / Aviation pressure deafness • 1783 - Charles  Hydrogen Balloon • World War I - Sidney Scott • World War II - Increase of Air power www.nayyarENT.com

  2. Mention anatomy of ET www.nayyarENT.com

  3. Boyle’s law • Volume is inversely proportional to pressure in fixed mass of gas www.nayyarENT.com

  4. MECHANICS OF BAROTRAUMA • As altitude ↑ environmental pressure ↓ • At 18000 ft pressure is half that of sea level, and at 34000 ft ¼ Relationship between altitude and barometric pressure www.nayyarENT.com

  5. As depth increases during diving , pressure increases • One atmospheric pressure increase for every 10 mtrs www.nayyarENT.com

  6. MECHANICS OF BAROTRAUMA elastin • Medial end is slit like, lies collapsed, in close proximity to lymphoid tissue • Opens on swallowing (pressure equalises) (effect of tensor & levator palati) • LEARN DIAGRAM Ostman pad of fat Cross-section of Cartilagenous part of Eustachian tube www.nayyarENT.com

  7. MECHANICS OF BAROTRAUMA ASCENT At high altitude ME pressure is higher than env pressure, therefore air from middle ear escapes passively along ET equalising pressures MiddleEar Nasopharynx www.nayyarENT.com

  8. MECHANICS OF BAROTRAUMA • During descent environmental pressure is higher than ME pressure, therefore we need to aerate the ME actively by VALSALVA manouvre/other methods • If the tube does not open and the pressure gradient increases beyond 90 mm of Hg, tube gets locked • Similar during deep sea diving & hyperbaric chamber Middle ear DESCENT Nasopharynx www.nayyarENT.com

  9. Aetiology of Otitic Barotrauma • Healthy subjects • Rapid descent • No attempt at auto-inflation • Sleep; sedation; position • Effect of alcohol • Anatomical differences • Pathological states • Acute infection  oedema of ET mucosa • Chronic ET obstruction  infected tonsils/nasal polypi /allergic rhinitis/ DNS/nasal allergy www.nayyarENT.com

  10. OTITIC BAROTRAUMA Clinical Features • Mild – Fullness/ slight hearing loss • Moderate – Pain/ deafness/ interstitial hemorrhage/ fluid • Severe – Severe pain/ deafness/ rupture www.nayyarENT.com

  11. OTITIC BAROTRAUMA- EARLY Tubal Occlusion www.nayyarENT.com

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  14. Other possible features • Middle ear • Ossicular disruption • Stapes avulsion • RW membrane rupture • 7th nerve barotrauma • Inner ear • Perilymph fistula • Implosive mechanism  forceful valsalva  patent ET  Implosive damage to RW • Explosive mechanism  forceful valsalva  blocked ET  ↑ CSF pressure  explosive damage to RW • Oval window in stapedectomized patients www.nayyarENT.com

  15. OTITIC BAROTRAUMA Treatment - Curative • No flying • Reascent & gradual descent • ET catheterisation • Antibiotics • Analgesics • Nasal + oral decongestants • Myringotomy • Grommets • Eliminate septic foci www.nayyarENT.com

  16. Treatment • TM rupture  no active management, remove clots if not healed by 3 mths  myringoplasty • Perilymph fistula  Bed rest, head elevation, labyrinthine sedatives, stool softeners, cough suppressant, Acetazolamide www.nayyarENT.com

  17. Prevention • Decompression chamber run on enrolment • Education of aircrew/ divers • Flying discipline • Auto-inflation techniques – frenzel’s manouvere for pilots www.nayyarENT.com

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