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Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

Ng AWA, Muller R, Orton J

Undersea Hyperb Med, 2017 8 5;44(2):101-107.
PMID: 28777900

CONTEXT: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB.
OBJECTIVE: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols.
DESIGN: Double-blinded, randomized controlled trial.
SETTING: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014.
PATIENTS: 100 participants undergoing their first hyperbaric oxygen therapy session.
INTERVENTION: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre- and post-treatment and then graded. Middle ear barotrauma was defined as an increase of at least one grade on a modified TEED scale.
RESULTS: The observed MEB incidence under the staged protocol was 48% compared to 62% using the linear protocol (P=0.12, exact one-sided binomial test), and thus the staged protocol did not show a significant improvement in MEB. However, the staged protocol resulted in significantly less severe deteriorations in MEB grades when compared to the linear protocol (P=0.028, exact one-sided Mann-Whitney type test).
CONCLUSION: The use of the assessed staged compression protocol for the first hyperbaric oxygen treatment showed no significant effect on the overall incidence of MEB when compared to the gold standard linear protocol but resulted in a significant improvement in the severity of the experienced MEBs. Further studies are needed to elucidate an optimal compression protocol to minimize middle ear barotrauma.

Matched MeSH terms: Barotrauma/etiology*
The rare cases of pneumatic colorectal perforation: A cautionary tale of compressed air misuse

Govindarajan MK, Durai B, Sundar VS, Uppupettai Ganeshbabu MB, Chiramel S

Med J Malaysia, 2025 Jan;80(Suppl 1):77-79.
PMID: 39773947

Barotrauma is a medical condition caused by sudden pressure changes in the body causing damage to multiple parts of the body. However, it is an infrequent occurrence when it comes to Colo-rectal perforation, wherein the trauma occurs due to the insufflation of compressed air through the anus. Several factors influence the outcome of a patient with colonic perforation due to barotrauma such as the severity of the injury, hemodynamic status of the patient, the patient's general health and well-being, the time taken for active medical/ surgical intervention since the injury, aggressive intravenous antibiotics administration to prevent sepsis, post-operative complications like surgical site infection, post-op ileus, anastomotic leak, etc. Overall, the patient's prognosis largely depends on early diagnosis, effective initial resuscitation, timely surgical intervention, and intensive post-operative care for a favorable outcome. Recently, we came across 2 cases of extensive pneumoperitoneum with Colo-rectal perforation as a result of the forceful insufflation of compressed air through the anus. Prompt medical intervention was necessary to prevent any further complications and they underwent surgical repair of the colorectal perforation.

Matched MeSH terms: Barotrauma/etiology

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