Otitis externa in military divers: more frequent and less harmful than reported

Management of tympanic membrane retractions: a systematic review

Importance

Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances.

Objective

To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction.

Evidence review

The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development.

Findings

In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs.

Conclusions and relevance

This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00405-021-06719-3.

Longitudinal screening of hearing threshold in navy divers: is diving really a hazard?

INTRODUCTION

Hearing loss (HL) is common in the adult working population. It is widely assumed that diving is a risk factor for HL. However, studies with sufficient follow-up comparing HL in divers to non-divers are limited. This study aimed to assess the hearing threshold (HT) of Royal Netherlands Navy divers who had been diving for more than 15 years and to compare it to the ISO standard 7029:2017 reference table.

METHODS

In this 25-year retrospective cohort study the Royal Netherlands Navy Diving Medical Centre audited the medical records of 1,117 Navy divers. Yearly dive medical assessments were performed according to professional standards, including audiometry. HTs were compared to the ISO 7029:2017 reference table, including Z-distribution, using paired t-tests.

RESULTS

Thirty-five divers were included who had been diving for 15 years or longer. The HT increased significantly in nine of the 16 measured frequencies, while the Z-score decreased significantly in nine of the 16 tested frequencies (eight in both ears). In the 25-year follow-up the pattern was more obvious, with one significantly increased HT, and 10 significantly decreased Z-scores.

DISCUSSION

The absolute HT increases after 15 years of military diving, but less than would be expected from normal age-related deterioration. Moreover, when comparing Z-scores, this sample of divers actually hear better than non-divers. We conclude that military diving is not an increased risk for HL compared to regular occupational hazards and suggest withdrawing the requirement for routine yearly audiometric evaluation as part of a dive medical examination.