injuries poisoning
Ear and Sinus Barotrauma
Treatment of Ear and Sinus Barotrauma
Decongestants and analgesics Sometimes oral corticosteroids, surgical repair, or both Most ear and sinus barotrauma injuries resolve spontaneously and require only symptomatic treatment and outpatient follow-up. Treatment with medications for sinus and middle ear barotrauma is identical. Decongestants (usuallyoxymetazoline0.05%, 2 sprays each nostril twice a day for 3 to 5 days orpseudoephedrine30 to 60 mg orally 2 to 4 times a day up to a maximum of 240 mg/day for 3 to 5 days) can help open occluded chambers. Severe cases can be treated with nasal corticosteroids. Pain can be controlled with nonsteroidal anti-inflammatory drugs or opioids. If bleeding or evidence of effusion is present, antibiotics are given (eg,amoxicillin500 mg orally every 12 hours for 10 days,trimethoprim/sulfamethoxazole 1 double-strength tablet orally twice a day for 10 days). For middle ear barotrauma, some physicians also advocate a short course of oral corticosteroids (eg,prednisone60 mg orally once a day for 6 days, then tapered over 7 to 10 days). Referral to an otorhinolaryngologist is indicated for severe or persistent symptoms. Urgent surgery (eg, tympanotomy for direct repair of a ruptured round or oval window, myringotomy to drain fluid from the middle ear, sinus decompression) may be necessary for serious inner or middle ear or sinus injuries. 