title: Retrospective review of grommet procedures under general versus local anaesthesia among patients undergoing hyperbaric oxygen therapy.
abstract: BACKGROUND
  One significant side effect of hyperbaric oxygen treatment (HBOT) is middle ear barotrauma (MEBT) may require tympanostomy tube (grommet) insertion by the Ear, Nose and Throat service. Where timely HBOT is needed, routine insertion of grommets under local anaesthesia (LA) is becoming common.
  
  
  OBJECTIVE
  To investigate the differences between patients receiving HBOT and concurrent grommets under LA versus general anesthesia (GA) at The Townsville Hospital (TTH).
  
  
  METHODS
  A retrospective chart analysis of patients receiving HBOT between 2008 and 2012 and requiring grommets was undertaken.
  
  
  RESULTS
  Thirty-one (5%) out of 685 patients treated with HBOT from 2008 to 2012 received grommets. Twelve cases received grommets under LA, and 19 under GA. Twenty out of the 31 cases had grommets following MEBT and the remainder prophylactically. Complications of grommet insertion comprised two cases with blocked grommets. There was a significant difference (P = 0.005) in the time in days from ENT referral to HBOT between the LA group (median 1 day, range 0-13 days) and the GA group (median 8 days, range 0-98 days).
  
  
  CONCLUSIONS
  A greater number of hyperbaric patients received grommets under GA than LA at the TTH. Insertion of grommets under LA was safe, offering advantages to both the patient and the treating team in the setting of HBOT-associated otic barotrauma.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia, Phone: +61-(0)7-4433-1111, Email: laura.lamprell@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Lamprell
authors.affiliation: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland.
authors.forename: Derelle
authors.initials: D
authors.lastname: Young
authors.affiliation: School of Medicine and Dentistry, James Cook University, Townsville, Queensland.
authors.forename: Venkat
authors.initials: V
authors.lastname: Vangaveti
authors.affiliation: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland.
authors.forename: John
authors.initials: J
authors.lastname: Orton
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, The Townsville Hospital, Queensland.
authors.forename: Anand
authors.initials: A
authors.lastname: Suruliraj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001469:Barotrauma / Q000209:etiology / Q000601:surgery*; D004432:Ear, Middle; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000379:methods*; D012189:Retrospective Studies
keywords: Barotrauma; ENT; ear barotrauma; hyperbaric oxygen; hyperbaric oxygen therapy