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At least 19 recordsLinked to original sources
PubMed1995

Frequency and importance of barotrauma in 100 patients with acute lung injury.

OBJECTIVES: To determine the occurrence rate of barotrauma in acute lung injury patients, whether barotrauma is an independent risk factor for mortality, and the role of barotrauma in the outcome of those patients who died. DESIGN: Prospective, cohort study. SETTING: Intensive care units at a university hospital. PATIENTS: Consecutive adult patients (n = 100) meeting the usual criteria for a diagnosis of acute lung injury requiring mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Barotrauma occurred in 13 (13%) of 100 patients. Mortality rates were not different in patients with (76%) and without (64%) barotrauma. Using univariate analysis, barotrauma was not associated with increased mortality (odds ratio 1.85; confidence interval 0.42 to 9.20; p = .53). However, when barotrauma was incorporated into a logistic regression model, along with other potential predictors of mortality, barotrauma was associated with increased mortality (odds ratio 6.15; confidence interval 1.11 to 33.9; p = .017). The presence of nonpulmonary organ dysfunction and sepsis was strongly associated with mortality. In the setting of barotrauma, the mortality rate was 100% if associated with two or more nonpulmonary organ dysfunctions compared with a mortality rate of 40% with one or no nonpulmonary organ failure. Barotrauma contributed directly to the cause of death in only one patient. CONCLUSIONS: Barotrauma occurred in only 13% of patients with acute lung injury. Barotrauma was an independent marker of mortality when adjusted for other predictors of mortality. However, barotrauma directly contributed to < 2% of all deaths. We hypothesize that barotrauma is an indication of severity of acute lung injury rather than a major cause of increased mortality.

Adult↗
PubMed2002

Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome.

The determinants of barotrauma in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) have not been clearly established. Using data from ARDS Network randomized controlled trials, we retrospectively examined the association between airway pressures and the risk of early barotrauma in a cohort of 718 patients with ALI/ARDS and no baseline barotrauma. We studied airway pressures at three exposure intervals: baseline, one day preceding the barotrauma event (one-day lag), and concurrent with the barotrauma event. During the first four study days, the cumulative incidence of barotrauma was 13% (95% confidence interval [CI] 10.6 to 15.6%). In a forward stepwise Cox proportional hazards analysis using time-dependent variables, higher concurrent positive end-expiratory pressure (PEEP) was associated with an increased risk of early barotrauma (relative hazard [RH] 1.67 per 5-cm H2O increment; 95% CI 1.35-2.07). Once concurrent PEEP was selected into the model, no other airway pressure was related to barotrauma, including plateau pressure. In the multivariate analysis, higher concurrent PEEP was also related to a greater risk of barotrauma (RH 1.93; 95% CI 1.44-2.60), controlling for age, ventilator group (6 versus 12 ml/kg), baseline PEEP, baseline plateau pressure, baseline tidal volume, Acute Physiology and Chronic Health Evaluation score, vasopressor use, serum albumin, hepatic failure, and coagulopathy. When one-day lagged values of PEEP were analyzed, higher PEEP was associated with a greater risk of barotrauma (RH 1.38 per 5-cm H2O increment; 95% CI 1.09-1.76). Controlling for the covariates, higher PEEP was related to an increased risk of barotrauma (RH 1.50; 95% CI 0.98- 2.30). In conclusion, higher PEEP may increase the likelihood of early barotrauma in ALI/ARDS.

Airway Resistance↗
PubMed2005

Evaluation of predive parameters related to eustachian tube dysfunction for symptomatic middle ear barotrauma in divers.

OBJECTIVE: Eustachian tube dysfunction plays an important role in the pathogenesis of middle ear barotrauma. This investigation evaluates the predictive value of several parameters related to tubal dysfunction, in relation to symptomatic middle ear barotrauma in divers. STUDY DESIGN: Prospective and blinded. PATIENTS: Thirty-one sport scuba divers with normal predive audiometry, tympanometry, and general and otorhinolaryngologic examination. METHODS: After an occurrence of middle ear barotrauma, the individual diver predive data on smoking, mild septal deviation, otitis media history, rhinosinusitis history, Valsalva, Toynbee, and nine-step inflation/deflation tympanometric test, as well as degree of mastoid pneumatization were registered for calculation of predictive value in relation to the barotrauma. All symptomatic ears were examined within 24 hours of diving by the investigator, who was blinded to the predive findings. Barotraumas that occurred during an upper respiratory tract infection were excluded. RESULTS: Divers completed a total of 774 dives (median, 25; range, 3-100). Symptomatic middle ear barotrauma occurred in 19 ears (31%) of 14 divers (45%) at one time or another. The rate of tubal dysfunction measured by the nine-step test and a mastoid pneumatization below average were significantly higher in divers (p <0.05) as well as in ears (p <0.005) with barotrauma. Positive and negative predictive values of both parameters for subsequent barotrauma were between 69% and 76%. Combining the results into a two-test battery in a strict approach (positive on both) increased the positive predictive value to 86%. CONCLUSION: Eustachian tube dysfunction measured by the nine-step test and a small size of the mastoid cell system seem to be risk factors for symptomatic middle ear barotrauma in otherwise healthy sport scuba divers. Evaluation of these factors in the predive examination of diving candidates may be useful in the determination of fitness to dive.

Acoustic Impedance Tests↗
PubMed1997

Predictors of barotrauma events in a Navy altitude chamber.

BACKGROUND: Barotrauma in the flight environment is a significant cause of incidents and mishaps. Upper respiratory infections and allergic rhinitis are considered to increase the risk of barotrauma in the changing pressure environment. In an attempt to identify antecedent conditions as predictors of barotrauma, all adverse outcomes which occurred in a Navy altitude chamber during 1993-94 were investigated. METHODS: A retrospective study of chamber logs, pre-chamber screening questionnaires, and a medical waiver database was conducted on altitude chamber trainees at the Naval Aerospace and Operational Medical Institute. Barotrauma cases were confirmed by reviewing ENT consultation records. Chamber screening questionnaires and medical waiver status were compared between barotrauma cases and a control group from the same chamber runs. RESULTS: Of 5851 trainees, 193 (3.3%) experienced adverse events during this period, with an additional 9 events occurring to inside observers. Barotrauma, with 160 cases, accounted for the greatest number of these events. Upper respiratory symptoms were present in 12 (7.7%) of the barotrauma cases and 15 (4.8%) of the controls. Waivers for upper respiratory conditions such as allergic rhinitis were present in 9 (6.1%) of the barotrauma cases and 17 (5.7%) of the controls. Under-reporting of upper respiratory conditions on pre-chamber screening was found however, with only 7 of 28 cases with recent cold symptoms reporting this prior to chamber training. CONCLUSIONS: No significant differences were found in predictors for barotrauma between cases and controls in this study group.

Altitude↗
PubMed2002

Relationship between mastoid pneumatization and middle ear barotrauma in divers.

OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization. RESULTS: ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2. CONCLUSION: Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.

Barotrauma↗
PubMed2004

Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients.

OBJECTIVE: To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. DESIGN AND SETTING: Prospective cohort of 361 intensive care units from 20 countries. PATIENTS AND PARTICIPANTS: A total of 5183 patients mechanically ventilated for more than 12 h. MEASUREMENTS AND RESULTS: Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9%). The incidence varied according to the reason for mechanical ventilation: 2.9% of patients with chronic obstructive pulmonary disease; 6.3% of patients with asthma; 10.0% of patients with chronic interstitial lung disease (ILD); 6.5% of patients with acute respiratory distress syndrome (ARDS); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95%CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95%CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95%CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2%; p=0.04) and prolonged ICU stay. CONCLUSIONS: In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increase in the ICU length of stay and mortality.

Adult↗
PubMed2000

Use of the nine-step inflation/deflation test as a predictor of middle ear barotrauma in sports scuba divers.

Middle ear (ME) barotrauma, the most common disorder encountered in diving, results from inadequate pressure equilibration between the ME and the ambient environment. Eustachian tube function plays a key role in the pathogenesis of barotrauma. This study was designed to investigate the predictive value and efficiency of tympanometric tests of Eustachian tube function (Valsalva test, Toynbee test and nine-step inflation/deflation test) in predicting ME barotrauma in 44 ears of 22 sports scuba divers who had normal audiometry, tympanometry and otorhinolaryngological examination without previous history of ear disease. The divers were counselled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by one investigator who was unaware of the pre-symptomatic test results. Decision matrix analysis was applied to the results of Eustachian tube function tests for predicting ears with barotrauma. Values were also evaluated for a battery of tests by 'Lax' (positive on A, B or C) and 'Strict' (positive on A, B and C) criteria. The nine-step test was found to be the most efficient (93%) test with highest predictive values (PPV 83%; NPV 95%), whereas the Valsalva and Toynbee tests were unreliable in predicting barotrauma, whereas the Valsalva and Toynbee tests were unreliable in predicting barotrauma (PPV of the Valsalva and Toynbee tests were 0% and 25% respectively). Combining the nine-step and Toynbee tests into a two-test battery in a strict approach increased the PPV (100%). It appears that the nine-step inflation/deflation test is a reliable method of predicting ME barotrauma sufferers, especially when applied with the Toynbee test. The nine-step test may have value in the evaluation of Eustachian tube function of sports scuba diving candidates after routine otorhinolaryngological, audiological and tympanometric evaluation.

Acoustic Impedance Tests↗
PubMed2006

Safety of performing percutaneous dilational tracheostomy in patients with preexisting barotrauma.

Since its introduction in 1985 by Ciaglia et al, percutaneous dilational tracheostomy (PDT) has gradually become the procedure of choice in establishing a long-term airway in many intensive care units (ICU). However, the safety of performing PDT in patients with barotrauma is still unknown and has never been reported. We present the case of a 35-year-old man with AIDS, who was admitted to our medical ICU for pneumonia and acute respiratory distress syndrome. He developed subcutaneous emphysema and pneumomediastinum as complications of mechanical ventilation. After stabilization of the barotrauma, he underwent PDT with the standard Ciaglia Blue Rhino technique. However, rapid and extensive progression of preexisting barotraumas occurred shortly after PDT. This severe complication was nearly fatal. The prolonged procedure during which the susceptible lung was exposed to longer duration of high airway pressure was thought to be the mechanism of rapid deterioration of the preexisting barotrauma. With aggressive supportive care, the patient survived. To prevent further deterioration of preexisting barotraumas during and after PDT in future cases, we propose some principles that should be strictly followed. Under administration of these principles, we safely performed PDT in another case with preexisting barotrauma 1 month later.

Adult↗
PubMed1997

Inner and middle ear hyperbaric oxygen-induced barotrauma.

Patients receiving hyperbaric oxygen (HBO) therapy can sustain inner and middle ear barotrauma. The purpose of this study is to define the incidence and significance of HBO-related barotrauma, in addition to establishing guidelines for prophylactic myringotomy or tympanostomy tube placement. Thirty patients were stratified into two groups (those able to autoinflate and those unable to autoinflate the middle ear) and barotrauma was assessed by otoscopy, tympanometry, high-frequency audiometry, and distortion product otoacoustic emission (DPOAE) testing. Ten of 11 patients (91%) from the noninflater group suffered middle ear barotrauma, and seven of 19 patients (37%) from the autoinflater group sustained middle ear barotrauma. Patients unable to autoinflate the middle ear were shown to have a higher incidence and greater severity of barotrauma than patients able to autoinflate. Pretreatment pressure-equalizing tubes or myringotomies should be considered for patients undergoing HBO therapy who have an artificial airway or have eustachian tube dysfunction and have failed conservative medical intervention. A significant change in DPOAEs (loss of emissions over a 1-kHz range) was found in four of 15 autoinflaters (27%) and two of seven noninflaters (29%). There was no significant difference between the groups. The decrease in DPOAEs was not associated with a change in conventional audiometry.

Barotrauma↗
PubMed1992

Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors.

The incidence of mediastinal emphysema (ME) and pneumothorax (PTX) was analyzed to determine the roentgenographic patterns and risk factors for the development of barotrauma in a population of mechanically ventilated patients. The roentgenograms of 139 intubated patients admitted to our medical intensive care unit over a ten-month period were evaluated for the presence of ME and PTX. Barotrauma was diagnosed in 34 of these patients, and ME was the initial manifestation in 24 patients. Of these patients with initial ME, ten subsequently developed PTX, a positive predictive value of 42 percent. The adult respiratory distress syndrome (ARDS) patient population was at highest risk for barotrauma, with an intermediate risk seen in those admitted with COPD or pneumonia. Values of peak inspiratory pressure, positive end-expiratory pressure level, respiratory rate, tidal volume, and minute ventilation were significantly elevated in patients who developed barotrauma as compared with patients who did not develop barotrauma. However, these elevations in part reflect the high incidence of barotrauma in the ARDS population, a patient group in which all of the above parameters were elevated.

Barotrauma↗
PubMed1995

The aetiology, consequences and prevention of barotrauma: a critical review of the literature.

PURPOSE: To review critically the literature on pulmonary barotrauma in mechanically ventilated patients. METHODS: Data sources included MEDLINE and citation lists of relevant articles. Articles investigating the aetiology or prevention of pulmonary barotrauma were critically evaluated according to published guidelines. RESULTS: Experimental animal studies and observational clinical studies consistently demonstrate that the high airway pressures and large tidal volumes associated with conventional modes of mechanical ventilation are major contributors to lung injury. Animal studies establish the correct temporal relationship and demonstrate a biological gradient. Observational clinical studies demonstrate an increased risk of barotrauma in the setting of acute lung injury. The results of three case series and two small randomised clinical trials indicate that a pressure-limited ventilation strategy aimed to reduce barotrauma may improve outcomes in patients with acute lung injury. CONCLUSIONS: Pulmonary barotrauma is a clinically important phenomenon that may delay the healing of injured lungs and lead to the development, or the exacerbation, of ARDS. Risk factors for barotrauma include high peak airway pressures, large tidal volumes and acute lung injury. Resolution of the role for pressure-limited ventilation in ARDS prevention and treatment requires a large-scale randomised clinical trial.

Airway Resistance↗
PubMed1985

Autopsy and experimental observations on factors leading to barotrauma in man.

Morbid anatomical data have been examined in detail from 13 fatal diving accidents in which the primary cause of death was due to pulmonary damage. In addition, the observations on 6 cases of experimental barotrauma on cadavers are recorded. The information is supplemented by the incidental findings in the respiratory system of 19 professional divers killed by causes other than barotrauma, and 97 healthy, age-matched controls who died suddenly or unnaturally. In cases of pneumothorax resulting both from diving and experiment the constant feature was the presence of pleural adhesions and lung bullae, some of which were involved in causing tissue damage. A high proportion (up to 26%) of lungs not involved in barotrauma also showed pleural adhesions. In cases of barotrauma, the parenchymal damage is not consistently related to scars or fibrous tissue. The observations suggest that a high incidence of pleural lesions are not detected or detectable on routine medical examination which do not compromise the lung. However once a pneumothorax has occurred it is highly probable that a further incident may rupture another bulla and these appear to be multiple. The converse appears to be true with parenchymal barotrauma that is not consistently related to scar tissue. This would therefore suggest that in a proven and recovered case of barotrauma it should not necessarily debar further diving activity.

Adult↗
PubMedDate not supplied

[Computed tomography in the diagnosis of pulmonary barotrauma associated with the adult respiratory distress syndrome].

In the patients suffering from adult respiratory distress syndrome (ARDS), pulmonary barotrauma is a frequent and fearful complication, whose timely and accurate diagnosis is therefore needed. To this purpose, bedside chest films often exhibit some diagnostic drawbacks. Computed tomography (CT) of the chest is rarely used because of the problems concerning the transfer and the control of these critically ill patients outside the Intensive Care Unit. The chest CT findings of 84 ARDS patients were retrospectively reviewed, investigating: a) the presence of barotrauma (pulmonary bullae, pneumothorax, pneumomediastinum, subcutaneous emphysema); b) the positioning of thoracostomy tubes; c) the chest films performed on the same day as CT. CT showed the presence of barotrauma in 41 patients. Pulmonary bullae were seen in 26 cases (31%), pneumothorax (mainly in anteromedial location) in 27 cases (32%) and pneumomediastinum in 11 cases (13%). In 22 patients with thoracostomy tubes CT demonstrated the exact site of the drainages: in 7 cases only the tubes were correctly positioned, or were working properly. The presence of pulmonary bullae (regarded as the evidence of interstitial pulmonary emphysema) proved to be associated with a higher mortality rate than that of the entire sample (58% vs 38%); in 30 of 41 patients with barotrauma (73%) CT proved to be superior to chest films, especially to demonstrate pulmonary bullae (26 cases detected by CT vs 7 cases diagnosed by chest films). In 14 of 41 patients with barotrauma the information yielded by CT directed the choice of treatment: thoracostomy tubes were positioned in the cases of pneumothorax undetected by chest films and in the cases of only partially drained multilocular pneumothorax, or replaced in the event of tube mispositioning. In conclusions, in ARDS patients the use of chest CT is recommended in selected cases only, when complications (especially barotrauma) are suspected and unrevealed by bedside chest films.

Adult↗
PubMed2003

Prenatal nicotine exposure and pulmonary barotrauma of newborns.

Smoking in adults increases the relative risk of contracting spontaneous pneumothorax, a form of pulmonary barotrauma. Maternal smoking habits affect the fetus. Pregnant females attend the antenatal clinic at the 8th to 12th weeks of pregnancy. There is a participation rate of 99% of all births in Sweden. Their smoking habits were registered at this stage. This study supported the hypothesis that the registered maternal smoking habits covariated with the risk of contracting pulmonary barotrauma in newborn infants. The infants of smokers do not seem to be at higher risk (95% C.I. of RR: 0.78-0.99) for contracting pulmonary barotrauma than those of nonsmokers. Thus far, the hypothesis is even rejected at the 5% significance level. However, after considering other factors, especially mother's education, it seems to be an open question whether or not a weak covariation is present. Newborn boys run almost twice the risk of contracting pulmonary barotrauma than girls. Furthermore, we found an increased risk for contracting pulmonary barotrauma in the subcohort of newborns whose mothers' smoking habits were not reported.

Barotrauma↗
PubMed2006

Does the slow compression technique of hyperbaric oxygen therapy decrease the incidence of middle-ear barotrauma?

OBJECTIVE: To note the incidence of middle-ear barotrauma following standard and slow compression during hyperbaric oxygen therapy (HBOT). The standards used were: (1) less than 40 per cent of the cohort should develop barotraumas, and (2) the incidence of barotrauma following the slow technique should be less than that caused by the standard technique. DESIGN: Prospective clinical audit. MATERIAL AND METHODS: Forty-two consecutive patients who received either standard compression or slow compression HBOT were included. Pre- and post-treatment otoscopy (graded according to a modified Teed's scale), tympanometry, audiometry and subjective ear complaints were compared between the groups and also compared with the set standard. RESULTS: Significantly less middle-ear barotrauma was noted when using the slow compression technique compared with the standard compression technique (p < 0.05). The incidence of barotrauma when using standard compression failed to meet the set standard of less than 40 per cent. CONCLUSION: The slow compression method of HBOT proved to be both safe and superior to the standard compression technique.

Adult↗
PubMedDate not supplied

Decreased pulmonary barotrauma with the use of volumetric diffusive respiration in pediatric patients with burns: the 1992 Moyer Award.

Pulmonary barotrauma is a frequent, life-threatening complication in the pediatric patient who is treated with mechanical ventilation. The volumetric diffusive respiration (VDR) ventilator, which employs a high-frequency progressive accumulation of subtidal volume breaths in a pressure-limited format with a percussive waveform, is capable of providing adequate gas exchange at lower airway pressures; this theoretically decreases the incidence of pulmonary barotrauma compared with conventional mechanical ventilation (CV). The incidence of pulmonary barotrauma since 1988 was evaluated in pediatric patients with burns who were younger than 2 years of age. Twenty-four patients who were treated with only CV were compared with 15 patients who were treated with only VDR. Pulmonary barotrauma was defined as the development of pneumothorax, pneumomediastinum, pneumopericardium, or pneumoperitoneum. There were no significant differences between CV-treated and VDR-treated groups (mean +/- SEM) in the patient characteristics of age (15.9 +/- 1.3 months vs 16.6 +/- 1.8 months), weight (11.2 +/- 0.5 kg vs 12.5 +/- 0.7 kg), percent total body surface burn (46.2% +/- 4.9% vs 55.6% +/- 6.2%), percent full-thickness burn (38.1% +/- 5.3% vs 50.0% +/- 6.6%), inhalation injury (40% vs 60%), or total number of days that mechanical ventilation was required (18.2 +/- 4.2 days vs 22.4 +/- 5.9 days); although these parameters show a slightly more severe degree of injury in the VDR-treated group. There was a reduction in the incidence of pulmonary barotrauma when VDR was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Awards and Prizes↗
PubMed1996

The application of endoscopic sinus surgery to the treatment of recurrent sinus barotrauma.

Recurrent sinus barotrauma is an uncommon condition but it may terminate the career of an aviator. Sinus barotrauma occurs almost exclusively on descent and probably results from occlusion of the sinus ostia through a combination of mucosal disease and anatomical abnormalities. Traditional methods of treating sinus barotrauma have achieved mixed results so we have employed functional endoscopic sinus surgery (FESS) since 1990. The presentation and outcome of 39 patients with recurrent sinus barotrauma managed by FESS have been reviewed. Ninety-five per cent were able to resume their full flying duties without further treatment or recurrence of sinus barotrauma. Passing a postoperative decompression testing is a reliable indicator of an aviators's fitness to fly after FESS.

Aerospace Medicine↗
PubMed2003

Barotrauma vis-a-vis the "chronic otitis media syndrome": two conditions with middle ear gas deficiency Is secretory otitis media a contraindication to air travel?

We compared 17 patients (29 ears) with barotrauma with 171 patients suffering from "chronic ears" (secretory otitis media, atelectasis, or previously operated cholesteatoma). The patients with "chronic ears" were followed up prospectively, and none were found to suffer from barotrauma after flying on a commercial airplane. The mastoid pneumatization (seen on lateral mastoid radiographs) was significantly larger in ears with barotrauma, averaging 16.85 cm2, versus 12.9 cm2 in normal controls, whereas in "chronic ears" it was only 3.6 cm2. During flight on a commercial airplane, the middle ear has to equalize about 20% of its gas volume with the ambient pressure. This equalization must happen within 15 to 20 minutes of ascent and descent in order to avoid barotrauma. This 20% is a fivefold greater task for ears with a large mastoid pneumatization than for ears with an undeveloped pneumatization; "chronic ears" usually have an undeveloped mastoid pneumatization. The smaller the middle ear (mastoid) volume, the smaller the volume of gas needed to pass through the eustachian tube in order to equalize pressure changes during flying. This factor may explain why "chronic ears" rarely suffer from barotrauma. It also implies that eustachian tubes of secretory otitis, atelectatic, and cholesteatomatous ears have little problem in equalizing large pressure differences (over 2,000 mm H2O) within 15 to 20 minutes of landing, in contrast to what has been traditionally believed. Individuals with "chronic ears" can be advised that they can fly safely.

Adult↗