{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:32:11Z","timestamp":1788352331469,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hyperbaric oxygen therapy (HBOT) is the standard treatment for moderate to severe carbon monoxide (CO) poisoning, but middle ear barotrauma (MEB) remains a common complication. This study identified risk factors associated with MEB in patients undergoing monoplace HBOT. Methods: This retrospective cohort study included patients treated for CO poisoning with monoplace HBOT at a tertiary academic hospital between May 2021 and December 2023. MEB severity was assessed before and after treatment using video otoscopy and graded according to the modified O\u2019Neill Grading System. Results: MEB occurred predominantly at lower severity grades according to the O\u2019Neill scale. In univariate analysis, significant risk factors for MEB included altered mental status at presentation (OR: 3.16, 95% CI: 1.35\u20137.40, p = 0.008), serum albumin &gt; 4.3 g\/dL (OR: 0.22, 95% CI: 0.10\u20130.65, p = 0.004), and magnesium levels (OR: 0.21, 95% CI: 0.05\u20130.98, p = 0.046). Multivariate analysis confirmed altered mental status (OR: 3.16, 95% CI: 1.05\u20139.52, p = 0.041), albumin &gt; 4.3 g\/dL (OR: 0.26, 95% CI: 0.10\u20130.65, p = 0.004), and magnesium level (OR: 0.21, 95% CI: 0.05\u20130.88, p = 0.033) as independent predictors of MEB. Patients with higher albumin and magnesium levels showed lower risk. Conclusions: Altered mental status, lower albumin, and lower magnesium levels predicted middle ear barotrauma in patients undergoing monoplace HBOT for CO poisoning. These findings highlight the importance of careful pre-treatment evaluation and close monitoring during therapy to reduce the incidence of MEB.<\/jats:p>","DOI":"10.3390\/jcm14092984","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:42:09Z","timestamp":1745577729000},"page":"2984","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk Factors for Middle Ear Barotrauma in Patients with Carbon Monoxide Poisoning Undergoing Monoplace Hyperbaric Oxygen Therapy: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jung-Ho","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyoung-Youn","family":"Lee","sequence":"additional","affiliation":[{"name":"Trauma Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"},{"name":"Trauma Center, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5473-9781","authenticated-orcid":false,"given":"Kyung-Hoon","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tag","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"},{"name":"Department of Emergency Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6310-3475","authenticated-orcid":false,"given":"Sung-Min","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"},{"name":"Department of Emergency Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/0960327119891214","article-title":"Worldwide epidemiology of carbon monoxide poisoning","volume":"39","author":"Mattiuzzi","year":"2020","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.3346\/jkms.2023.38.e125","article-title":"Prevalence of Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy in Korea: Analysis of National Claims Data in 2010\u20132019","volume":"38","author":"Han","year":"2023","journal-title":"J. Korean Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100","DOI":"10.35986\/me.2020.18.3.100","article-title":"Clinical Characteristics of People Who Attempted Suicide by Carbon Monoxide Poisoning in Korea","volume":"18","author":"Jo","year":"2020","journal-title":"Mood Emot."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1164\/rccm.201606-1275CI","article-title":"Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy","volume":"195","author":"Rose","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e910","DOI":"10.1097\/CCM.0000000000005112","article-title":"Effect of Hyperbaric Oxygen Therapy Initiation Time in Acute Carbon Monoxide Poisoning","volume":"49","author":"Lee","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, P., Zhang, X.M., Zhai, Z.H., and Li, P.L. (2013). MRI findings of otic and sinus barotrauma in patients with carbon monoxide poisoning during hyperbaric oxygen therapy. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0065672"},{"key":"ref_7","first-page":"203","article-title":"Middle-ear barotrauma after hyperbaric oxygen therapy","volume":"37","author":"Bessereau","year":"2010","journal-title":"Undersea Hyperb. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1055\/s-0034-1366974","article-title":"Update on middle ear barotrauma after hyperbaric oxygen therapy-insights on pathophysiology","volume":"18","author":"Lima","year":"2014","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_9","first-page":"393","article-title":"Middle ear barotrauma in hyperbaric oxygen therapy","volume":"41","author":"Heyboer","year":"2014","journal-title":"Undersea Hyperb. Med."},{"key":"ref_10","unstructured":"O\u2019Neill, O.N., Brett, K., and Frank, A.J. (2025). Middle Ear Barotrauma. StatPearls, StatPearls Publishing."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5935\/0946-5448.20120032","article-title":"Middle ear barotrauma after hyperbaric oxygen therapy\u2014The role of insuflation maneuvers","volume":"17","author":"Lima","year":"2012","journal-title":"Int. Tinnitus J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107","DOI":"10.22462\/04.06.2019.3","article-title":"Methods for preventing middle ear barotrauma in computer-controlled pressurization of monoplace hyperbaric chambers","volume":"46","author":"Hwang","year":"2019","journal-title":"Undersea Hyperb. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1056\/NEJMoa013121","article-title":"Hyperbaric oxygen for acute carbon monoxide poisoning","volume":"347","author":"Weaver","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_14","first-page":"265","article-title":"The O\u2019Neill grading system for evaluation of the tympanic membrane: A practical approach for clinical hyperbaric patients","volume":"42","author":"Weitzner","year":"2015","journal-title":"Undersea Hyperb. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/00129804-200609000-00004","article-title":"The role of albumin in fluid and electrolyte balance","volume":"29","author":"Hankins","year":"2006","journal-title":"J. Infus. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13613-020-00697-1","article-title":"Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: A review","volume":"10","author":"Aldecoa","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1288\/00005537-199201000-00009","article-title":"Hyperbaric oxygen therapy: Effect on middle ear and eustachian tube function","volume":"102","author":"Fernau","year":"1992","journal-title":"Laryngoscope"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1152\/japplphysiol.00201.2001","article-title":"Effects of albumin supplementation on microvascular permeability in septic patients","volume":"92","author":"Margarson","year":"2002","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/j.febslet.2008.04.057","article-title":"The antioxidant properties of serum albumin","volume":"582","author":"Roche","year":"2008","journal-title":"FEBS Lett."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/01.CCM.0000257234.87784.91","article-title":"Anti-inflammatory activity of albumin","volume":"35","author":"Wiedermann","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s10895-016-1948-3","article-title":"Comparative Study of the Interactions between Ovalbumin and five Antioxidants by Spectroscopic Methods","volume":"27","author":"Li","year":"2017","journal-title":"J. Fluoresc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.foodres.2019.05.021","article-title":"Protective effects of bovine serum albumin on blueberry anthocyanins under illumination conditions and their mechanism analysis","volume":"122","author":"Lang","year":"2019","journal-title":"Food Res. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3892\/mmr.2023.13147","article-title":"Albumin, an interesting and functionally diverse protein, varies from \u2018native\u2019 to \u2018effective\u2019 (Review)","volume":"29","author":"Wu","year":"2024","journal-title":"Mol. Med. Rep."},{"key":"ref_24","first-page":"691928","article-title":"The immunomodulatory effects of albumin in vitro and in vivo","volume":"2011","author":"Wheeler","year":"2011","journal-title":"Adv. Pharmacol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4367240","DOI":"10.1155\/2019\/4367240","article-title":"Evidence Supporting the Hypothesis That Inflammation-Induced Vasospasm Is Involved in the Pathogenesis of Acquired Sensorineural Hearing Loss","volume":"2019","author":"Eisenhut","year":"2019","journal-title":"Int. J. Otolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1161\/01.HYP.0000146536.68208.84","article-title":"Magnesium inhibits norepinephrine release by blocking N-type calcium channels at peripheral sympathetic nerve endings","volume":"44","author":"Shimosawa","year":"2004","journal-title":"Hypertension"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6338","DOI":"10.4049\/jimmunol.1101765","article-title":"Magnesium decreases inflammatory cytokine production: A novel innate immunomodulatory mechanism","volume":"188","author":"Sugimoto","year":"2012","journal-title":"J. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Alvarado, J.C., Fuentes-Santamar\u00eda, V., Melgar-Rojas, P., Gabald\u00f3n-Ull, M.C., Cabanes-Sanchis, J.J., and Juiz, J.M. (2020). Oral Antioxidant Vitamins and Magnesium Limit Noise-Induced Hearing Loss by Promoting Sensory Hair Cell Survival: Role of Antioxidant Enzymes and Apoptosis Genes. Antioxidants, 9.","DOI":"10.20944\/preprints202011.0442.v1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2984\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:21:47Z","timestamp":1760030507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14092984"],"URL":"https:\/\/doi.org\/10.3390\/jcm14092984","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}