Study objectives: Hyperbaric oxygen therapy (HBOT) has been used for many years for multiple disease processes. One of the most frequently encountered adverse effects of this treatment is otic barotrauma resulting from atmospheric pressure changes. We determine whether patients with specific disease processes are at increased risk for barotrauma during HBOT.

Methods: Historical and clinical data were obtained from January 2000 to December 2003 by a computerized tracking system. The hyperbaric facility is based at a suburban hospital with an emergency medicine residency program. HBOTs are on an emergency and nonemergency basis. Statistical analysis based on treatment indication was performed. Requirement of myringotomy tubes (tubes) was considered “significant” otic barotrauma. Excluded were 13 patients who received tubes before HBOT. Statistical tests used were 95% confidence intervals (CIs) and Fisher exact test as indicated.

Results: Two hundred sixty-five patients were screened, 62% were male patients, and median age was 59 years (data available from 95% of patients); 252 patients met inclusion criteria. Forty-one (16%) patients overall (95% CI 2% to 30%) required tube placement. Tubes were not required in patients with air embolism, CO poisoning, gas gangrene, decompression sickness, or arterial insufficiency. Five percent of patients with necrotizing soft tissue infection (P=.33), 11% of patients with failed/threatened graft (P=.28), 17% of patients with chronic refractory osteomyelitis (P=.80), 22% of patients with problem wounds (P=.4), 22% of patients with soft tissue radionecrosis or osteoradionecrosis (P=.07), and 50% of patients with crush injury (P=.03) required tubes. With subset analysis based on radionecrosis or osteoradionecrosis affecting head and neck (57 patients), 28% of patients required tubes (P=.013). Eighteen percent (22/120) of patients treated at 2.0 atmospheres absolute (ATA) compared with 14% (19/132; P=.49) of patients in the greater than 2.0 ATA group required tubes.

Conclusion: A moderate number of patients overall required tubes. Those patients with head and neck radiation and crush injury were at a significantly increased risk for otic barotrauma. No correlation about depth of treatment was demonstrated.