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Author: admin | 28.06.2014 | Category: Ringing Of The Ears Treatment

OBJECTIVE: To analyze the association of insuflation maneuvers status before hyperbaric oxygen therapy with middle ear barotrauma.
MATERIALS AND METHODS: Fouty-one patients (82 ears) admitted to the Department of Hyperbaric Medicine from May 2011 to July 2012. RESULTS: Of the 82 ears included in the study, 32 (39%) had barotrauma after the first session.
CONCLUSION: Positive Valsalva and Toynbee maneuvers before the first session, alone or associated were protective factors for middle ear barotrauma by ear after the first session. The Hyperbaric Oxygen Therapy (HBOT) is an accepted treatment modality for primary and adjuvant treatment of various diseases1,2. Symptoms range from discomfort, ear pain, ear fullness, hearing loss, tinnitus and even otorrhagia2,3,6. There are conflicting opinions regarding the role of the Eustachian tube (ET) in the occurrence of MEB7. The role of self-insuflation maneuvers (Valsalva and Toynbee) status before HBOT is controversial and many authors have used tubal function tests instead, to try to predict MEB. This research was conducted to analyze the relevance of insuflation maneuvers status before hyperbaric oxygen therapy in order to stratify patients into similar categories of MEB risk. The study group consisted of 41 patients (82 ears) admitted to the Hyperbaric Medicine Department at Brasilia Armed Force Hospital, from May 2011 to July 2012, for the treatment of various diseases. Inclusion criteria: all patients undergoing HBOT evaluated by an otolaryngologist before and after the first session, with no history of ear disease. Were considered ear diseases for purposes of exclusion: chronic otitis media, history of previous otologic operations such as tympanostomy, tympanoplasty or mastoidectomy. The sample was selected by convenience respecting the free choice of the patient to participate (with signing of informed consent term). The equipment used for HBOT was a Seaway Diver multiplace chamber with eight places, model A-240. Videootoscopy was performed and recorded with the intent of reducing the interobserver difference in the degree of evaluated barotrauma. Tympanostomy with Ventilation tubes (VT) placement was heldin MEB grades 3 and 4 and in cases of severe pain in grade 2.
To perform the Valsalva maneuver, patients were instructed to pinch the nostrils and inflate the cheeks through forced expiration with the mouth closed until a sensation of fullness was achieved in the ears. Besides the evaluation of each maneuver (Valsalva and Toynbee) separately, it was evaluated the result of the combined two maneuvers by ear. In the analysis of the Valsalva maneuver by patient, the subjects were classified into Inflaters and Non-inflaters. After the first session of HBOT, there were 22 patients with MEB (53.65%), 12 unilateral and 10 bilateral. In the present study, the refractory ulcers were the main indication for HBOT (29.3%) (Figure 3). There was no correlation of reported nasal obstruction before the first session with MEB after the first session. Further analysis tested whether the insuflation categorized as symmetric or asymmetric had any association with MEB (Table 2).
As in the present study, Diaz Caparros10 reported that the refractory ulcers constituted the major indication for HBOT in his sample (73.8%). In the present study there was a correlation with both positive Valsalva or Toynbee maneuvers before the first session with the absence of MEB after the first session.
Igarashi et al.11 evaluated the findings of the Valsalva maneuver prior to the beginning of HBOT (easy or difficult maneuver) and found no correlation with MEB. Beuerlein et al.1, in a prospective study, compared MEB incidence in auto-inflaters (which could lateralizate the TM during the Valsalva maneuver attested by otoscopy) and non-inflaters (comatose patients with artificial airways or patients who failed to perform Valsalva maneuver).
In this study patients were divided into auto-inflaters (by similar criterion used by Beuerlein et al.1) and non-inflaters (patients who could not perform the Valsalva maneuver). Although no association has been found between asymmetric tubal insufflation and increased MEB rate, there was a strong tendency in this direction that can be further investigated in future studies.
4 Specialist in Otology and Neurotology by Harvard Medical School, Boston, MA, USA, PhD in Medical Sciences from the University of Brasilia, Professor at Health Sciences School - University of Brasilia - Brasilia - DF - Brazil.
Paper submitted to the ITJ-SGP (Publishing Management System) on August 28, 2013; and accepted on September 28, 2013. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Conde Nast. It's hard to believe that at such slow speeds your body can become injured, but researchers recently conducted low speed rear impact tests and concluded that 29% of people developed symptoms related to whiplash at speeds of just 2.5 mph.
Keep in mind, the speed of the collision does not correlate to the degree of injury your body may sustain.
It is recommended to make an appointment for a simple consultation and exam just to make sure that you do not have any a€?hiddena€™ injuries. Depending upon your rating and the severity of the injuries, you may be entitled to monthly or even lifetime care.
You may also be entitled to a dollar amount settlement (to be determined by a personal injury attorney who reviews your case with the treating doctors).
Whether obtaining legal representation may be in your best interest, and if so recommend some excellent attorneys. Injuries commonly sustained from auto accidents are usually soft tissue injuries, which are typically spine related (such as disc or ligament damage). Doctors of chiropractic are educated with a heavy emphasis on diagnosis and treatment of conditions related to the musculoskeletal system (the muscles, ligaments and joints of the spine and extremities) and the nerves that supply them. Treatments can last anywhere from a few weeks to a few months depending on the severity of the injuries, and involve a hands-on approach to care. The reason that so many people turn to chiropractic care is because it is an alternative form of treatment that manipulates the spine and neck to improve the condition as minimally invasive as possible.
Whiplash injury is one of the leading causes of disability and loss of productive years of life because it affect so many people early in life.
Disc herniation or ligament injury of the spine may exist in addition to the soft tissue injury.


Whiplash injuries not only increase the incidence of chronic neck and shoulder pain, it also significantly increases the incidence of other systemic ill health effects.
Traumatic Brain Injuries (TBI) are a leading cause of death and disability in the United States, and car accidents are one of the leading causes of TBIs. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for more than 40% of new spinal cord injuries each year.
Whiplash is the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in short or long-term disability.
Whiplash injuries have been extensively studied and researched years; there are thousands of scientific studies describing every aspect of injuries, vehicle dynamics, short term affects, and long term consequences.
Traumatic Brain Injury can cause any of a number of physical, cognitive and emotional symptoms. If you have any of these symptoms after a whiplash injury, especially if they persist for more than a few days, you should be evaluated to see if you have a Traumatic Brain Injury (TBI). Seatbelt and shoulder harness webbing are designed to hold you safely in your seat and away from steering wheels, dashboards, and windshields. Side impact collisions are particularly dangerous because the driver or passenger has little in the way of structural protection in the event of a near-side impact. Upon impact, the target vehicle begins to move forward into the occupant, making contact through the seat back.
Any stored energy in the seat back from its deflection (usually about 5-15 degrees) will be released as the occupant begins to move forward into the re-entry phase. Depending on the initial position of the occupant with respect to safety harnesses, the lap and shoulder portions will eventually restrain the forward moving torso which will effectively aggravate the neck's bending moment since the forward moving head's inertia again is behaving in accordance with Newton's 1st law of motion-this time in the forward (x) direction with some angular momentum and acceleration. If you have had a recent accident, please bring your accident report, your PI lawyers contact information (if you have a lawyer representing you), your auto medical pay information, and any other information that may assist Dr.
If you or the other party does not have auto medical pay and you have been hurt in an auto, you will need to retain a personal injury attorney to represent you (Dr. HBOT is not without risks and the middle ear barotrauma (MEB) is its most common side effect3,4. Some authors advocate tube dysfunction as the primary risk factor for this condition1,8-10. Otoscopy persists as the most reliable method for detecting changes in the ME induced by HBOT2,7,12. It was attempted to make an otolaryngological profile of patients undergoing HBOT, in order to establish more accurate protocols for the prevention and treatment of MEB.
During the evaluations were performed: otoscopy with Valsalva and Toynbee maneuvers, video otoscopy and specific questionnaire. When there were signs of MEB on otoscopy, self-inflating maneuvers were not realized after the sessions, to prevent pain or discomfort. Were excluded 3 patients who required bilateral VT placement before the beginning of sessions and a patient who already had bilateral VT, totaling 4 exclusions. It was adopted a standardized treatment protocol which consisted of one session per day (5 days per week) (Figure 1).Were included both inpatients and outpatients. To accomplish the Toynbee maneuver, the patients were asked to swallow while pinching the nostrils. The following groups of ears were obtained: those with positive Valsalva and Toynbee maneuvers, those with only one positive maneuver (Valsalva or Toynbee), those with negative Valsalva and Toynbee maneuvers. To be considered Inflater the patient should perform the Valsalva maneuver successfully in both ears. Patients were divided into three groups: those patients who could perform the maneuver Toynbee in both ears, those who could not perform the Toynbee maneuver in both ears, and those who could do it unilaterally. It was obtained 4 maneuvers per subject that were categorized as: 4 positive maneuvers (Valsalva and Toynbee maneuvers positive bilaterally), 3 positive maneuvers and 1 negative, 2 positive and 2 negative maneuvers, 1 positive and 3 negative maneuvers, 4 negative maneuvers (Valsalva and Toynbee maneuvers negative bilaterally).
The number of sessions per patient ranged from 1 to 100 sessions, with an average of 28.46 sessions.
Unlike this study, these authors found no influence of history of allergic rhinitis in MEB.
Bessereau et al.5 reported the same incidence of MEB in patients who did or didn't perform the Valsalva maneuver. But the finding was not statistically significant given the small number of non-inflaters (n = 3, 2 intubated patients and 1 with tracheostomy).
Counteracting the opinion of several authors, it is believed that the capacity of self-insuflation (by Valsalva and Toynbee maneuvers) is relevant and should be evaluated before HBOT. It has been shown that a 10 mph rear end collision can produce up to 9 G's of force in your neck! This is an impressive number given that the National Safety Council (NSC) has determined there to be more than 12 million MVA's annually involving more than 20 million vehicles. Green and by a board certified medical doctor, who together can place an impairment rating on your injury, which ultimately places a value on your injury case.
These painful conditions often either involve or impact the nervous system, which can cause referred pain and dysfunction. A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. The resulting damage affects ligaments in the neck or back which is the primary source of pain. The spine, usually the head and neck, was unexpectedly thrown very quickly in one direction and then rebounded in the opposite direction.
It is characterized by a collection of sysmptoms caused by a rapid movement of the head backward, forward or side to side. Auto collisions cause injury to the spine, which has long term consequences that will lead to degenerative changes within two years.
Of course, not every patient will have all of these symptoms, and some patients will have symptoms not listed here. Frontal crashes at lower to moderate speeds are highly survivable, however, when restraints are not worn, the results of a crash are predicted by Newton's first law of motion. And, under significant loading, they will stretch a small amount, allowing additional ride down.


Seat backs, shoulder harnesses, and head restraints offer little protection in these crashes. This has the effect of further flexing the upper cervical spine and hyperextending the lower cervical spine (primarily the C5-6 segments) and the spine assumes an S-shaped configuration The head also is induced to extend along with the neck as the head takes up the backset distance during the head lag phase. Lower cervical hyperextension during the S-shaped phase is also likely to be associated with injury. Green is one of the only chiropractors in the State of Indiana who is certified in Colossus, the software used specifically by auto insurance adjustors to value injury claims.
Green is certified in whiplash and brain traumatology; is an expert witness for auto accidents, as well as an accident reconstructionist. Green will work with your personal injury attorney from your initial treatment through testifying in court on your behalf. Green will review your films in x-rays to determine any issues with your spine, hips, neck, extremities (knees, hands, etc.), which may be the cause of your pain or discomfort.
Green has reviewed you history, symptoms and x-rays, he will go over a suggested treatment plan. In both cases, the patient underwent maneuvers during otoscopy, allowing the examiner to assess the movement of the TM.
Using these categories, the insuflation of each ear was rated respectively as: Good, Medium and Bad. The group of Non-inflaters was then constituted by two subgroups: those who could not perform the Valsalva maneuver in both ears, and those who could do it unilaterally. Using these categories the insuflation of each patient was rated respectively as: Good, Medium (for 3 intermediate categories) and Bad. As the diagnosis of allergic rhinitis was based on patients self-reporting, it is subject to bias, which may have result in this unexpected finding of inverse correlation with MEB. By grouping the results of the two tests, the correlation was even better (P = 0.013) with good differentiation of MEB rates by ear between the three categories of tubal insuflation.
They attribute this finding to patients who perform ineffective Valsalva maneuvers, which would be under increased risk of MEB.
The authors conclude that the non-inflaters have increased risk for MEB and therefore recommends prophylactic VT placement in patients with artificial airways and in patients with tubal dysfunction who do not respond to medical therapy. There are insufficient studies to evaluate the risk of MEB in non-inflaters without airway alterations or altered state of consciousness.
Does the slow compression technique of hyperbaric oxygen therapy decrease the incidence of middle-ear barotrauma?
Eustachian tube function and middle ear barotrauma associated with extremes in atmospheric pressure. Estudio del barotraumas de oido medio en pacientes sometidos a tratamiento con oxigenoterapia hiperbarica. Evaluation of predive parameters related to eustachian tube dysfunction for symptomatic middle ear barotrauma in divers. Side airbags, which may be mounted in the B-pillar, overhead, or the seat back itself, provide some measure of protection in side impact crashes. Global hyperextension of the neck can occur, depending on head restraint geometry, but we and other researchers have produced injuries in volunteers well within the normal physiological range of motion of the neck. He understands how to correctly diagnose and document auto injuries so that you recieve the medical attention you need to recover. He has experience treating severe whiplash injuries, concussions, and many other musculo-skeletal injuries caused by auto injuries.
Its incidence ranges from 8 to 68.7% and achieves up to 91% in patients unable to auto-inflate their middle ear (ME)5. During the Valsalva maneuver was expected lateralization of TM and during the Toynbee maneuver, its medialization. In the studies evaluated it hasn't been described if the auto-inflator can perform the Valsalva maneuver successfully in both ears or in just one. Green will determine what type of injuries you may have sustained, usually through a series of range of motion tests and X-rays. So, in a 25 mph collision, when your car strikes an immovable object and stops, your body will continue forward at 25 mph until it is acted upon by your car's interior parts. In more severe crashes, the primary risk is to thoracic and abdominal viscera (internal body cavity), as well as to the head. It is also possible that further injury can occur during the forward phase, and this is somewhat more likely in females (and small males) because of their lower inertia and higher resulting acceleration.
Green will show you any misalignments, whiplash injuries, bone spurs, disc dengeneration or other disc diseases, etc. Tubal insuflation was classified in Good, Median and Bad according to combined results of Valsalva and Toynbee maneuvers. When these outcomes occurred maneuvers were classified as positive and otherwise as negative.
In this study, to be considered auto-inflater, the patient should perform the Valsalva maneuver successfully in both ears. As the vertical force extends upwards into the neck it initiates flexion of the upper cervical motion segments and hyperextension of the lower segments. It should be pointed out that second collisions may also aggravate this second phase by imposing additional decelerative effects and accentuating neck bending moments and shear forces. Inclusion criteria: patients evaluated by an otolaryngologist before and after the first session, with no history of ear disease, who agreed to participate in the research (convenience sample). Compression then quickly gives way to tension as the upward moving head and now downward moving torso attempt to disengage.
Also, as the torso moves forward with respect to the head, significant amounts of horizontal shear force occur in the neck roughly parallel to the facet joint line. As this is initiated under conditions of compression, the overall stiffness of the neck may be diminished as a result of ligamentous slack.



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