Otitis media with effusion in childhood

OM and OME are common disorders of childhood. Middle ear disease is related to anatomic abnormalities, prior episodes of AOM, chronic rhinitis, allergy, age, sex, race, season, perinatal factors, viral infections, and irritant exposure. ET dysfunction plays an important role in OME, as does the presence of bacteria or bacterial products in the middle ear. Viral infection, nasal allergy, previous episodes of OM and primary mucosal disease all may contribute to this chronic disorder. Diagnostic evaluation involves an appropriate personal and environmental history, a physical examination, pneumatic otoscopy, tympanometry, pure tone audiometry, and (if indicated) allergic and immunologic evaluation. Treatment may include environmental control, antibiotic therapy, decongestants and/or antihistamines, topical corticosteroids, and possibly immunization or allergic immunotherapy (hyposensitization). In order to facilitate strategies to prevent acute and recurrent OM as well as chronic effusion, further knowledge regarding the etiology, pathogenesis, and risk factors is essential. Well designed, controlled studies are imperative to provide further understanding and more effective treatment of this common, chronic and often very frustrating medical problem.

Oxygen toxicity and other ventilatory complications of treatment of infants with persistent pulmonary hypertension

While current ventilator therapy has greatly improved the outlook for infants with persistent pulmonary hypertension, it brings with it substantial risk for serious lung injury from oxygen toxicity, barotrauma, and alveolar rupture. This article discusses the mechanisms by which these complications occur and methods by which they can be prevented.

Report of an isolated mid-frequency hearing loss following inner ear barotrauma

A case describing an isolated mid-frequency hearing loss as a result of inner ear barotrauma is presented. The onset of symptoms was insidious but progressed to a profound total-range hearing loss in the right ear. This loss resolved rapidly with cessation of diving activity, bed rest, and head elevation, leaving only an isolated 20-dB hearing decrement at 1000 Hz. Since the diver was participating in evaluation of experimental decompression tables, differentiation had to be made between barotrauma and inner ear decompression sickness.

Pneumothorax and pneumomediastinum during pediatric mechanical ventilation

The incidence of pulmonary barotrauma during mechanical ventilation in children beyond the neonatal age group was studied in two groups of patients. In the first group, 179 cases of pediatric mechanical ventilation for over 12 hours were retrospectively analyzed for the occurrence of pneumothorax and pneumomediastrinum. Eleven percent (6 of 57) of young infants (0--6 months) without hyaline membrane disease and 3% (4 of 122) of older infants and children (over 6 months) developed these complications. Pulmonary barotrauma in young infants occurred only after cardiothoracic surgery and involved the same site as the intraoperative repair in all cases. Pulmonary barotrauma in older infants and children occurred in patients with severe respiratory disease requiring high peak airway pressures, PEEP, and respiratory rates. In the second group, the incidence of pulmonary barotrauma during ventilation with PEEP greater than or equal to 15 cm H2O was analyzed in 14 patients including 4 patients from the previous group. Overall, 64% (9 of 14) of this group developed pulmonary barotrauma and 43% (6 of 14) developed pneumothorax. Of 9 patients receiving PEEP greater than or equal to 15 cm H2O for longer than 24 hours, 6 developed pulmonary barotrauma after the first 24 hours. The incidence of pneumothorax and pneumomediastinum in ventilated infants without hyaline membrane disease and children is comparable to adult series.

Aeromedical aspects of otolaryngology

Abnormalities in the ENT area that are directly related to aerospace operations are largely secondary to man's persistence in operating outside his intended environment. These are spatial disorientation, motion sickness, barotrauma, noise-induced hearing loss, and certain clinical entities which have the capability of producing sudden incapacitation. Pertinent features of these primary problem areas are discussed.

Civilian air travel and the otolaryngologist

Thousands of individuals fly commercial airlines and private aircraft daily. One airline boasts of serving more than 100,000 passengers each day. Of these individuals exposed to barometric alterations, an undocumented number will develop significant barotrauma and may seek help from an otolaryngologist. Although many otolaryngologists learn the mechanics and management of barotrauma as military flight surgeons, residents in otolaryngology usually receive no specific training in this area. Because private and commercial aviation are so common today, we believe that a basic knowledge of barometric changes experienced while flying is essential for the practicing otolaryngologist. These basic principles are covered in this presentation. Case histories will also be discussed. One patient, who presented with signs of perilymph fistula, including sensorineural deafness and abnormal ENG, recovered spontaneously.