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Le Zyncet D Tablets(Unichem)

ORSinarestLevoTablets(Centaur) (Action lasts for 12 hours)


1tablet,2x daily with a little water after breakfast & dinner on day /
days of flight
Otrivin Nasal Spray(Novartis) (Action lasts for 12 hours)
1spray into each nostril in theerectposition,2times a day on day /
days of flight.
Vicks Vaporub inhaler(Action lasts for few minutes)
Inhale frequently every few minutes especially during aircraft
descent .
Azeflo Nasal Spray(Lupin) ORCombinase Nasal
Spray(German Remedies) (Action lasts for 24 hours)
(Pressurised Metered dose inhaler delivering Azelasine &
Fluticasone propionate.)
1 application (puff) in each nostril once a day on day / days of flight.

There are 5 conditions that make


barotrauma possible. We use the
acronym MARGE to help remember
them:
Membrane lined with blood supply
Ambient pressure change
Rigid walls
Gas filled space
Enclosed space

Treatment: depends on the severity of the


damage and the Teed score. Generally, we will
restrict diving until they are healed.
Teed 0-1 8-72 hours
Teed 2-3 1-8 days
Teed 4-5 6 weeks, if there is a perforation
Other therapies includeoral and topical (nasal)
decongestants, pain control, and avoiding diving
until its healed. I would consider antibiotics IF
the tympanic membrane is ruptured.

Eustachian tube can be considered


functionally as a flutter valve
allowing air to flow passively from
the middle ear into the nasopharynx.
This flutter valve must be opened
actively by the contraction of the
muscles of the palate in order to
allow the passage of air in the
reverse direction, ie, from the
nasopharynx into the middle ear.

If the surrounding atmospheric pressure is lowered (e.g. during ascent),


the pressure within the middle ear cleft rises in relation to the
atmospheric pressure. When this occurs, the eustachian tube will open
passively to allow the flow of air from the middle ear into the
nasopharynx.
If the surrounding atmospheric pressure is raised (e.g., during descent),
the pressure within the middle ear will be lowered in relation to the
atmospheric pressure. Pain in the ear is usually experienced as the
increased atmospheric pressure pushes the eardrum medially. When
this occurs, the eustachian tube must be opened actively by swallowing
or Valsalva's maneuver in order to allow the entry of air from the
nasopharynx into the middle ear with consequent equalization of the
transtympanic pressure differential. When the pressure differential
exceeds 90 mm Hg, the soft tissues near the opening of the eustachian
tube are forced into its lumen and active opening of the tube is no
longer possible (a locked eustachian tube).

OTITIC BAROTRAUMA:
SEROUS EFFUSION
People with normal eustachian tube function generally do not
experience difficulty in coping with gradual pressure changes.
Problems arise when either the eustachian tube function is
impaired or when the pressure change is rapid or too great for
the capacity of the eustachian and are most likely to develop in
those individuals who have impaired eustachian tube function.
The most common cause of eustachian tube failure in patients
who develop otitic barotrauma is usually an upper respiratory
infection.

BAROTRAUMA:
SEROUS EFFUSION
Otitic barotrauma can also develop in patients undergoing hyperbaric oxygen
therapy in a decompression chamber
The damage in otitic barotrauma occurs as the tympanic membrane is
displaced medially by the increased surrounding atmospheric pressure. There
is a splinting and loss of the mobility of the tympanic membrane and the
inward stretching causes pain. In some cases linear inters hemorrhages may
develop within the drum, most c monly in the pars flaccida.The relative
negative pressre within the middle ear can cause hyperemia, ecchymosis and
edema of the middle ear mucosa resulting in the transudation of a thin,
golden yellow serous fluid. Less commonly, the mucosal blood vessels may
rupture, causing a frank hemorrhage into the middle ear cleft
(hemotympamum). Unlike chronic effusions, this acute transudative process is
typically associated with a severe earache due to the speed of the pressure
change.

OTITIC BAROTRAUMA:
INTERSTITIAL HEMHORRAGE
Extreme pressure changes may disrupt the
oval or round window seals, causing the
leakage of perilymph into middle ear. The
presence of vertigo or a fluctuating
sensorineural hearing loss are worrisome
symptoms suggestive of a perilymph fistula.
This is an otologic emergency which can be
confirmed and treated only by surgical
exploration of the middle ear.

patient experienced a mild


discomfort in her ears during descent
in an airplane.The only evidence of
barotrauma is the linear interstitial
hemorrhage which can be seen
extending along the drum on either
side of the handle of the malleus.

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External ear b

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