Middle-ear barotrauma after hyperbaric oxygen therapy: a five-year retrospective analysis on 2,610 patients.

Introduction: Hyperbaric oxygen (HBO2) therapy is the use of oxygen or gas mixtures at a pressure above atmospheric pressure for therapeutic purposes. This treatment is used in numerous pathological processes. Its main side effect is middle ear barotrauma (MEB), which represents a great concern for iatrogenic HBO2 therapy. The aim of this work is to describe this adverse event in order to highlight clinical elements that can contribute to its prevention and management.

Methods: We conducted a five-year retrospective study from January 2013 to December 2017, where 2,610 patients were selected, in the Hyperbaric Medicine Centre, Sainte- Marguerite Hospital of Marseille, France.

Results: 262 patients experienced MEB after HBO2, representing a prevalence of 10.04% and incidence of 0.587%. Their average age was 55 ± 19 years. Women were more affected than men. We have not highlighted a seasonality to this condition. Risk factors were: age older than 55 years, female gender, ear, nose and throat history (cancer, radiotherapy, infections or allergies, malformations or benign tumors), general history (smoking, obstructive breathing disorders, thyroid disorders and obesity), HBO2-approved indications of sudden deafness and delayed wound healing, and altered tympanic mobility on initial examination. Although the benign stages of Haines-Harris classification were the most encountered in our study, MEB was responsible for premature discontinuation of HBO2.

Conclusion: MEB is a common condition responsible for many premature discontinuations of HBO2. Its origin is multifactorial, associating non-modifiable and modifiable factors. Better management of this affection will further contribute to making HBO2 a low-risk treatment.