The effect of hyperbaric oxygen therapy on central macular thickness and choroidal thickness in the healthy eyes of patients with idiopathic sudden sensorineural hearing loss.

PURPOSE: To evaluate the effect of hyperbaric oxygen therapy (HBOT) for idiopathic sudden sensorineural hearing loss (ISSNHL) on central macular thickness (CMT) and choroidal thickness (CT). MATERIALS AND METHODS: The study included 42 healthy eyes of 21 patients with ISSNHL (aged 24-61 years) who started HBOT within the first three days of the onset of hearing loss. Duration and severity of hearing loss were noted before starting HBOT. Central macular thickness (CMT), choroidal thickness (CT) 1500 µm nasal and temporal of the fovea, and subfoveal CT were measured by spectral domain optic coherence tomography before the first session of HBOT and after sessions 10 and 20. Measurements obtained before and after HBOT were compared. RESULTS: Eleven patients (52.4%) were men and 10 (47.6%) were women. The mean age was 44.67 ± 10.1 years. The mean duration of sudden hearing loss before HBOT was 2.05 ± 1 day. Hearing loss was mild in five patients, moderate in five patients, moderate to severe in 2 patients, severe in 4 patients and profound in 5 patients. Comparison of measurements obtained before HBOT and after 10 and 20 sessions of HBOT revealed no significant differences in CMT (219.17 ± 22.91, 220.33 ± 19.66, and 220.21 ± 19.3 µm), subfoveal CT (347.71 ± 66.82, 348.38 ± 74.55, and 345.45 ± 75.39 µm), nasal CT (328.64 ± 82.31, 316.02 ± 79.32, and 313.52 ± 89.92 µm), or temporal CT (321.76 ± 71.29, 317.05 ± 73.94, and 314.05 ± 74.61 µm, respectively) (p > 0.05). CONCLUSIONS: HBOT for the treatment of ISSNHL had no significant effect on CMT or CT in healthy eyes.

Acute effect of hyperbaric oxygen therapy on macular and choroidal thickness in patients with type 2 diabetes and diabetic foot ulcers: Optical coherence tomography based study.

PURPOSE: To evaluate the acute effect of hyperbaric oxygen therapy (HBOT) on central macular thickness (CMT) and choroidal thickness (CT) in patients with type 2 diabetes mellitus (T2D) undergoing HBOT due to diabetic foot ulcer (DFU). METHODS: For this cross-sectional study, patients with T2D were recruited between May 2019 and June 2020. Only eyes with non-proliferative or no diabetic retinopathy (DR) were included. CMT and subfoveal, nasal, and temporal CT values measured by spectral-domain optical coherence tomography (Nidek RS-3000 Advance, Aichi, Japan) before and 45 minutes after the first HBOT session were compared between eyes with and without DR and between patients receiving only insulin therapy (group 1) or insulin+oral antidiabetic (group 2). Relationships between post-HBOT change in these parameters and age, sex, HbA1c level, and DR presence and stage were evaluated. RESULTS: The study included 49 eyes of 26 patients with DFU (aged 43-75 years). Post-HBOT changes in CMT and CT were not significant or associated with age, gender, DR stage, or HbA1c level (p > 0.05). Eyes with DR had significantly higher pre- and post-HBOT CMT, nasal CT, and temporal CT values compared to non-DR eyes. Nasal CT increased significantly after HBOT in eyes with DR. Group 1 (28 eyes, 15 patients) had higher pre-HBOT mean subfoveal CT and greater post-HBOT change in subfoveal CT than group 2 (21 eyes, 11 patients). CONCLUSIONS: HBOT was not associated with acute changes in CMT or CT in patients with T2D, although an increase in nasal CT was observed in eyes with DR.

Hyperbaric oxygen treatment for toxic epidermal necrolysis: A case report.

Toxic epidermal necrolysis (TEN) is a potentially life-threatening muco-cutaneous disease, largely caused by an idiosyncratic reaction to medication or infectious disease, and is characterised by acute necrosis of the epidermis. No definitive consensus regarding the treatment of TEN has been agreed. A 60-year-old woman, diagnosed with multiple myeloma three months prior, was admitted with signs of TEN to the intensive care burns unit. She had been given ciprofloxacin to treat a urinary tract infection. She complained of malaise and pain, with maculopapular and bullous eruptions over her whole body on the third day of ciprofloxacin administration. Her supportive cares included intravenous immunoglobulins, pain control with analgesics, wound care, nutrition, and fluid support. Hyperbaric oxygen treatment (HBOT) was added on the second day of admission. The patient underwent 5 sessions of HBOT at 243.1 kPa (2.4 atmospheres absolute). Desquamation was noted to stop after the first session of HBOT and re-epithelisation commenced rapidly. The patient was discharged from the burn unit after 14 days of hospital admission. Improvement in this case was temporally related to the initiation of HBOT.

Nutrition and Chronic Wounds: Improving Clinical Outcomes.

There is increasing awareness that chronic wound healing is very dependent on the patient's nutritional status, but there are no clearly established and accepted assessment protocols or interventions in clinical practice. Much of the data used as guidelines for chronic wound patients are extrapolated from acutely wounded trauma patients, but the 2 groups are very different patient populations. While most trauma patients are young, healthy, and well-nourished before injury, the chronic wound patient is usually old, with comorbidities and frequently malnourished. We suggest the assumption that all geriatric wound patients are malnourished until proved otherwise. Evaluation should include complete history and physical and a formal nutritional evaluation should be obtained. Laboratory studies can be used in conjunction with this clinical information to confirm the assessment. While extensive studies are available in relation to prevention and treatment of pressure ulcers and perioperative nutrition, less is known of the effect of nutritional deficits and supplementation of the diabetic foot ulcer and venous stasis ulcer patient. This does not necessarily mean that nutritional support of these patients is not helpful. In the pursuit of wound healing, we provide systemic support of cardiac and pulmonary function and cessation of smoking, improve vascular inflow, improve venous outflow, decrease edema, and treat with hyperbaric oxygen. If we address all of these other conditions, why would we not wish to support the most basic of organismal needs in the form of nutrition?

Cerebellar lesions in the acute setting of carbon monoxide poisoning.

Bilateral globus pallidus and supratentorial white matter injury are common findings in the acute and chronic setting of carbon monoxide (CO) poisoning. However, isolated cerebellar lesions are extremely rare. In this case report, we shared our findings in siblings with cerebellar injury with different imaging patterns in the acute setting of CO poisoning.

Carbon monoxide-induced cortical visual loss: treatment with hyperbaric oxygen four years later.

OBJECTIVE: We present a patient who developed visual loss after carbon monoxide (CO) poisoning and was treated with hyperbaric oxygen. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old woman poisoned with CO (with coma lasting 4 h and carboxyhemoglobin level 46%) developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An (18)F-fluorodeoxyglucose positron emission tomography (PET) scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. CONCLUSION: PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury.

Effectiveness of hyperbaric oxygen on sudden sensorineural hearing loss: prospective clinical research.

The role of hyperbaric oxygen (HBO) treatment in sudden sensorineural hearing loss (SSNHL) is still controversial. In this study, 80 patients were treated for SSNHL. Fifty-five patients who received HBO and medical treatment and 25 patients who received medical treatment only were studied. There was a statistically significant difference between the HBO and medical treatment group and the medical treatment group for hearing gain and the degree of hearing loss after treatment (p<.05). In the HBO and medical treatment group, patients with tinnitus showed the highest hearing improvement. The patients who had tinnitus had a statistically significant difference for hearing gain in the HBO and medical treatment group (p<.05) but not in the medical treatment group (p>.05). In the HBO and medical treatment group, average hearing gain on each audiometric frequency was better than in the medical treatment group (p<.05).

Maggot debridement therapy in the treatment of chronic wounds in a military hospital setup in Turkey.

BACKGROUND: The medicinal use of maggots for the biological debridement of chronic wounds is increasing around the world, due to its efficacy, safety and simplicity. Thousands of patients have been treated in private and governmental hospitals during the last 10 years. OBJECTIVE: To examine the efficacy of maggot debridement therapy (MDT) in the debridement of chronic wounds in a military hospital. METHODS: MDT was applied for 1-9 days to 7 male and 4 female soldiers or their family members (21-72 years old) with chronic wounds. RESULTS: Complete debridement was achieved in 10 out of 11 patients, while in 1 patient the wound could be cleaned only partially. A remarkable reduction in the odor emanating from the wound and notable granulation were observed in all debrided wounds. Increased pain was observed in 1 patient with a venous stasis ulcer. CONCLUSION: We believe that MDT is a rapid and effective method for the debridement of chronic wounds in a military environment especially in times of war in developing countries.