phenylephrine-hydrochloride and Barotrauma

Orbital blowout fractures are nearly always caused by acute trauma. Non-traumatic cases of orbital blowout fractures have only been rarely described. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. The patient developed unilateral eye swelling and orbital emphysema. It is important for the clinician to investigate all suspected orbital blowout fractures with imaging and full ophthalmological examination regardless of a trauma history. Most cases of orbital emphysema resolve spontaneously, however one must always exclude compression of the central retinal artery. This may present as acute loss of vision and/or ophthalmoplegia.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Barotrauma; beta-Lactamase Inhibitors; Epistaxis; Female; Humans; Nose; Orbital Fractures; Patient Education as Topic; Referral and Consultation; Tomography, X-Ray Computed; Treatment Outcome

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

Topics: Adult; Airway Resistance; Audiometry, Pure-Tone; Barotrauma; Diving; Ear, Middle; Epithelial Cells; Female; Hearing Loss; Humans; Italy; Male; Manometry; Nose; Otitis Externa; Otoscopy; Rhinitis; Sinusitis; Time Factors

A fracture of the orbital floor as a result of nose blowing is rare and we know of only three reported cases. We present a 40-year-old man who required repair of a blowout fracture of the orbital floor as a result of vigorous nose blowing. Patients who present with acute periorbital emphysema after nose blowing require careful assessment with potential blowout fractures in mind.

Topics: Adult; Barotrauma; Diplopia; Fractures, Comminuted; Hematoma; Humans; Male; Nose; Orbital Fractures; Subcutaneous Emphysema

Topics: Aged; Anti-Bacterial Agents; Barotrauma; Humans; Male; Meningitis, Haemophilus; Nose; Pneumocephalus; Radiography; Treatment Outcome

We reviewed the records of 136 patients who had inner ear disorders including hearing loss and vertigo caused by pressure change. We divided them into three groups, according to the aetiology: group A, change in atmospheric pressure (diving, airplane travel, etc.); group B, rapid change in ear pressure in normal atmosphere (nose blowing, heavy lifting, etc.); and group C, blast injury. A flat initial audiogram was the most common type in groups A and B. In group C, high-tone hearing loss was the most common type of audiogram. These results correspond to findings previously reported in animal experiments. Exploratory tympanotomy was performed more than 12 days after the pressure change in 16 patients. Although the vertigo disappeared after surgery, hearing did not improve.

Topics: Adolescent; Adult; Aged; Animals; Audiometry; Aviation; Barotrauma; Blast Injuries; Child; Diving; Female; Hearing Disorders; Hearing Loss, High-Frequency; Hearing Loss, Sensorineural; Humans; Labyrinth Diseases; Lifting; Male; Middle Aged; Mountaineering; Nose; Pressure; Sneezing; Treatment Outcome; Tympanic Membrane; Vertigo

Topics: Adolescent; Barotrauma; Ear, Middle; Facial Nerve Injuries; Facial Paralysis; Humans; Male; Nose; Pressure

The nasal cavity and sinus system is extensive but its examination is limited. Listening to breathing and respiration can afford useful clues to underlying abnormality. Examination of the nasal cavity may reveal the pale swollen mucosa of allergic rhinitis or the overdeveloped lining seen in perennial rhinorrhoea and hypertropic rhinitis. Localised hypertrophy gives rise to the nasal polyp which usually forms in the region of the ethmoid sinus. Atrophic rhinitis is a destructive condition of the nasal lining. Sinusitis may be open or closed, presenting with localised pain and displacement of the eye in the case of frontal or ethmoidal abscess or mucocoele. Deformities of the external nose or nasal septum are often encountered during examination. Epistaxis may be caused by bleeding simply from Kiesselbach's vessels, or may be an early feature of telangiectasia or cardiovascular diseases. Tumors are rarely found but include papillomata and the mucous membrane melanoma.

Topics: Aerospace Medicine; Barotrauma; Epistaxis; Humans; Nose; Nose Diseases; Nose Neoplasms; Otitis; Rhinitis; Sinusitis

Topics: Barotrauma; Ear, Inner; Fistula; Labyrinth Diseases; Membranes; Nose; Rupture

Chinchillas were colonized intranasally with type 7F Streptococcus pneumoniae, and pneumococcal otitis media developed in greater than 50% of the animals during the first week after negative middle ear pressure (-25 mm Hg) was briefly applied. Twenty-three chinchillas were vaccinated subcutaneously with the capsular polysaccharde of type 7F S. pneumoniae to determine whether vaccination could prevent the development of experimental otitis media. Following vaccination, 14 animals seroconverted with at least a twofold rise in serum antibody concentration; nine animals that were vaccinated did not seroconvert. All of 23 vaccinated animals and 42 of 42 unvaccinated control animals became colonized after intranasal inoculation with pneumococci. Only one (7%) of the vaccinated seroconverting animals developed pneumococcal otitis media, whereas 26 (62%) of the control animals developed middle ear infection with type 7F pneumococci. Four (44%) of nine vaccinated nonseroconverting animals developed pneumococcal otitis media. Protection was associated with high levels of serum antibody prior to intranasal inoculation. Higher antibody levels were found in sterile middle ear effusions than in S. pneumoniae-infected effusions. Vaccination with type 7F pneumococcal capsular polysaccharide significantly reduced the incidence of pneumococcal otitis media following intranasal inoculation of type 7F S. pneumoniae in chinchillas.

Topics: Animals; Antibodies, Bacterial; Bacterial Vaccines; Barotrauma; Chinchilla; Ear, Middle; Nose; Otitis Media; Polysaccharides, Bacterial; Streptococcus pneumoniae