Hearing impairment caused by intratympanic pressure changes during general anesthesia

Patterson, Mack E.; Bartlett, Philip C.

doi:10.1288/00005537-197603000-00009

Cited by 88 publications

(41 citation statements)

References 5 publications

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“…Even though cases of oval and round window rupture may not be predicted with the use of nitrous oxide, it is certainly possible to avoid cases of ossicle displacement and damage to ME in patients who had been submitted to otological surgeries in the past 32 . Therefore, anesthesia with nitrous oxide should be avoided in these patients, if possible 2,8,13 .…”

Section: Discussionmentioning

confidence: 99%

“…As to tympanoplasties, displacement of graft is a common finding in otological surgery with protoxide 8,11,13,33 , caused by changes in intratympanic pressure during and right after the anesthesia 8,16,33 , which may cause significant implications in stability of ME reconstituted components 11 . For this reason, its use in this type of surgery and in patients that were submitted to ossicle reconstruction is questionable.…”

Section: Immittanciometrymentioning

confidence: 99%

“…In the elimination phase, when administration is interrupted, there is quick reabsorption caused by low blood solubility; thus, in this step, negative pressure generated by middle ear (ME) leads to removal of fluids from intratympanic cavity mucosa capillaries, which may cause effusion of liquids generating serous otitis media (SOM) 13 . The magnitude of increase in volume or pressure caused by the gas is influenced by partial pressure of the lungs, blood flow and duration of protoxide administration 14 .…”

Section: Introductionmentioning

confidence: 99%

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Avaliação de alterações timpanométricas em pacientes submetidos à anestesia geral com óxido nitroso

Teixeira¹,

Tomita

Lima

2005

Rev. Bras. Otorrinolaringol.

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Ni trous oxide is an inhaling gas that can increase intratympanic pressure during the anesthetic act and cause negative pressure after it is discontinued, mainly in patients with Eustachian tube dysfunction. These pressure variations may come up with clinical implications such as tympanic membrane rupture, ossicular system disarticulation, haemotympanum, barotraumas, prosthesis displacement stapaedotomy and tympanic graft lateralization after tympanoplasty, in addition to serous fluid entrance into the middle ear during the negative pressure phase. Aim: To evaluate the nitrous oxide influence on the middle ear pressure in a population without tube malfunction performing pre and postoperative tympanometry. Study design: Transversal cohort. Material and Method: A prospective study was carried out with Universitário Clementino Fraga Filho Hospital-UFRJ inpatients submitted to general anesthesia with the use of 50% nitrous oxide from April to June 2003. It was also evaluated whether the duration of surgery, associated anesthetics, presence of allergic rhinitis and nasal septal deviation could contribute to the onset of intratympanic pressure alteration. Results: The sample was made up of 50 patients and in almost half of them (48%), postoperative tympanometry alterations (type C curve) were found when comparing to preoperative tympanometric control (type A curve). Neither gender nor age interfered in the onset of postoperative tympanometry alterations, similarly to surgery duration. The associated volatile anesthetic type, nasal septal deviation and allergic rhinitis were not able to influence postoperative middle ear pressure. Conclusion: Nitrous oxide modifies intratympanic pressure during the anesthetic act and after its discontinuation.Palavras-chave: óxido nitroso, pressão intratimpânica, alterações timpanométricas.

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Section: Discussionmentioning

confidence: 99%

Section: Immittanciometrymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Avaliação de alterações timpanométricas em pacientes submetidos à anestesia geral com óxido nitroso

Teixeira¹,

Tomita

Lima

2005

Rev. Bras. Otorrinolaringol.

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“…Increase in PMEC may result in membrane rupture due to the increase in intra-tympanic pressure, and damage to ossicular structures, eventually causing hearing loss [3,4]. The studies involving new volatile anesthetics indicate that sevoflurane and desflurane may also increase PMEC [5,6].…”

mentioning

confidence: 99%

Sevoflurane vs. TIVA in Terms of Middle Ear Pressure During Laparoscopic Surgery

Güler¹,

Apan²,

Muluk³

et al. 2014

Adv Clin Exp Med

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Objectives. The aim of this study was to investigate the effects of CO 2 insufflation on the pressure of the middle ear cavity (PMEC) during laparoscopic surgery under total intravenous anesthesia (TIVA) with propofol or sevoflurane as an inhalational anesthetic maintenance. Material and Methods. Sixty patients who underwent laparoscopic/or non-laparoscopic surgery under general anesthesia were included in the study. For anesthetic maintenance with inhalation agents, 20 non-laparoscopic surgery patients in Group 1 were applied sevoflurane (2-2.5%). Forty patients who underwent laparoscopic surgery were randomized into two groups. Anesthesia was maintained with sevoflurane (2-2.5%) in twenty patients in Group 2 and the TIVA technique in 20 patients in Group 3. In Group 1, PMEC was measured before anesthesia, 10 and 30 min after endotracheal intubation, 10 min before extubation, and 15, 30, 60 min and 6 hours in the postoperative period. In Group 2 and 3, PMEC was measured before the anesthesia, 10 min after intubation, 10 and 30 min after CO 2 insufflation, just before the CO 2 elimination, 10 min before the extubation, and 15, 30, 60 min and 6 hours after extubation in the postoperative period. Results. PMEC was significantly increased in Group 1 at 10 min after intubation, at 30 min of the operation, before extubation, and at postoperative 15 and 30 min (p < 0.05). In Group 3, differences between PMECs were detected at the 30 th min of insufflation (p = 0.005), and during elimination (p = 0.035) compared to the initial measurement. Generally, the values remained positive in Group 1 and negative in Group 3. There was a significant difference between Group 1 and Group 3 at 10 min after the induction (p = 0.001). There was no statistically significant difference in PMECs between Group 2 and 3 patients undergoing laparoscopic surgery. Conclusions. Our results indicate that, in laparoscopic surgery, TIVA used for the maintenance of anesthesia did not increase the PMEC and the changes caused by sevoflurane were also in the normal range of middle ear pressures. In patients with previous ear surgery, if there is a need of classical surgical procedures in the future, sevoflurane anesthesia should not be the first choice due to its effects on PMEC, which cause it to be increased over 50 daPa, especially at 30 min after intubation. Patient characteristics including previous ear surgery should be considered in selecting the optimum anesthetic agents and technique (Adv Clin Exp Med 2014, 23, 3, 447-454).

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“…1,3,6,7 Several investigators have also noted development of negative middle ear pressure following the discontinuation of nitrous oxide ~'3,s and in at least one instance rupture of the tympanic membrane was caused by the negative pressure developed, s'9 However, systematic study of middle ear pressures has not been reported in children.…”

mentioning

confidence: 99%

Negative pressure in the middle ear in children after nitrous oxide anaesthesia

Blackstock

Gettes

1986

Can Anaesth Soc J

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Hearing impairment caused by intratympanic pressure changes during general anesthesia

Cited by 88 publications

References 5 publications

Avaliação de alterações timpanométricas em pacientes submetidos à anestesia geral com óxido nitroso

Avaliação de alterações timpanométricas em pacientes submetidos à anestesia geral com óxido nitroso

Sevoflurane vs. TIVA in Terms of Middle Ear Pressure During Laparoscopic Surgery

Negative pressure in the middle ear in children after nitrous oxide anaesthesia

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