Difference between revisions of "Carlson"

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'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The topical nasal decongestant, oxymetazoline, did not reduce the rate of middle-ear barotrauma in patients having hyperbaric oxygen therapy.</span>'''
 
  
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<span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;">
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">The topical nasal decongestant oxymetazoline did not reduce the rate of middle-ear barotrauma in patients having hyperbaric oxygen therapy.</span></span>'''</span>
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<span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Clinical Bottom Line:</span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. No evidence that topical decongestants reduce middle ear barotrauma.</span></span>
 
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</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Appraised by:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Sydney; Thursday, 04 February, 1999</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Clinical Scenario:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> A patient presents for hyperbaric oxygen therapy. We wondered if topical nasal decongestants would decrease the incidence of aural barotrauma.</span>
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Bottom Line:</span></span>'''</span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Three-part Question:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> 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?</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Search Terms:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> ear, middle, barotrauma, nasal decongestants</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The Study:</span>'''
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#<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">No evidence that topical decongestants reduce middle ear barotrauma during hyperbaric therapy.</span></span></span>  
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Adults requiring hyperbaric therapy for acute carbon monoxide poisoning and able to make informed consent.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">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.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">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.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">The Evidence:</span>'''
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{|
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Water group rate</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Oxymet group rate</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Relative risk increase</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Absolute risk increase</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">NNH</span>'''</span></span>  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Citation/s:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Carlson S, Jones J, Brown M, Hess C. Prevention of hyperbaric-associated middle ear barotrauma. Annals of Emergency Medicine 1992; 21:1468-1471.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Scenario:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">A patient presents for hyperbaric oxygen therapy. We wondered if topical nasal decongestants would decrease the incidence of aural barotrauma.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Three-part Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">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?</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">ear, middle, barotrauma, nasal decongestants</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">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.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group (N = 30; 30 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Two sprays of sterile water into each nostril at least 15 minutes prior to hyperbaric exposure at 2.4 ATA.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Experimental group (N = 30; 30 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Two sprays of oxymetazoline hydrochloride into each nostril at least 15 minutes prior to hyperbaric exposure at 2.4 ATA.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Evidence:</span></span>'''</span>
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{| class="Table" style="border:solid windowtext 1.0pt"
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Teed score > zero after treatment</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.4</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.467</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">17%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.067</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">15</span></span>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Water group</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Oxymet group</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative risk increase</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute risk increase</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNH</span></span>'''</span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">95% CI:</span>'''</span></span> ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-46% to 79%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-0.183to 0.317</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNH ''' 3 to INF </span></span><span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNT = 5to INF</span></span>  
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| rowspan="2" style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Teed score > zero after treatment</span></span>'''</span>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.4</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.47</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">17%</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.067</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">15</span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Ear pain on compression</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.2</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.300</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">50%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.100</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">10</span></span>  
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| colspan="2" style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-46% to 79%</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.18 to 0.32</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNH 3 to INF</span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 5 to INF</span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">95% CI:</span>'''</span></span> ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-59% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-0.118 to 0.318</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNH ''' 3 to INF </span></span><span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNT = 8 to INF</span></span>  
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| rowspan="2" style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Ear pain on compression</span></span>'''</span>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.2</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.3</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">50%</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.1</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">10</span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Asymptomatic compression</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.333</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">0.367</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">10%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-0.034</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">29</span></span>  
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| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
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| style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-59% to 100%</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.12 to 0.32</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNH 3 to INF</span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 8 to INF</span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">95% CI:</span>'''</span></span> ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-62% to 83%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">-0.207 to 0.275</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNH ''' 4 to INF </span></span><span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px; text-align: center;">NNT = 5 to INF</span></span>  
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| rowspan="2" style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Asymptomatic compression</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.333</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.367</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">10%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.034</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">29</span></span></span></p>  
 
|-
 
|-
 +
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 +
| style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-62% to 83%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.21 to 0.28</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNH 4 to INF</span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 5 to INF</span></span></span></p>
 
|}
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Comments:</span>'''
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Comments:</span></span>'''</span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. Well-designed study with 80% power to detect 50% reduction in the incidence of barotrauma.</span>
+
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">2. All CO poisoned patients, probably treated in a monoplace chamber.</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Well-designed study with 80% power to detect 50% reduction in the incidence of barotrauma.</span></span></span>
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">3. Most patients experienced some discomfort in the ears.</span>
+
 
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">4. Compression rate not specified.</span>
+
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. All CO poisoned patients, probably treated in a monoplace chamber.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. Most patients experienced some discomfort in the ears.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">4. Compression rate not specified.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital</span></span><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Sydney; Thursday, 04 February, 1999</span></span></span>
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Expiry date</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">: June 2020</span>
+
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Expiry date:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">June 2022</span></span></span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">References: </span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. Carlson S, Jones J, Brown M, Hess C. Prevention of hyperbaric-associated middle ear barotrauma. Annals of Emergency Medicine 1992; 21:1468-1471.</span>
 
  
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<span style="display: block; text-align: center;"><span style="font-size: 29.9px;">[[Audiovestibular | BACK]]</span></span>
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<span style="display: block; text-align: center;"><span style="font-size: 29.9px;">[[Audiovestibular|BACK]]</span></span>

Latest revision as of 01:14, 5 October 2021

The topical nasal decongestant oxymetazoline did not reduce the rate of middle-ear barotrauma in patients having hyperbaric oxygen therapy.

Clinical Bottom Line:

  1. 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

 

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