title: Tympanic membrane bleeding complications during hyperbaric oxygen treatment in patients with or without antiplatelet and anticoagulant drug treatment.
abstract: BACKGROUND
  Middle ear barotrauma (MEBt) is a frequently occurring complication of hyperbaric oxygen treatment (HBOT). High-grade MEBt may involve tympanic membrane (TM) haemorrhaging. Although many patients undergoing HBOT use antiplatelet or anticoagulant drugs, it is unknown whether these drugs increase the risk of MEBt and particularly TM bleeding complications.
  
  
  METHODS
  This multicentre, prospective cohort study investigates the prevalence of MEBt and TM bleeding during HBOT in patients using antiplatelet/anticoagulant drugs, compared with control patients not on such medications. MEBt was assessed by video otoscopy of the TM pre and post HBOT and scored according to the modified Teed score. Any complications from previous HBOT sessions were retrospectively documented.
  
  
  RESULTS
  Of 73 patients receiving HBOT, 34 used antiplatelet/anticoagulant drugs. Mild MEBt (Teed score 1 or 2) occurred in 23 of these 34 patients and in 31 of the 39 controls. Teed score 3 MEBt occurred in only two of the control-group patients and none of the patients using antiplatelet/anticoagulant drugs. Two patients using anticoagulant drugs reported epistaxis during a previous HBOT session, epistaxis was not reported by any control patients.
  
  
  CONCLUSIONS
  Low-grade MEBt is common during HBOT, however, high-grade barotrauma is rare with current chamber operating procedures. Patients using antiplatelet/anticoagulant drugs potentially may be prone to MEBt-associated haemorrhagic complications, but we did not observe any such increase in this cohort. Only mild epistaxis occurred in patients using anticoagulant drugs.
authors.affiliation: Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands, Phone: +31-(0)65-220-2206, E-mail: va.fijen@mindef.nl.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Fijen
authors.affiliation: Albert Schweitzer Hospital, Dept. Internal Medicine, Dordrecht, The Netherlands.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Westerweel
authors.affiliation: Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands.
authors.forename: Pieter Jan A M
authors.initials: PJ
authors.lastname: van Ooij
authors.affiliation: Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: van Hulst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001469:Barotrauma / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D004427:Ear Diseases / Q000453:epidemiology / Q000209:etiology*; D004432:Ear, Middle / Q000293:injuries; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D038781:Otoscopy / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011446:Prospective Studies; D018401:Sample Size; D011795:Surveys and Questionnaires; D014432:Tympanic Membrane / Q000293:injuries*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Middle ear; barotrauma; cardiovascular; haematology; hyperbaric oxygen therapy; medication; risk factors