Chest
Bilateral Otorrhagia Associated with Continuous Positive Airway Pressure
Section snippets
CASE REPORT
A 49-year-old man was admitted with recurrent upper gastrointestinal bleeding. The patient was alert, and his examination was unremarkable. The tympanic membranes and auditory canals were normal. He had adequate arterial oxygenation while breathing supplemental oxygen at 4 L/min by nasal cannula.
Shortly after admission, the patient had profuse hematemesis associated with hypotension which was treated with intravenous (IV) blood and crystalloid administration, as well as intravenous
DISCUSSION
CPAP is an effective and simple method to increase arterial oxygenation in nonintubated patients.2 In this case, intubation was required for hypercapnia, although arterial oxygenation improved with CPAP and increased FIO2.
There are many complications associated with CPAP,3 including subconjunctival emphysema,4 pulmonary venous and systemic gas embolism,5 and corneal abrasions.6 Pneumocephalus has been reported in association with CPAP in a patient with an unrecognized basilar skull fracture.3
ACKNOWLEDGMENTS
We wish to thank Terry P. Clemmer, M.D., for his critical review of this manuscript. A special thanks to Pat Petersen for preparing the manuscript.
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Cited by (25)
A rare complication of continuous positive airway pressure treatment – rectus sheath hematoma: a case report
2021, Brazilian Journal of Anesthesiology (English Edition)Middle ear pressure during sleep and the effects of continuous positive airway pressure
2015, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :A study conducted in guinea pigs demonstrated that elevating MEP with air up to 250 daPa had no effect on auditory thresholds measured by auditory brainstem response (ABR) [8]. While it appears that hearing is likely not significantly affected in most individuals, there have been rare reports of tympanic membrane rupture, pneumocephalus, and tension pneumocranium with CPAP use [9–12]. Although rare, these findings should prompt caution with CPAP use following head trauma, rhinologic or otologic surgery, and particularly following intradural skull base procedures.
Petechial hemorrhages of the tympanic membrane in attempted suicide by hanging: A case report
2013, Journal of Forensic and Legal MedicineCitation Excerpt :There have however not been reports on tympanic PH during child birth and similar situations, which gives this mechanism less credibility as the cause of our findings. Compression of the larynx or trachea simulates closed glottis since the upper respiratory tract is forcefully closed and during hanging or strangulation vigorous respiratory effort is performed.6–10 We believe that the PH develop from the capillaries located in lamina propria of the epidermal layer above the fibrous layer.
Complications of Managing the Airway
2013, Benumof and Hagberg's Airway ManagementComplications of Managing the Airway
2012, Benumof and Hagberg's Airway Management: Third EditionAn unusual case of otorrhagia
2012, Journal of Emergency MedicineCitation Excerpt :Otorrhagia is an uncommon finding with a limited literature except for a longstanding association with basilar skull fractures (1). It has also been described in association with continuous positive airway pressure ventilation, trauma of various types including strangulation, internal carotid artery aneurysms, tumors, and tympanostomy tubes (2–5). Unfortunately, very few of these reports have appeared in emergency medicine journals (6,7).