ABSTRACT Moayedi S, Gizaw A, Sweet S, Sethuraman K, Witting M. Pseudoephedrine prophylaxis does not prevent middle ear barotrauma in hyperbaric oxygen therapy. Undersea Hyperb Med. 2025 Second Quarter; 52(2):101-107. A common complication of hyperbaric oxygen (HBO2) treatment is middle ear barotrauma (MEB), which can lead to pain, treatment abandonment, or delay in treatment. Studies have shown that pseudoephedrine decreases MEB for pressure changes in SCUBA divers and airplane travelers. We conducted a randomized, double-blind, placebo-controlled trial to determine if pseudoephedrine effectively decreases MEB rates in patients receiving their first HBO2 treatment. There was no statistically significant difference between the pseudoephedrine and placebo groups concerning ear pain ratings, tympanic membrane injury, or rescue medication to help equalize ear pressure. Pseudoephedrine prophylaxis, given between 45 minutes and two hours before multiplace HBO2 treatment, does not mitigate MEB or treatment delays. Keywords: barotrauma; ear barotrauma; hyperbaric oxygen treatment; middle ear; pseudoephedrine
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