Barotrauma

Barotrauma, otitic & Barotrauma, sinus
Classification and external resources
ICD-10 T70.0, T70.1
ICD-9 993.0, 993.1
DiseasesDB 3491
eMedicine emerg/53
MeSH D001469

Barotrauma is physical damage to body tissues caused by a difference in pressure between an air space inside or beside the body and the surrounding fluid.[1][2]

Barotrauma typically occurs to air spaces within a body when that body moves to or from a higher pressure environment, such as when a SCUBA diver, a free-diving diver or an airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel. Boyle's law defines the relationship between the volume of the air space and the ambient pressure.

Damage occurs in the tissues around the body's air spaces because gases are compressible and the tissues are not. During increases in ambient pressure, the internal air space provides the surrounding tissues with little support to resist the higher external pressure. During decreases in ambient pressure, the higher pressure of the gas inside the air spaces causes damage to the surrounding tissues if that gas becomes trapped.

Contents

Types of injury

Examples of organs or tissues easily damaged by barotrauma are:

Diving barotrauma

Ear barotrauma

Barotrauma can affect the external, middle, or inner ear. Middle ear barotrauma (MEBT) is the most common being experienced by between 10% and 30% of divers and is due to insufficient equilibration of the middle ear. External ear barotrauma may occur on ascent if high pressure air is trapped in the external auditory canal either by tight fitting SCUBA equipment or ear wax. Inner ear barotrauma (IEBT) though much less common than MEBT shares a similar mechanism. Mechanical trauma to the inner ear can lead to varying degrees of conductive and sensorineural hearing loss as well as vertigo.[19]

Barosinusitis

The sinuses similar to other air filled cavities are susceptible to barotrauma if their openings become obstructed. This can result in pain as well as epistaxis.[20]

Mask squeeze

If a diver's mask is not equalized during descent the relative negative pressure can produce petechial hemorrhages in the area covered by the mask along with subconjunctival hemorrhages.[20]

Pulmonary barotrauma

Pulmonary (lung) pressure damage in scuba divers is usually caused by breath-holding on ascent. The compressed gas in the lungs expands as the ambient pressure decreases causing the lungs to over expand and rupture unless the diver breathes out. The lungs do not sense pain when over-expanded giving the diver little warning to prevent the injury. This does not affect breath-hold skin divers as they bring a lungfull of air with them from the surface, which merely re-expands safely to near its original volume on ascent. The problem only arises if a breath of compressed gas is taken at depth, which will then expand on ascent to more than the lung volume. Pulmonary barotrauma may also be caused by explosive decompression of a pressurised aircraft.

Causes

When diving, the pressure differences needed to cause the barotrauma come from two sources:

Avoidance and treatment

Diving barotrauma can be avoided by eliminating any pressure differences acting on the tissue or organ by equalizing the pressure. There are a variety of techniques:

Following barotrauma of the ears or lungs from diving the diver should not dive again until thoroughly cleared by a doctor, which can take many months. [22]

Use of a hyperbaric chamber. Patients undergoing hyperbaric oxygen therapy must learn to equalize in order to avoid barotrauma.[23] Some patients may be at greater risk of otic barotrauma than others.[23]

Blast induced barotrauma

An explosive blast and explosive decompression create a pressure wave that can induce barotrauma. The difference in pressure between internal organs and the outer surface of the body causes injuries to internal organs that contain gas, such as the lungs, gastrointestinal tract, and ear.[24]

Lung injuries can also occur during rapid decompression, although the risk of injury is lower than with explosive decompression.[25][26]

Ventilator induced barotrauma

Mechanical ventilation can lead to barotrauma of the lungs. This can be due to either:

The resultant alveolar rupture can lead to pneumothorax, pulmonary interstitial emphysema (PIE) and pneumomediastinum.

Industry-related barotrauma in animals

Bats suffer fatal barotrauma around wind farms due to their tiny, mammalian lungs and in contrast with Avian lungs.[27]

See also

References

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  2. ^ a b c d e f Brubakk, A. O.; T. S. Neuman (2003). Bennett and Elliott's physiology and medicine of diving, 5th Rev ed.. United States: Saunders Ltd.. pp. 800. ISBN 0702025712. 
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  21. ^ Bolognini A, Delehaye E, Cau M, Cosso L (2008). "Barotraumatic orbital emphysema of rhinogenic origin in a breath-hold diver: a case report". Undersea and Hyperbaric Medicine 35 (3): 163–7. PMID 18619111. http://archive.rubicon-foundation.org/8090. Retrieved 2009-08-07. 
  22. ^ Life effects of Barotrauma at the American Hearing Research Foundation
  23. ^ a b Lehm Jan P, Bennett Michael H (2003). "Predictors of middle ear barotrauma associated with hyperbaric oxygen therapy". South Pacific Underwater Medicine Society Journal 33: 127–133. http://archive.rubicon-foundation.org/8076. Retrieved 2009-07-15. 
  24. ^ Torkki, Markus; Virve Koljonen, Kirsi Sillanpää1, Erkki Tukiainen, Sari Pyörälä, Esko Kemppainen, Juha Kalske, Eero Arajärvi, Ulla Keränen, Eero Hirvensalo (August 2006). "Triage in a Bomb Disaster with 166 Casualties". European Journal of Trauma 32 (4): 374–80. doi:10.1007/s00068-006-6039-8. 
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  27. ^ The Times, 26 August 2008, Wind farms cause thousands of bats to die from trauma