nsneicio morse Journal of Health Science da 7 oiiutl 9 ningnen - fue 2541 Vol. 7 No. 3 July ~ September 1998 fimsouady Original Article wid s, Uadufidaniusiiu Middle Ear Barotrauma eee re | Awanwafansrimaauitiineinniauuy SCUBA WA. 2540 Znunn Imoiro Wu, Ww, (uN) Lakkana Thaikruea M.D., M.S.(Epidemiology), Diplomate paatinsinansaloniin ‘Thai Boetd of Preventive Medicine (Epidemiology) mnataniriehanrguien reucunnentsiny Department of Community Medicine, Facuity of Medicine sonrinenitadston’ savtnas Chiang Mai Universty, Chiang Mai ‘unfinuo Jonemmiounitulasinncrersngennines Aa navi imnaringe semenceinrtennyem neste taasTen sitamnnrmanerangarenuscrnltiuslashedduiumelurrn ulin mde ex bactaune tan dostuanmquunefiaciiaturorieeuTa aneidusayortuuttumsgaaisoneiiuastn samara duns Cohort Tears nnn ansienfumseusany fumnnanenering aga ond uncleanuiitnd Suu os am diiunrtoumudesarasnhuneTaethfiasmnmanneinnenms (Decompression ness OC!) sraiteanmliRA’ Sot Consined Undarwater Breathing Apparatus (SCUBA) 72m 5 su Trurenunerramiernafmeisunasatesnnu 4 A9¢ sefieiiuant neu uyudoumn saenagiemauinmny waenrray (otoso00e) annn@nwwtrin Swany 28 au wis 36 mk ergiofe ars dé shaintounduunsenderewine 2as6 vf fe agers aa una o827 fe ate7 wf Aeiouromrronundiuerniulaglanas Eeurndrahusnendh Couns 90,41, $7 tae 56 muti) uactiudafagrnaii (chi-square for rand p-value = 0.008, odds | alos = 1.0, 0.9, 0.4, uae 0.4 wri) dndnnoermrurmaanyannstumadahmteniey (fous: 99, 94, 28, unt 21 wut Shiu) wwiusfinrininon chi-square for trend TaisiiahRqvrest® san endgehumnimint sinnaTyenN wioeney | ca mu manderremnttevessnonds wutlayurngiiinun 25 naGioune 99) avi 17 _ratungaidundeuarndioranh edit 1 Coune 68) eruruunetiageyturety + ain § eR Goune 24) defeidomrndinion nquiirnBvernttity Seytidnvtannsdanninrantuwrmdamgonrnnaa tue (AR Baus 15 fa 10, p-value < 0.001) useniudtlomsnrvenuerwdmlrvacdiayatay 2.7 wemoanguinliulaiw (ss Cl = 0.9, 7.9; prvalue = 0.020) aiuiidaeylomanrienurnstiuiuandensny 6.7 wnwaunguitanlany (95% Cl = 22, 20.0; p-value < 0.001) ain | ne ce natant nterdnrrindatntereimetrsdandtidy masinndingernln’ anmashaydhuttivinradinmavstuvenayuag sedutomrmliuundaunchuternshs 9 tay Soyo sarah hthayoalitunntngn®meundrenanguiiee savdecfinreanufanhaeanrembuneucu datums gO | srumrndtunan | Risk Factors Associated with Middle Ear Barotrauma | among Health Workers Attending SCUBA Training, 1997 | (ABSTRACT ‘Thailand's Ministry of Public Health has established @ “Mating Public Health Project” aimed at sea gypsy divers, | tener anette ek hing hath pron, Han ce wor engnd nt po wnap SSCUBA ding 303304 _ Risk Factors Associated with Middle Ear Barolrauma among Health Workers Attending SCUBA Training, 1997 ‘training, and have been studied prospectively for incidence, ‘severity, and risk factors associated with middle ear barotrauma (MEB). A prospective cohort study was conducted ‘among 64 health workers attending a SCUBA diving training program. Tho training included theory . the management of decompression iness (OCI), case studies, and a field practice of 4-5 dives in the Sea. Parcpants wero ileowed and realvedotoscope exainatons before and ater each de. Theo were 64 subjects (26 ‘males, 36 females) with an average age of 3126 years, Each underwent 4~5 cles in the sea, at depths ranging from 2446 feet {0 40415 fet, fr 35 rminues to 4147 minutes. Proporion of subject porting easly adusled middle ear pressure icrasod wih the numberof diving experiences (38%, 41%, 87% and se%s, consaquenty) with stastcaly signtoant (chi-square for trend Palio = c008, odds ratos = 1.0, a8, a and 0.4, eonsequonty). Proportions expefercing ear pain deceased withthe Increasing number of dives (89%, 34%, 29% and 21%, consequenty) but chi-square for trend analysis had no statistically ‘significant. Almost all cases occurred during descent, ‘There were 28 instances of MEB (30%). Of these cases, 68% occured ‘during the first dive; most (84%) were of grade 1/5 severity ((mnld). Subjocts experiencing dificulty in adjusting ear pressure were more likely to have ear pain than those without dfcuty (RR 15-18; p-value < 0.0001). This group also had a higher risk of ‘tympanic membrane injury (RA «7; 95% Cl = 2-20). The incidence of MEB ‘among this group of health workers was lower than tar studios, parly because of the added content dilered fom prior taining, which emphasized understanding and prevention Ear pain may bo usu indator fr tympanic membrane uy. The rests of his study shoud be apple in ring enc ‘health education program for health workers and divers. umn eodayuny oalaumandutine urna wiavh Valsava's Manewor usawinrwodiaunsarsvequacmy, prunsfiuteedutunmadorormiinbdeciinduvae Ausouneanmanaeniindidgmmegumntes Useiuarudineintinndy nenunmaagadiin Tmamrinonuinoniat wiitulnimrnics fom ovsuamihdenovanigugdumencistduifinten yrernmmemaunnelaitntath Tsafiinnnmsanerann momruacminldoualeetiindiluneny tunst eel UtnnTmrummueanouninorsngesenin Wareniinge mmeqummeaimntenshmiava donsinhuw SCUBA iy finnafinmmwacits Suemnugaiio open water turnnilsisnn auftiiutungdndon vite vlog sulumonns dufummovmlungauom wena une Shnierorsae tulesmamaranugienmaaits «durmnFiuniingaasintredy opon water iudomuoylan fivinsonnsanmrinneimA (Decompression ness, DC!) uanainTarenavauna deifTan Decompression sickness, Arterial gas embolism (AGE) une Barotrauma voreiineme > mudemaAanmsdtydaounereuniiqn momfiuennfuluinygunens —tunidnfidu doniy srrunaiuoimahsingysaunabraugaiiuerunnaiy soriiunanon dfornunamulih wobilmiusunne ay wife sormetnldunsetuganmdnlah uavacannatio drug Midete ear baro-trauma (MEB) Wuileiiin ‘haioulugiinhuuy SCUBA uactunainengdaosld hyperbaric oxygen "Sahm tunquiliennaiia msoiuaernoruurenedTin santiladesidurhustiunaiin ‘Tn dusnithigmrtoiiuunh Sneuecdosiuenuquars dacvintusennenrevnalmedwumnesy drifted Aaya dupuldtunraquarmntuacvinntanaian thitunaguagilaulu hyperbaric chamber wah! uen sind fammnsmbtdseyndiunruushyadaud thenouerdrinh nqueurnuyaghuseinsetnh tanita yqlusitnateionnutugedaritliughies Woon wares Fnquac¥nnainer Wunnrinwmesvintnuuy prospective cohort Tunguisimniviamangusansoningngaisnt med uacdaesnuiiting siahiumrevmimagiomemsiaSedusfauusty Midd Ear Baretrauma husrmiierorsnquiiandniuu SCUBA Ws, 2540 fuse 20-22 mu Sunn 3 qu Ha 64 mu curs evrutermadihuncln DOI Useneuaay 3 sua 1. memgufjueimariah nalamamurinves sumetiliaultunruinnenmafinetn ruidadiowos Tnnfiinsanmanae nena 2, Ann Middle ear barotrauma (Case study) sonighnusty use 3. neulgi@tunrthuve souBA Tua eau pmadinbsin 2-3 vans Suny 1-2 een uneh setumrindun 20-00 ya Tauiull 9-5 finenlgiinte van W SCUBA Summ 2 sfeiot luteus 2 Tuiamotn gous euUUUiiumueinoNURsmeMieN dobwinzede unsiumammayiuoeramuntoowmsy Yiufintayadtugm seuanwtin (maximum depth) Ten ramranb (bottom tine ) prrsunconmmuant unui Aqmniinduselsiutnn wiaskinhmnt uaa tnalrarntunggdnanataltuunmnaheesunese wanasainw 1, FNMA Ly oy Gertummounafonin 64 a dumm 26 au GJouar 44) wis 36 mu CFaune 6) onmndis 30.945.0 0 shiseSiaglmnuantune 5 disimartuan + eu uncieutenugitinadivinionylnuunatutudae 305 Shanarenene 1 A unlinudlenornshesRRene the 1 outa diwemunseior th vreinhmety 1 ds mu inebty 2 nem 1 en tune Bo 1 eu anusialty 6 fim (eral 1-17 af) Geren sbdneduunncrtescnine 29.885.7 rip de 4ots149 yp wm sasteo fi 41.2479 wot Tnussinernaindun 9 tunvintint 12 emaUInnUluniuATRUlatOn acourraingtunsiatinsinsads avminhedeuin (Dive 1) wun 34 eu aun urnubaonylinor 21 am Gaunr 60) flim aha, ours 33) érlanitinaneadlitvts eetanty mmmuiduuseiuhwedariautivyada Gowns 76) Iu mvniinhetitinos (Dive 2) senilnghFiumaiuiony W (Toure 52) anndu wy 22 muflernrnlaay oun 34) Tdinduanedmoniornuonnnneiliinte ‘rougad Gone 64) tunainhntefon (Ove 2) Gavmsturn 96 eu srameviumwatioeg new Gousz 57) uns 15 nuvin 69 Ai fienmralaay oun 2a) trintvsiedusasnanteiamainestith shornugets Gover 80) umauhntd (Dive » finnuinh 69 mu min 38 suurradulutinny Ywrw Geune 56) uaz 14 mulling (House 22) dudneneineevtonstminialfoue tatoo typi Gaur 03) (wml 1 use 2) provi 1 seslunrmmamauivenudelyiiunenatannshibusincede seturnnearnn ah an 2 an @ eae 4 vfun nai Goune) Gowns) Goure) Goure) fu 24 (38) 26 (41) 6) 25.(68) wor 32 (50) 33 (82) 22 (35) 1 (29) rowan 0) <© 30) zn) “hinow 10) +0) 2@ 3@) 7 64 (100) 4 (100), 23 (400) 62 (100), Janu, 1 ruth vRomnasedumramuriondoyurnsduTidy 5 munkinneinbethll 2 Fendhunetel 9 anew nA 4