Role of tympanocentesis in the prevention of middle ear barotrauma induced by fast buoyant ascent escape from 200 m underwater
Authors:   Department of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China, Liu Xu ,   Department of Otorhinolaryngology and Head and Neck Surgery, No. 905 Hospital of PLA Navy, Shanghai, China,   contributed equally to this work, Yuan Hengrong ,   Department of Diving and Hyperbaric Medicine, Naval Medical Center, Naval Medical University, Shanghai, China,   contributed equally to this work, Peng Jieying ,   Department of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China,   contributed equally to this work, Zhu Guanghao ,   Department of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China, Wang Nan ,   Department of Diving and Hyperbaric Medicine, Naval Medical Center, Naval Medical University, Shanghai, China, Wen Yukun ,   Department of Diving and Hyperbaric Medicine, Naval Medical Center, Naval Medical University, Shanghai, China, Zheng Hongliang ,   Department of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China, Fang Yiqun ,   Department of Diving and Hyperbaric Medicine, Naval Medical Center, Naval Medical University, Shanghai, China, Wang Wei ,   Department of Otolaryngology – Head and Neck Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
Published: September 2024

Introduction: We aimed to study middle ear barotrauma caused by fast compression followed by buoyant ascent escape from 200 m underwater and its effect on the auditory system, and to validate the preventive effect of tympanocentesis on middle ear barotrauma. Methods: Twenty Sprague Dawley rats were divided into two groups: rats in group A underwent a simulated fast buoyant ascent escape from a depth of 200 m, while those in group B underwent tympanocentesis before the procedure described for group A. Ear endoscopy, acoustic conductance, and auditory brainstem response (ABR) tests were conducted before and after the procedure to evaluate the severity of middle ear barotrauma and auditory function in both groups. Additionally, histopathological examination of the middle ear in both groups was conducted to evaluate the severity of middle ear barotrauma by observing submucosal haemorrhage. Results: None of the ears in either group showed any abnormalities before the experiment. In group A, middle ear barotrauma was universally observed after the simulation procedure. The tympanograms of all ears were initially type A and became type B after the procedure. Further, after the simulation, the hearing thresholds at different frequencies (4, 8, 16, 24, and 32 kHz) assessed by ABR significantly increased compared to those before the procedure. In group B, no middle ear barotrauma was observed, and the hearing threshold at each frequency did not change significantly compared with post-puncturing. After dissecting the middle ear, gross pathological observations were consistent with the above results. Microscopically, blood accumulation and submucosal haemorrhage in the middle ear cavity were observed in group A but not in group B. Conclusions: Fast buoyant ascent from 200 m underwater can cause middle ear barotrauma, resulting in hearing loss. Tympanic membrane puncture can effectively prevent middle ear barotrauma caused by the rapid buoyant ascent escape procedure.