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.


Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 04 February, 1999

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 rate
Oxymet group rate
Relative risk increase
Absolute risk increase
NNH
Teed score > zero after treatment
0.4
0.467
17%
0.067
15
95% CI:


-46% to 79%
-0.183to 0.317
NNH = 3 to INF NNT = 5to INF
Ear pain on compression
0.2
0.300
50%
0.100
10
95% CI:


-59% to 100%
-0.118 to 0.318
NNH = 3 to INF NNT = 8 to INF
Asymptomatic compression
0.333
0.367
10%
-0.034
29
95% CI:


-62% to 83%
-0.207 to 0.275
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.

Expiry date: June 2020
References: 1. Carlson S, Jones J, Brown M, Hess C. Prevention of hyperbaric-associated middle ear barotrauma. Annals of Emergency Medicine 1992; 21:1468-1471.



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