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DETAILS FOR ROUND FOUR GRANTS

WHAT IS THE INCIDENCE OF MIDDLE EAR BAROTRAUMA IN NOVICE SCUBA DIVERS AND CAN IT BE REDUCED?


THE EFFECT OF HYPERBARIC OXYGEN TREATMENT ON LARGE BONE DEFECT HEALING USING TISSUE ENGINEERED BONE SUBSTITUTES

Chief Investigator:
Dr Denise Blake
Emergency Department
The Townsville Hospital
100 Angus Smith Drive, Douglas, QLD, Australia, 4814
Mobile: 0427 158 788
Fax: 07 4796 2901
Denise_blake@health.qld.gov.au


Other investigators:

Dr Katherine H Commons MBChB
Registrar, Hyperbaric Medicine Unit, The Townsville Hospital.

Dr Clinton R Gibbs MBBS, FACEM, Dip DHM (SPUMS), PGCertAME
Staff Specialist, Emergency Department, The Townsville Hospital.

Dr Catherine A Meehan MBBS, PG DIP Med Sci (Diving and Hyperbaric Medicine, Dip DHM (SPUMS)
General Practitioner, McLeod Street Medical, Cairns, Queensland.

Lawrence H Brown MPH&TM
Senior Principal Research Officer, School of Public Health, Tropical Medicine and Rehabilitation Services, James Cook University.

Institution at which research will be conducted:

Prodive, Cairns dive training centre, pool and dive boats Deep Sea Divers Den, Cairns dive training centre, pool and dive boats


Hypothesis and aims:

The aim of this study is to assess the hypothesis that education about ear equalization techniques using video otoscopy in open water Self Contained Underwater Breathing Apparatus (SCUBA) diver candidates will decrease the incidence of middle ear barotrauma.

This study will test two null hypotheses:

HO1: There is no difference in the frequency of grade 2 or greater post-dive barotrauma in PADI open water dive candidates who participate in an extra educational session on ear equalization techniques compared with dive candidates who are not exposed to the extra educational session.

HO2: There is no difference in the severity of post-dive barotrauma in PADI open water dive candidates who participate in an extra educational session on ear equalization techniques compared with dive candidates who are not exposed to the extra educational session.

This will be a prospective study performed to assess middle ear barotrauma in PADI open water diver candidates after an education session on ear equalization techniques. The PADI open water diver candidates will have completed and passed their dive medicals prior to enrolment in the study. To decrease the ability of students and instructors to share knowledge of ear equalization techniques, entire open water classes will be used as the control and intervention groups. The groups will be allocated to control and intervention with all controls being completed before the intervention. The intervention group will have an education session on basic ear anatomy and physiology and a practical session on ear equalization techniques with video otoscopy to show them movement of their tympanic membranes with the Valsalva manoeuvre. Photographs of their tympanic membranes will be taken and tympanometry completed. The control group will have photographs taken, otoscopy to visualize tympanic membrane movement with Valsalva, and tympanometry but with no formal ear equalization education and no viewing of TM movement. The candidates will be assessed at the training centre prior to confined water sessions, after confined water sessions and after open water dives. Education sessions will take place at the dive training centre. The frequency of grade 2 or greater barotrauma in the two study groups will be compared using relative risk; the severity (grade) of barotraumas in the two study groups will be compared using the Wilcoxon test.

 

Outcomes and significances:

Divers:
  • Potential for reduction in the risk of barotrauma, through initiation of preventative measures:
    • Reduction in pain;
    • Reduction in further complications of middle ear barotraumas eg. hearing loss

Health System:

  • Potential for reduction in other diving injuries:
    • if more dives can be completed during the initial supervised course, divers may go on to learns more safe practices before heading out into the water by themselves;
    • new divers able to focus on other aspects of dive safety therefore reducing rapid ascents and buddy separation due to ear pain

Dive Companies:

  • More enjoyable, less painful diving is more likely to encourage divers back into the sea and to recommend the activity to friends
  • Decrease the number of dives missed by divers due to aural barotrauma

Results obtained from this research project will be used to develop a formal training program for SCUBA instructors to teach assessment of ears and education about ear equalization techniques for open water SCUBA diver candidates.




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