Abstract
Many authors have reported middle ear pressure variations during inhalation of high concentrations of nitrous oxide. An on-going study on subjects anaesthetized with nitrous oxide and oxygen supplemented with halogens or narcotics and excluding operations on the ear enables us to register three typical curves of middle ear pressure according to the patency of the Eustachian tube. We recorded significant negative middle ear pressures during the recovery period when there was important obstruction of the Eustachian tube.
The presence of a tympanic “neomembrane” due to an old perforation associated with important obstruction of the Eustachian tube could lead to a tympanic perforation that may be unnoticed by the anaesthetist if it is not specifically investigated. In our series, we report one case of tympanic perforation and one case of haemotympanum as examples of such consequences.
Résumé
Plusieurs auteurs ont rapporté, à date, des variations de la pression de l’oreille moyenne au cours de l’inhalation de concentrations cliniques de protoxyde d’azote. Une étude entreprise chez des sujets subissant une anesthésie au protoxyde d’azote-oxygène additionnée de narcotiques ou de substance halogénée, nous permet de mettre en évidence trois types de courbes de pression intra-auriculaire selon l’état de perméabilité de la trompe d’Eustache. Il est possible d’observer d’importantes pressions négatives dans l’oreille moyenne durant la période de réveil chez les malades qui ont une obstruction complète de la trompe d’Eustache.
La présence de cicatrice d’anciennes perforations du tympan associée à une obstruction importante de la trompe d’Eustache constitue un facteur de risque significatif pouvant conduire à une perforation tympanique qui peut passer inaperçue si elle n’est pas recherchée spécifiquement. Nous rapportons, dans notre courte série, un cas de perforation tympanique et un cas d’hémotympan.
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References
Thomsen, K.A., Terkildsen, K. &Arnfred, I. Middle ear pressure variations during anesthesia. Arch. Otolaryngol.82: 609–611 (1965).
Matz, G.J., Rattenborg, C.G. &Holaday, D.A. Effects of nitrous oxide on middle ear pressure. Anesthesiology28: 948–950 (1967).
Patterson, M.E. &Bartlett, P.C. Hearing impairment caused by intratympanic pressure changes during general anaesthesia. Laryngoscope86: 399–404 (1976).
Dueker, C.W., Lambertsen, C.J., Rosowski, J.J. &Saunders, J.C. Middle ear gas exchange in isobaric counterdiffusion. J. Appl. Physiol.47:1239–1244 (1979).
Ostfeld, E. &Blonder, J.et al. Middle ear gas composition during nitrous oxide-oxygen ventilation. Ann. Otolaryngol.89: 165–167 (1980).
Davis, I., Moore, J.R.M., &Lahiri, S.K. Nitrous oxide and middle ear. Anesthesia34: 147–151 (1979).
Waun, J.E., Sweitzer, R.S. &Hamilton, W.K. Effect of nitrous oxide on middle ear mechanics and hearing acuity. Anesthesiology28:846–850 (1967).
Owens, W.D., Gustave, F. &Sclaroff, A. Tympanic membrane rupture with nitrous oxide anesthesia. Anesth. Analg.57:283–286 (1978).
Perreault, L., Rousseau, P., Garneau, J.F.et al. Problème de la diffusion gazeuse dans l’oreille moyenne au cours de l’anesthésie pour tympanoplastie. Canad. Anaesth. Soc. J.28: 136–140 (1981).
Munson, E.S. Transfer of nitrous oxide into body air cavities. Br. J. Anaesth.46: 202–209 (1974).
Paul, W.L., Munson, E.S. &Maniscalco, J.E. Cerebrospinal fluid pressure during O2 encephalograpy and N2O inhalation. Anesth. Analg.55: 849–851 (1976).
Eliachar, I. &Northern, J.L. Studies in tympanometry: Validation of the present technique for determining intra-tympanic pressures through the intact eardrum. Laryngoscope84: 247–255 (1974).
Williams, P.S. A tympanometric pressure swallow test for asessment of Eustachian tube function. Ann. Otolaryngol.84: 339–343 (1975).
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Perreault, L., Normandin, N., Plamondon, L. et al. Middle ear pressure variations during nitrous oxide and oxygen anaesthesia. Canad. Anaesth. Soc. J. 29, 428–434 (1982). https://doi.org/10.1007/BF03009404
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DOI: https://doi.org/10.1007/BF03009404