Susceptibility of the Inner Ear Structure to Shunt-Related Decompression Sickness

Ignatescu, Mihaela; Bryson, Philip; Klingmann, Christoph

doi:10.3357/asem.3326.2012

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…The higher prevalence of RLS in our patients (50%) compared with 25-30% in the control population suggests that sudden deafness may be attributable to a paradoxical embolism, i.e. emboli from venous circulation as a result of RLS 310 .…”

Section: Discussioncontrasting

confidence: 50%

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Capuano

Cavaliere

Lopardo

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY In the present retrospective cohort study, we investigated the association between idiopathic sudden sensorineural hearing loss (ISSNHL) and right-to-left shunt (RLS). For this study, we recruited 40 patients with ISSNHL treated in our department between January 2015 and January 2016. Inclusion criteria were: ≥ 18 years old, unilateral sensorineural hearing loss diagnosed within 2 weeks after onset, unknown cause, no previous surgery in the respective ear and no ﬂuctuation in hearing loss. All patients underwent a pure-tone audiogram and a trans-cranial Doppler ultrasonography (TCD) with contrast saline (c-TCD) and received hyperbaric oxygen (HBO) and concomitant steroid therapy. C-TCD examination detected the RLS in 20 patients (50%). ISSNHL patients with RLS were younger than those without RLS (p = 0.007). Vertigo was present mainly in the RLS group, while hypercholesterolaemia, arterial hypertension and hyperglycaemia were mainly seen in the “no RLS” group. The proportion of complete recovery was highest in the “No RLS” Group (40%), although it was not statistically significant. In conclusion, RLS is frequent in ISSNHL, particularly in young patients without comorbidities and with associated dizziness, who should routinely undergo TCD to exclude the presence of RLS. Unfortunately, TCD can only detect the RLS, and not the location of the shunt. This would be possible through transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE), which are much more invasive than TCD, and require further study.

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Section: Discussioncontrasting

confidence: 50%

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Capuano

Cavaliere

Lopardo

et al. 2019

Acta Otorhinolaryngol Ital

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“…Under normal circumstances this delayed desaturation is well tolerable. However, if bubbles shunt into the inner ear, bubble growth could be triggered by the inert gas pool of the endo-/perilymph (Klingmann et al, 2003;Ignatescu et al, 2012). In contrast, the brain is a very fast tissue, which is desaturated very fast and does not act as an inert gas reservoir for bubble growth during a normal dive.…”

Section: Discussionmentioning

confidence: 99%

Livedo Racemosa – The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt

Härtig¹,

Reider²,

Sojer³

et al. 2020

Front. Physiol.

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Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata (CM). Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis (LR), and livedo racemosa (LRC) are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a netlike, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. Unlike in diving medicine, in clinical medicine/dermatology the pathology of livedo racemosa is well described as a thrombotic/embolic occlusion of arteries. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. Recent studies have shown a high correlation of cardiac right/left (R/L) shunts with arterial gas embolism and skin bends in divers with unexplained DCI. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. The R/L shunt screening results of 18 divers who suffered from an unexplained decompression illness (DCI) and presented with livedo racemosa were retrospectively analyzed. All of the divers were diagnosed with a R/L shunt, 83% with a cardiac shunt [patent foramen ovale (PFO)/atrium septum defect (ASD)], and 17% with a non-cardiac shunt. We therefore not only confirm this hypothesis but when using appropriate echocardiographic techniques even found a 100% match between skin lesions and R/L shunt. In conclusion, in diving medicine the term cutis marmorata/livedo reticularis is used incorrectly for describing the actual pathology of livedo racemosa. Moreover, this pathology could be a good explanation for the high correlation of livedo racemosa with cardiac and non-cardiac right/left shunts in divers without omission of decompression procedures.

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“…The incidence of DCS is much lower in both divers and aircrews [27] than the prevalence of PFO in the general population [135]. A higher than normal prevalence of PFO in divers with DCS has been reported, especially with neurological symptoms [12,13,136], inner-ear DCS [11,138,139] and cutaneous DCS [14], particularly cutis marmorata [14,23,139].…”

Section: Is Pfo Associated With Decompression Sickness? Which Are the Underlying Mechanisms?mentioning

confidence: 99%

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Pristipino¹,

Germonpré²,

Toni³

et al. 2021

EuroIntervention

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Susceptibility of the Inner Ear Structure to Shunt-Related Decompression Sickness

Cited by 14 publications

References 11 publications

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Right-to-left shunt and idiopathic sudden sensorineural hearing loss

Livedo Racemosa – The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

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