PURPOSE: Sudden sensorineural hearing loss (SSNHL) is a time-sensitive urgent condition. The aim of this study was to evaluate the frequency of hearing improvement in patients with idiopathic SSNHL who only received hype...PURPOSE: Sudden sensorineural hearing loss (SSNHL) is a time-sensitive urgent condition. The aim of this study was to evaluate the frequency of hearing improvement in patients with idiopathic SSNHL who only received hyperbaric oxygen (HBO2) therapy within three days of symptom onset, instead of conventional corticosteroid treatment. METHODS: The medical charts of patients who experienced SSNHL between January 1, 2012, and December 31, 2021, were reviewed. The present study included all adult patients who were diagnosed with idiopathic SSNHL and started HBO2 therapy within 72 hours of symptom onset. These subjects did not take corticosteroids due to contraindications or because they were concerned about possible side effects. The HBO2 therapy protocol consisted of at least 10 sessions of 85 minutes each with pure oxygen inhalation at 2.5 atmospheres absolute pressure. RESULTS: Overall, 49 subjects (26 males and 23 females) met the inclusion criteria, with a mean age of 47 (± 20.4) years. The mean initial hearing threshold was 69.8 dB (±18.0). After HBO2 therapy, complete hearing recovery was observed in 35 patients (71.4%), and the mean hearing threshold improved significantly (p≺0.001) to 31.4 dB (±24.5). In patients with complete hearing recovery, no significant differences were found between males and females (p=0.79), right and left ears (p=0.72) or initial grades of hearing loss (p=0.90). CONCLUSION: This study suggests that, in the absence of the confounding effect of concurrent steroid therapy, starting HBO2 therapy within three days of symptom onset could have a positive impact on patients with idiopathic SSNHL.
On November 9, 1963, a coal dust explosion occurred at the Miike Mikawa Coal Mine (Omuta, Kyushu Region of Japan). This resulted in a massive release of carbon monoxide (CO) gas that resulted in 458 fatalities and 839 vi...On November 9, 1963, a coal dust explosion occurred at the Miike Mikawa Coal Mine (Omuta, Kyushu Region of Japan). This resulted in a massive release of carbon monoxide (CO) gas that resulted in 458 fatalities and 839 victims of CO poisoning. After the accident, the Department of Neuropsychiatry, Kumamoto University School of Medicine (including the authors) immediately began to conduct periodic medical examinations of the victims. Such a long-term follow up of so many CO-poisoned patients is globally unprecedented. When the Miike Mine was closed in March of 1997, 33 years after the disaster, we conducted the final follow-up study.
INTRODUCTION: In fatal accidents during scuba diving, it is necessary to differentiate a death from primary drowning from a secondary drowning death that is primarily due to other etiopathogenetic factors. The inhalation...INTRODUCTION: In fatal accidents during scuba diving, it is necessary to differentiate a death from primary drowning from a secondary drowning death that is primarily due to other etiopathogenetic factors. The inhalation of water can only be the end point of a series of events capable of causing the diver's exitus. This study aims to demonstrate that even low-risk heart disease in daily life become potentially fatal during scuba diving. METHODS: In this case series, we describe all cases of deaths in the course of diving that came to the observation of the Forensic Institute of the University Bari over 20 years (2000-2020). A judicial autopsy was performed on all subjects, with ancillary execution of histological and toxicological investigations. RESULTS: The results of the medicolegal investigations carried out in the complex identified heart failure with acute myocardial infarction as the cause of death in four cases characterized by severe myocardiocoronarosclerosis, a primary drowning in a subject without previous pathological substrate in one case, and a terminal atrial fibrillation induced by acute dynamic heart failure due to functional overload of the right ventricle in one case. CONCLUSION: Our study demonstrates that lethal events during diving are often related to the presence of unrecognized or subclinical cardiovascular diseases. Such deaths could be prevented and avoided if a greater regulatory sensitivity to preventing and controlling diving was encouraged, considering both the inherent risks of this activity and the possible unrecognized or underestimated pathologies.
INTRODUCTION: In this study, we aimed to examine dental barotrauma and temporomandibular joint (TMJ) complaints in a large group of divers. METHODS: This survey study included scuba divers older than 18. The questionnair...INTRODUCTION: In this study, we aimed to examine dental barotrauma and temporomandibular joint (TMJ) complaints in a large group of divers. METHODS: This survey study included scuba divers older than 18. The questionnaire contained 25 questions about the demographic characteristics of divers, dental health behaviors, and diving-related dental, sinus and/or temporomandibular joint pain. RESULTS: The study group consisted of 287 instructors, recreational and commercial divers (mean age 38.96 years) (79.1% males). A total of 46% of divers reported a frequency of tooth brushing less than twice a day; 28% never receive a routine dental examination; 22.6% experienced dental pain after and/or during diving, mostly in the upper posterior teeth (40%); 17% required dental treatment; 77% of these cases are restoration fracture. TMJ symptoms after diving were statistically significantly higher in women (p=0.04). Jaw and masticatory muscle pain in the morning (p≺0.001) limitation of mouth opening (p=0.04) and joint sounds in daily life (p≺0.001) were recorded as exacerbated after diving; the results were found to be statistically significant. CONCLUSION: In our study, the localization of barodontalgia was consistent with the distribution of caries and restored tooth areas in the literature. Dive-related TMJ pain was also more common in those with pre-dive problems such as bruxism and joint noise. Our results are important to remind us of the necessity of preventive dentistry practices and early diagnosis of problems in divers. Divers should take personal precautions, such as brushing their teeth twice a day and avoiding the need for urgent treatment. The use of a personalized mouthpiece is also recommended for divers to prevent dive-related temporomandibular joint diseases.
During deep-sea freediving, many freedivers describe symptoms fairly similar to what has been related to inert gas narcosis in scuba divers. This manuscript aims to present the potential mechanisms underlying these sympt...During deep-sea freediving, many freedivers describe symptoms fairly similar to what has been related to inert gas narcosis in scuba divers. This manuscript aims to present the potential mechanisms underlying these symptoms. First, known mechanisms of narcosis are summarized while scuba diving. Then, potential underlying mechanisms involving the toxicity of gases (nitrogen, carbon dioxide and oxygen) are presented in freedivers. As the symptoms are felt during ascent, nitrogen is likely not the only gas involved. Since freedivers are frequently exposed to hypercapnic hypoxia toward the end of the dive, it is proposed that carbon dioxide and oxygen gases both play a major role. Finally, a new "hemodynamic hypothesis" based on the diving reflex is proposed in freedivers. The underlying mechanisms are undoubtedly multifactorial and therefore require further research and a new descriptive name. We propose a new term for these types of symptoms: freediving transient cognitive impairment.
The Swedish Armed Forces (SwAF) air dive tables are under revision. Currently, the air dive table from the U.S. Navy (USN) Diving Manual (DM) Rev. 6 is used with an msw-to-fsw conversion. Since 2017, the USN has been div...The Swedish Armed Forces (SwAF) air dive tables are under revision. Currently, the air dive table from the U.S. Navy (USN) Diving Manual (DM) Rev. 6 is used with an msw-to-fsw conversion. Since 2017, the USN has been diving according to USN DM rev. 7, which incorporates updated air dive tables derived from the Thalmann Exponential Linear Decompression Algorithm (EL-DCM) with VVAL79 parameters. The SwAF decided to replicate and analyze the USN table development methodology before revising their current tables. The ambition was to potentially find a table that correlates with the desired risk of decompression sickness. New compartmental parameters for the EL-DCM algorithm, called SWEN21B, were developed by applying maximum likelihood methods on 2,953 scientifically controlled direct ascent air dives with known outcomes of decompression sickness (DCS). The targeted probability of DCS for direct ascent air dives was ≤1% overall and ≤1‰ for neurological DCS (CNS-DCS). One hundred fifty-four wet validation dives were performed with air between 18 to 57 msw. Both direct ascent and decompression stop dives were conducted, resulting in incidences of two joint pain DCS (18 msw/59 minutes), one leg numbness CNS-DCS (51 msw/10 minutes with deco-stop), and nine marginal DCS cases, such as rashes and itching. A total of three DCS incidences, including one CNS-DCS, yield a predicted risk level (95% confidence interval) of 0.4-5.6% for DCS and 0.0-3.6% for CNS-DCS. Two out of three divers with DCS had patent foramen ovale. The SWEN21 table is recommended for the SwAF for air diving as it, after results from validation dives, suggests being within the desired risk levels for DCS and CNS-DCS.
This case report describes the successful management of an out-of-hospital arrest in a diver following a suspected arterial gas embolism (AGE). It illustrates both the inherent risks of diving and the importance of promp...This case report describes the successful management of an out-of-hospital arrest in a diver following a suspected arterial gas embolism (AGE). It illustrates both the inherent risks of diving and the importance of prompt and effective implementation of the "chain of survival" from bystanders. Rapid on-scene responses from paramedics and helicopter emergency medical services facilitated prompt evacuation to a Category 1 (multiplace) recompression chamber (RCC) where specialists in cardiology and hyperbaric medicine were available. Alternative causes of cardiac arrest were considered, with a presumed AGE successfully treated with multiple rounds of hyperbaric oxygen therapy. The key factors which led to this successful outcome are discussed, including early recognition and call for help, competent cardiopulmonary resuscitation, and direct evacuation to a Category 1 RCC, with additional consideration of the diagnosis leading to cardiac arrest. The case clearly illustrates the need for all those involved in diving regularly to be competent and confident in performing basic life support, as well as the awareness of the emergency services of the need for diving casualties to be treated at appropriate hyperbaric facilities. Were it not for the simple, prompt and effective treatment this diver received, both on scene and in hospital, it is highly unlikely that such a positive outcome would have been achieved.
BACKGROUND: Doppler ultrasound is used currently in decompression research for the evaluation of venous gas emboli (VGE). Estimation of heart rate from post-dive Doppler ultrasound recordings can provide a tool for the e...BACKGROUND: Doppler ultrasound is used currently in decompression research for the evaluation of venous gas emboli (VGE). Estimation of heart rate from post-dive Doppler ultrasound recordings can provide a tool for the evaluation of physiological changes from decompression stress, as well as aid in the development of automated VGE detection algorithms that relate VGE presence to cardiac activity. METHOD: An algorithm based on short-term autocorrelation was developed in MATLAB to estimate the heart rate in post-dive precordial Doppler ultrasound. The algorithm was evaluated on 21 previously acquired and labeled precordial recordings spanning Kisman-Masurel (KM) codes of 111-444 (KM I-IV) with manually derived instantaneous heart rates. RESULTS: A window size of at least two seconds was necessary for robust and accurate instantaneous heart rate estimation with a mean error of 1.56 ± 7.10 bpm. Larger window sizes improved the algorithm performance, at the cost of beat-to-beat heart rate estimates. We also found that our algorithm provides good results for low KM grade Doppler recordings with and without flexion, and high KM grades without flexion. High KM grades observed after movement produced the greatest mean absolute error of 6.12 ± 8.40 bpm. CONCLUSION: We have developed a fully automated algorithm for the estimation of heart rate in post-dive precordial Doppler ultrasound recordings.
BACKGROUND: Rheumatoid arthritis is a debilitating and destructive disease for which limited therapeutic options exist. OBJECTIVE: This report summarizes serial magnetic resonance imaging (MRI) findings from nine study p...BACKGROUND: Rheumatoid arthritis is a debilitating and destructive disease for which limited therapeutic options exist. OBJECTIVE: This report summarizes serial magnetic resonance imaging (MRI) findings from nine study participants treated with hyperbaric oxygen (HBO2) therapy and expands upon an earlier pilot study that showed improvement in disease activity and joint pain as determined by multiple, validated clinical measures. METHODS: Rheumatoid arthritis patients received 30 hyperbaric oxygen treatments over six to 10 weeks. MRI with and without contrast was completed at baseline, and at three- and six-month intervals following initiation of HBO2 therapy. Ratings were based on Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) criteria, the standard method for quantification of inflammation and damage by MRI in RA trials. RESULTS: Using RAMRIS criteria, nine of nine patients demonstrated no radiologic progression of erosions, synovitis, or bone marrow edema at three- and six-month scans. CONCLUSION: Our findings suggest that HBO2 therapy may be useful as an adjunctive or alternative treatment to disease-modifying drugs for rheumatoid arthritis.
INTRODUCTION: Deep second-degree burn injuries are the most challenging situations for the burn surgeon in the treatment of adult cases. While waiting for spontaneous closure increases the risk of hypertrophic scar and k...INTRODUCTION: Deep second-degree burn injuries are the most challenging situations for the burn surgeon in the treatment of adult cases. While waiting for spontaneous closure increases the risk of hypertrophic scar and keloid, early excision and grafting pose the risk of donor site wound and permanent color differences. Unlike many studies in the literature, the current study was planned in a way to minimize factors other than burn wounds to investigate the effect of adding hyperbaric oxygen (HBO2) therapy to conventional treatment in deep second-degree burn wounds. MATERIAL AND METHODS: This prospective observational study included patients with burn injuries who underwent conventional treatment alone and those who underwent conventional plus HBO2 treatment performed by a single experienced surgeon and who met the study criteria. RESULTS: Thirty-eight patients completed the study. Mean burned total body surface area (TBSA) was. 9.22 ± 3 43% (range 5% to 20%). There was no difference between the two groups in terms of age, burned TBSA, and burn etiology. The need for surgery and grafting was lower in patients who received HBO2 in addition to conventional treatment (p=0.003 and p=0.03, respectively). The patients in the HBO2 group had a shorter hospital stay, and their wounds epithelialized in a shorter time (p=0.169 and p≺0.001, respectively). They also had a higher satisfaction level and lower treatment cost (p=0.03 and p=0.36, respectively). DISCUSSION: The results of this prospective study, in which co-factors were eliminated, showed that adding HBO2 to the conventional treatment of deep second-degree burns had a significant positive effect on patient outcomes, as well as reducing treatment costs.
BACKGROUND AND OBJECTIVE: Hyperbaric oxygen (HBO2) has been the subject of research in many areas of dentistry. HBO2 seems to be a useable, additional treatment method. However, there are still no certain conclusions and...BACKGROUND AND OBJECTIVE: Hyperbaric oxygen (HBO2) has been the subject of research in many areas of dentistry. HBO2 seems to be a useable, additional treatment method. However, there are still no certain conclusions and clear guidelines for procedures. The aim of the study was to collect current literature assessing the use of hyperbaric oxygen therapy in the treatment of periodontitis. MATERIALS AND METHODS: The following review was performed using medical databases Medline via PubMed and Google Scholar. The review presents articles which assess the effect of hyperbaric oxygen therapy in combination with non-surgical scaling and root planing (SRP) in patients with periodontitis as an adjunctive method to standard protocols. RESULTS: There are potentially plausible mechanisms by which HBO2 could be beneficial. Further well-designed science research and clinical trials are needed. Due to a small body of literature, differences in methodology and observation periods the data are not sufficient for statistical analysis. CONCLUSION: The use of HBO2 seems to be reasonable as an adjunct method of the periodontitis treatment. However, authors of this literature review could not unambiguously state that hyperbaric oxygen therapy could be commonly recommended as a potential method of periodontitis treatment. It is essential to develop consistent protocols for the procedure and further research in this area.
INTRODUCTION: Radiation therapy to the pelvis can result in radiation-induced vaginal soft tissue necrosis. This significantly impacts quality of life. Studies evaluating the efficacy of HBO2 are limited. METHODS: In thi...INTRODUCTION: Radiation therapy to the pelvis can result in radiation-induced vaginal soft tissue necrosis. This significantly impacts quality of life. Studies evaluating the efficacy of HBO2 are limited. METHODS: In this retrospective report, we reviewed the medical records of patients treated with once-daily HBO2 for radiation-induced vaginal soft tissue necrosis. We included females between the ages of 18 to 90 with history of pelvic cancer treated with radiotherapy and resultant soft tissue radionecrosis. Data collected included age, comorbid disease, cancer type, radiation dose, HBO2 treatment pressure, time, and total treatments. Primary outcome was improvement of radionecrosis; secondary outcomes were improvement of pelvic pain, reduction in need for analgesia, and improvement of vaginal bleeding. RESULTS: Seven patients were identified, of which six received HBO2. One patient had a vaginal fistula. Four patients had documented improvement of radionecrosis. Four out of five patients with pelvic pain had resolution of their pain, with two patients no longer requiring opioid analgesia. Two patients who presented with vaginal bleeding showed improvement with one resolved and one significantly decreased requiring no further hospitalization or transfusion. One patient experienced no documented improvement in any of the measured outcomes. CONCLUSION: In this case series, five out of six (83%) patients treated with HBO2 for radiation-induced vaginal necrosis improved in at least one outcome measure. While the sample size is small, these results add to the data available that supports the use of HBO2 in suitable candidates without contraindications who have symptoms related to radiation-induced vaginal soft tissue necrosis.
Acute carbon monoxide (CO) intoxication may result in delayed neurological sequelae, which can include amnesia, ataxia, aphasia, emotional lability, disorientation, dysphagia, and other manifestations. A 27-year-old man...Acute carbon monoxide (CO) intoxication may result in delayed neurological sequelae, which can include amnesia, ataxia, aphasia, emotional lability, disorientation, dysphagia, and other manifestations. A 27-year-old man reported symptoms of aphasia with agraphia and alexia in a review after CO intoxication. The patient received outpatient speech therapy, as well as repeated sessions of hyperbaric oxygen for 15 days, interspersing speech therapy with hyperbaric oxygen therapy for two months. After this period of combined treatment the aphasic symptomatology remitted, and oral and written language was normal. The complete disappearance of aphasia with agraphia and alexia confirms the efficacy of the combined intervention. More data from large clinical studies are needed to assess the outcomes of hyperbaric oxygen treatment in patients with delayed neurological sequelae after CO intoxication, but this case suggests it may be a good therapeutic option in combination with specific speech therapy.
As the UHMS observes the distinguished anniversary of the publication of 50 volumes of the Undersea and Hyperbaric Medicine Journal, two of our past editors take a look at the evolution of our flagship publications.As the UHMS observes the distinguished anniversary of the publication of 50 volumes of the Undersea and Hyperbaric Medicine Journal, two of our past editors take a look at the evolution of our flagship publications.
Central retinal artery occlusion (CRAO) is a relatively rare emergent condition of the eye resulting in sudden painless vision loss. This vision loss is usually dramatic and permanent, and the prognosis for visual recove...Central retinal artery occlusion (CRAO) is a relatively rare emergent condition of the eye resulting in sudden painless vision loss. This vision loss is usually dramatic and permanent, and the prognosis for visual recovery is poor. A wide variety of treatment modalities have been tried over the last 100 years with little to no success, with the exception of hyperbaric oxygen therapy. The optimum number of treatments will vary depending on the severity and duration of the patient's symptoms and the degree of response to treatment. The majority of patients will stabilize within a few days after symptom onset. Utilization review is recommended for patients treated for more than three days after clinical plateau.
OBJECTIVE: Hyperbaric oxygen (HBO2) is used in several clinical and research fields. This study aimed to analyze the 100 most-cited hyperbaric-related publications of the past 10 years to understand the trends in HBO2 re...OBJECTIVE: Hyperbaric oxygen (HBO2) is used in several clinical and research fields. This study aimed to analyze the 100 most-cited hyperbaric-related publications of the past 10 years to understand the trends in HBO2 research. METHODS: This was a literature review. All publication and citation data were retrieved from the Scopus database. Publications with "hyperbaric oxygen," "hyperbaric oxygenation," "HBO," and "HBOT" in the title, abstract, or keywords published between January 01, 2011, and December 31, 2020, were enrolled. The 100 most-cited HBO2-focused publications were identified, and their publication title, authors' nationality, publication journal, year, type (original or review), and application field were recorded and analyzed using descriptive statistics. Linear regression was used to evaluate the trends in publication numbers. RESULTS: A total of 6,517 publications were enrolled. The annual rate of increase was 4.56 per year (p-value = 0.13, 95% CI: -1.62 to 10.74). The total, average, median and mode of citations were 67,726, 10.4, 4, and 0, respectively. The 100 most-cited HBO2-focused publications accounted for 1.5% (100/6,517) of all publications and 8.1% (5509/67,726) of the total number of times cited. The most-cited publications originated from 17 countries and were published in 65 journals, led by the Cochrane Database of Systematic Reviews. CONCLUSIONS: The annual number of HBO2 publications was stationary. The citation numbers showed a skewed distribution. The United States was the leading country in HBO2 research. Of 26 application fields, traumatic brain injury, stroke, and diabetic foot were the leading three fields.
BACKGROUND: Early recompression therapy is suggested for a better clinical outcome of decompression sickness (DCS) patients. This study analyzed the efficacy of our 24-hour on-call system for early recompression therapy....BACKGROUND: Early recompression therapy is suggested for a better clinical outcome of decompression sickness (DCS) patients. This study analyzed the efficacy of our 24-hour on-call system for early recompression therapy. METHODS: We conducted a single-center retrospective cohort study. They were classified into DCS Type I versus Type II, duty time versus non-duty time groups based on the time of emergency department (ED) admission, and hospitalization versus discharge groups according to clinical outcomes. Baseline characteristics, diving variables, and in-hospital course were analyzed. RESULTS: This study investigated 341 acute DCS patients. A total of 81 and 260 patients had Type I and Type II DCS, respectively. While 198 patients accessed the center during duty time, 143 presented during non-duty time. Fifty patients were admitted, and 291 patients were discharged. Total median time from symptom onset to HBO2 therapy was 259 minutes: 240 minutes for the duty group and 292 minutes for the non-duty group (p=0.16); 251 minutes for the discharged group and 291 minutes for the hospitalized group (p<0.001). The median time from ED admission to HBO2 therapy was 65 minutes: 60 minutes for the duty group and 69 minutes for the non-duty group (p=0.23); 63.4 minutes for the discharged group and 92 minutes for the hospitalized group (p=0.05). CONCLUSION: The 24-hour on-call system was able to provide acute DCS patients with early recompression therapy even during non-duty time. However, in terms of the outcome of treatment of patients, quicker arrival at the hospital and swifter recompression therapy are needed.
INTRODUCTION: We aimed to assess the efficacy and safety of a standardized hyperbaric oxygen (HBO2) therapy protocol in patients with retinal artery occlusion (RAO). METHODS: A retrospective study was conducted in our te...INTRODUCTION: We aimed to assess the efficacy and safety of a standardized hyperbaric oxygen (HBO2) therapy protocol in patients with retinal artery occlusion (RAO). METHODS: A retrospective study was conducted in our tertiary care center from July 2016 to September 2019. Patients experiencing central RAO and branch RAO for less than seven days were included. Once the diagnosis was made, patients were urgently referred to the HBO2 department to receive a first 90-minute HBO2 session at a pressure of 2.5 ATA. Patients underwent two daily sessions seven days a week for at least 15 days. If no reperfusion was seen on fluorescein angiography on Day 15, treatment was continued for an additional week with an assessment on Day 21. The primary endpoint was BCVA improvement defined as a decrease by 0.3 logMAR at one month. RESULTS: Twenty-eight patients were included during the study period. Fifty-seven percent of patients were treated more than 12 hours after the onset of the first symptoms. The mean BCVA was 1.5 logMAR at the time of referral and improved to 0.9 logMAR after HBO2 (p=0.001). A multivariate analysis identified a high blood pressure (p=0.039) and a low initial BCVA (p=0.005) as poor prognostic factors. CONCLUSION: Performing HBO2 sessions twice daily at a pressure of 2.5 ATA appears to be an effective and safe treatment for RAO.