Carlson
The topical nasal decongestant oxymetazoline did not reduce the rate of middle-ear barotrauma in patients having hyperbaric oxygen therapy.
Clinical Bottom Line:
- No evidence that topical decongestants reduce middle ear barotrauma during hyperbaric therapy.
Citation/s:1. Carlson S, Jones J, Brown M, Hess C. Prevention of hyperbaric-associated middle ear barotrauma. Annals of Emergency Medicine 1992; 21:1468-1471.
Clinical Scenario:A patient presents for hyperbaric oxygen therapy. We wondered if topical nasal decongestants would decrease the incidence of aural barotrauma.
Three-part Question:In patients undergoing hyperbaric oxygen therapy, does the pre-hyperbaric use of topical nasal decongestant compared to no specific pre-treatment, result in less middle ear barotrauma?
Search Terms:ear, middle, barotrauma, nasal decongestants
The Study:Double-blinded concealed randomised controlled trial with intention-to-treat. Adults requiring hyperbaric therapy for acute carbon monoxide poisoning and able to make informed consent.
Control group (N = 30; 30 analysed):Two sprays of sterile water into each nostril at least 15 minutes prior to hyperbaric exposure at 2.4 ATA.
Experimental group (N = 30; 30 analysed):Two sprays of oxymetazoline hydrochloride into each nostril at least 15 minutes prior to hyperbaric exposure at 2.4 ATA.
The Evidence:
Outcome |
Water group |
Oxymet group |
Relative risk increase |
Absolute risk increase |
NNH |
|
Teed score > zero after treatment |
0.4 |
0.47 |
17% |
0.067 |
15 |
95% CI: |
-46% to 79% |
-0.18 to 0.32 |
NNH 3 to INF NNT 5 to INF | ||
|
Ear pain on compression |
0.2 |
0.3 |
50% |
0.1 |
10 |
95% CI: |
-59% to 100% |
-0.12 to 0.32 |
NNH 3 to INF NNT 8 to INF | ||
|
Asymptomatic compression |
0.333 |
0.367 |
10% |
-0.034 |
29 |
95% CI: |
-62% to 83% |
-0.21 to 0.28 |
NNH 4 to INF NNT 5 to INF | ||
Comments:
1. Well-designed study with 80% power to detect 50% reduction in the incidence of barotrauma.
2. All CO poisoned patients, probably treated in a monoplace chamber.
3. Most patients experienced some discomfort in the ears.
4. Compression rate not specified.
Appraised by:Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales HospitalSydney; Thursday, 04 February, 1999
Expiry date:June 2022
