OTITIC BAROTRAUMA Aero-otitis media / Aviation pressure deafness

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 1 Mention anatomy of ET www.nayyarENT.com

2 Boyles law Volume is inversely proportional to pressure in fixed mass of gas www.nayyarENT.com 3 MECHANICS OF BAROTRAUMA As altitude environmental pressure At 18000 ft pressure

is half that of sea level, and at 34000 ft Relationship between www.nayyarENT.com altitude and barometric pressure 4 As depth increases during diving , pressure increases One atmospheric pressure increase for every 10 mtrs www.nayyarENT.com 5

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) Ostman pad of fat LEARN

Cross-section of Cartilagenous part of www.nayyarENT.com Eustachian tube DIAGRAM 6 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 Middle Ear Nasopharynx www.nayyarENT.com 7 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 Middle ear DESCENT Nasopharynx If the tube does not open and the pressure gradient increases beyond 90 mm of Hg, tube gets locked Similar during deep sea diving &

www.nayyarENT.com 8 hyperbaric chamber 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/ www.nayyarENT.com DNS/nasal allergy

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

10 OTITIC BAROTRAUMA- EARLY Tubal Occlusion www.nayyarENT.com 11 www.nayyarENT.com 12 Findings Grade

Symptoms (pain, nausea, vomiting, etc.) Without changes in the tympanic membrane 0 Injection of the tympanic membrane (may be most noticeable along the handle of the malleus) I Injection plus mild haemorrhage within the tympanic membrane II Gross haemorrhage within the tympanic membrane

III Free blood in the middle ear (tympanic membrane blue and bulging) IV Perforation of the tympanic membrane (commonest in AI quadrant) V www.nayyarENT.com 13 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 14 OTITIC BAROTRAUMA Treatment - Curative

No flying Reascent & gradual descent ET catheterisation Antibiotics Analgesics Nasal + oral decongestants Myringotomy Grommets Eliminate septic foci www.nayyarENT.com 15 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 16 Prevention Decompression chamber run on enrolment Education of aircrew/ divers

Flying discipline Auto-inflation techniques frenzels manouvere for pilots www.nayyarENT.com 17

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