We hypothesized the following: (1) MRI can depict otic and sinus barotrauma, (2) MRI can differentiate otic and sinus barotrauma from acute otitis media and sinusitis, and (3) MRI can be used to follow the progress of otic and sinus barotrauma.įrom January 2010 to March 2012, a computer search identified 90 patients with CO-poisoning who underwent head MRI at our institution to predict delayed encephalopathy.
We conducted this study to retrospectively investigate otic and sinus barotrauma by MRI. To our knowledge, no studies have investigated the MRI abnormalities of otic and sinus barotrauma. MRI is available to depict the early and subtle mucosal changes of the middle ear and paranasal sinuses, and it has the potential to observe otic and sinus barotrauma. Segev et al reported that frontal sinus barotrauma of a flight passenger showed hyperintensity on both T1WI and T2WI sequences, which was consistent with subacute submucosal hemorrhage. Mucosal thickening in paranasal sinuses exceeding 3 mm is considered abnormal –. MRI can also be used to investigate the abnormalities of sinuses. On MR images, air and bone are black, and it is easy to distinguish air or bone from mucosal edema or hemorrhage. Some studies have reported the MRI findings of temporal bone abnormalities –. Owing to its high sensitivity to water and fluid on T2-weighted imaging (T2WI) and high sensitivity to hemorrhage on T2WI, magnetic resonance imaging (MRI) has advantages for observing the abnormalities of the middle ear and paranasal sinuses, such as mucosal edema, fluid exudation and subperiosteal hemorrhage. Therefore, early diagnosis and differential diagnosis are important to relieve early symptoms and prevent disease progression. This situation may lead to a misdiagnosis and/or delay in diagnosis and treatment. Patients with CO- poisoning and with reduced sensory and cognitive function may have no or slight symptoms of otic and sinus barotrauma after HBO therapy. The treatments depend on the symptoms and clinical examinations, such as temporary cessation of HBO therapy and the use of decongestants and antibiotics occasionally, functional middle ear or sinus surgery is needed –. Sinus barotrauma can cause headache, pain and fullness in the sinuses.The diagnosis is based on symptoms and otoscopy or rhinoscopy. Otic barotrauma can cause many discomforts, such as tinnitus, hearing loss, pain and fullness in the sinus and middle ear, and even tympanic membrane perforation. When the eustachian tube or sinus ostia is blocked or the pressure change exceeds the capacity of its regulation, otic and sinus barotrauma occurs –. Under normal conditions, the eustachian tube must open to eliminate the pressure difference between the internal and ambient environments.
Otic barotrauma is one of the most common barotraumas after HBO therapy and is sometimes accompanied by sinus barotraumas –. Pressure changes can affect the ears, the sinuses, and the lungs, resulting in injury. According to Boyle’s law, a primary change in environmental pressure results in an inverse change in volume. Barotrauma is defined as tissue damage resulting from the direct effects of pressure –. Although patients with CO-poisoning could benefit from the therapy, the side effects, such as barotrauma, should not be overlooked. It is useful to decrease the incidence of delayed neuropsychologic sequelae in patients with CO-poisoning –. HBO therapy has been used widely in clinical practice.
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