Evaluation of Middle Ear Function by Tympanometry and the Influence of Lower Barometric Pressure at High Altitude

2020 ◽  
Author(s):  
Tao Jiang ◽  
Liping Zhao ◽  
Yanbo Yin ◽  
Huiqian Yu ◽  
Qingzhong Li
Keyword(s):  
High Altitude ◽  
Middle Ear ◽  
Barometric Pressure

Improvement in lung diffusion by endothelin A receptor blockade at high altitude

2012 ◽  
Vol 112 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Claire de Bisschop ◽  
Jean-Benoit Martinot ◽  
Gil Leurquin-Sterk ◽  
Vitalie Faoro ◽  
Hervé Guénard ◽  
...  
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Exercise Capacity ◽  
Barometric Pressure ◽  
Membrane Component ◽  
Alveolar Volume ◽  
Double Blind ◽  
Lung Diffusion ◽  
Endothelin A Receptor ◽  
Endothelin A

Lung diffusing capacity has been reported variably in high-altitude newcomers and may be in relation to different pulmonary vascular resistance (PVR). Twenty-two healthy volunteers were investigated at sea level and at 5,050 m before and after random double-blind intake of the endothelin A receptor blocker sitaxsentan (100 mg/day) vs. a placebo during 1 wk. PVR was estimated by Doppler echocardiography, and exercise capacity by maximal oxygen uptake (V̇o2 max). The diffusing capacities for nitric oxide (DLNO) and carbon monoxide (DLCO) were measured using a single-breath method before and 30 min after maximal exercise. The membrane component of DLCO (Dm) and capillary volume (Vc) was calculated with corrections for hemoglobin, alveolar volume, and barometric pressure. Altitude exposure was associated with unchanged DLCO, DLNO, and Dm but a slight decrease in Vc. Exercise at altitude decreased DLNO and Dm. Sitaxsentan intake improved V̇o2 max together with an increase in resting and postexercise DLNO and Dm. Sitaxsentan-induced decrease in PVR was inversely correlated to DLNO. Both DLCO and DLNO were correlated to V̇o2 max at sea level ( r = 0.41–0.42, P < 0.1) and more so at altitude ( r = 0.56–0.59, P < 0.05). Pharmacological pulmonary vasodilation improves the membrane component of lung diffusion in high-altitude newcomers, which may contribute to exercise capacity.

Physiology in Medicine: A physiologic approach to prevention and treatment of acute high-altitude illnesses

2015 ◽  
Vol 118 (5) ◽  
pp. 509-519 ◽  
Author(s):  
Andrew M. Luks
Keyword(s):  
High Altitude ◽  
Acute Hypoxia ◽  
Acute Mountain Sickness ◽  
Travel Medicine ◽  
Barometric Pressure ◽  
Time Frame ◽  
Low Oxygen ◽  
Organ Systems ◽  
Prevention And Treatment ◽  
Physiologic Responses

With the growing interest in adventure travel and the increasing ease and affordability of air, rail, and road-based transportation, increasing numbers of individuals are traveling to high altitude. The decline in barometric pressure and ambient oxygen tensions in this environment trigger a series of physiologic responses across organ systems and over a varying time frame that help the individual acclimatize to the low oxygen conditions but occasionally lead to maladaptive responses and one or several forms of acute altitude illness. The goal of this Physiology in Medicine article is to provide information that providers can use when counseling patients who present to primary care or travel medicine clinics seeking advice about how to prevent these problems. After discussing the primary physiologic responses to acute hypoxia from the organ to the molecular level in normal individuals, the review describes the main forms of acute altitude illness—acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema—and the basic approaches to their prevention and treatment of these problems, with an emphasis throughout on the physiologic basis for the development of these illnesses and their management.

Adaptations to High-Altitude Hypoxia

2021 ◽  
Author(s):  
Cynthia M. Beall ◽  
Kingman P. Strohl
Keyword(s):  
High Altitude ◽  
Oxygen Delivery ◽  
Hemoglobin Concentration ◽  
Barometric Pressure ◽  
Ambient Air ◽  
Extreme Environment ◽  
Indigenous Populations ◽  
East African ◽  
Short Term

Biological anthropologists aim to explain the hows and whys of human biological variation using the concepts of evolution and adaptation. High-altitude environments provide informative natural laboratories with the unique stress of hypobaric hypoxia, which is less than usual oxygen in the ambient air arising from lower barometric pressure. Indigenous populations have adapted biologically to their extreme environment with acclimatization, developmental adaptation, and genetic adaptation. People have used the East African and Tibetan Plateaus above 3,000 m for at least 30,000 years and the Andean Plateau for at least 12,000 years. Ancient DNA shows evidence that the ancestors of modern highlanders have used all three high-altitude areas for at least 3,000 years. It is necessary to examine the differences in biological processes involved in oxygen exchange, transport, and use among these populations. Such an approach compares oxygen delivery traits reported for East African Amhara, Tibetans, and Andean highlanders with one another and with short-term visitors and long-term upward migrants in the early or later stages of acclimatization to hypoxia. Tibetan and Andean highlanders provide most of the data and differ quantitatively in biological characteristics. The best supported difference is the unelevated hemoglobin concentration of Tibetans and Amhara compared with Andean highlanders as well as short- and long-term upward migrants. Moreover, among Tibetans, several features of oxygen transfer and oxygen delivery resemble those of short-term acclimatization, while several features of Andean highlanders resemble the long-term responses. Genes and molecules of the oxygen homeostasis pathways contribute to some of the differences.

Effect of beta-adrenoceptor blockade on renin-aldosterone and alpha-ANF during exercise at altitude

1989 ◽  
Vol 67 (1) ◽  
pp. 141-146 ◽  
Author(s):  
P. Bouissou ◽  
J. P. Richalet ◽  
F. X. Galen ◽  
M. Lartigue ◽  
P. Larmignat ◽  
...  
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Acute Mountain Sickness ◽  
Plasma Renin ◽  
Barometric Pressure ◽  
Suppressive Effect ◽  
Beta Blockade ◽  
Plasma Norepinephrine ◽  
Plasma Aldosterone Concentration ◽  
Ergometer Exercise

The renin-aldosterone system may be depressed in subjects exercising at high altitude, thereby preventing excessive angiotensin I (ANG I) and aldosterone levels, which could favor the onset of acute mountain sickness. The role of beta-adrenoceptors in hormonal responses to hypoxia was investigated in 12 subjects treated with a nonselective beta-blocker, pindolol. The subjects performed a standardized maximal bicycle ergometer exercise with (P) and without (C) acute pindolol treatment (15 mg/day) at sea level, as well as during a 5-day period at high altitude (4,350 m, barometric pressure 450 mmHg). During sea-level exercise, pindolol caused a reduction in plasma renin activity (PRA, 2.83 +/- 0.35 vs. 5.13 +/- 0.7 ng ANG I.ml-1.h-1, P less than 0.01), an increase in plasma alpha-atrial natriuretic factor (alpha-ANF) level (23.1 +/- 2.9 (P) vs. 10.4 +/- 1.5 (C) pmol/1, P less than 0.01), and no change in plasma aldosterone concentration [0.50 +/- 0.04 (P) vs. 0.53 +/- 0.03 (C) nmol/1]. Compared with sea-level values, PRA (3.45 +/- 0.7 ng ANG I.ml-1.h-1) and PA (0.39 +/- 0.03 nmol/1) were significantly lower (P less than 0.05) during exercise at high altitude. alpha-ANF was not affected by hypoxia. When beta-blockade was achieved at high altitude, exercise-induced elevation in PRA was completely abolished, but no additional decline in PA occurred. Plasma norepinephrine and epinephrine concentrations tended to be lower during maximal exercise at altitude; however, these differences were not statistically significant. Our results provide further evidence that hypoxia has a suppressive effect on the renin-aldosterone system. However, beta-adrenergic mechanisms do not appear to be responsible for inhibition of renin secretion at high altitude.

scholarly journals Respiratory and circulatory control at high altitudes.

1982 ◽  
Vol 100 (1) ◽  
pp. 147-157
Author(s):  
J B West
Keyword(s):  
Oxygen Consumption ◽  
High Altitude ◽  
Acute Hypoxia ◽  
Maximal Oxygen Consumption ◽  
Barometric Pressure ◽  
Mount Everest ◽  
Exercise Ventilation ◽  
Circulatory Control ◽  
Work Level ◽  
Oxygen Requirements

Hyperventilation is one of the most important features of acclimatization to high altitude. Resting ventilation at extreme altitudes increases up to fourfold and exercise ventilation for a given work level increases to the same extent. Hypoxic stimulation of the peripheral chemoreceptors is the chief mechanism for the hyperventilation but there is also evidence that central sensitization of the respiratory centres occurs. Permanent residents of high altitude have a blunted hypoxic ventilatory response compared to acclimatized lowlanders. Cardiac output increases in responses to acute hypoxia but returns to normal in acclimatized lowlanders. Oxygen uptake at extreme altitudes is markedly limited by the diffusion properties of the blood gas barrier. As a consequence the maximal oxygen consumption of a climber near the summit of Mount Everest is near his basal oxygen requirements. Maximal oxygen consumption is so sensitive to barometric pressure that it may be that day-to-day variations will affect the chances of a climber reaching the summit without supplementary oxygen.

Ventilation-perfusion inequality in normal humans during exercise at sea level and simulated altitude

1985 ◽  
Vol 58 (3) ◽  
pp. 978-988 ◽  
Author(s):  
G. E. Gale ◽  
J. R. Torre-Bueno ◽  
R. E. Moon ◽  
H. A. Saltzman ◽  
P. D. Wagner
Keyword(s):  
Blood Flow ◽  
High Altitude ◽  
Sea Level ◽  
Statistical Significance ◽  
Barometric Pressure ◽  
Bicycle Ergometer ◽  
Lung Model ◽  
Inert Gas ◽  
Topographical Distribution ◽  
Normal Humans

To investigate the effects of both exercise and acute exposure to high altitude on ventilation-perfusion (VA/Q) relationships in the lungs, nine young men were studied at rest and at up to three different levels of exercise on a bicycle ergometer. Altitude was simulated in a hypobaric chamber with measurements made at sea level (mean barometric pressure = 755 Torr) and at simulated altitudes of 5,000 (632 Torr), 10,000 (523 Torr), and 15,000 ft (429 Torr). VA/Q distributions were estimated using the multiple inert gas elimination technique. Dispersion of the distributions of blood flow and ventilation were evaluated by both loge standard deviations (derived from the VA/Q 50-compartment lung model) and three new indices of dispersion that are derived directly from inert gas data. Both methods indicated a broadening of the distributions of blood flow and ventilation with increasing exercise at sea level, but the trend was of borderline statistical significance. There was no change in the resting distributions with altitude. However, with exercise at high altitude (10,000 and 15,000 ft) there was a significant increase in dispersion of blood flow (P less than 0.05) which implies an increase in intraregional inhomogeneity that more than counteracts the more uniform topographical distribution that occurs. Since breathing 100% O2 at 15,000 ft abolished the increased dispersion, the greater VA/Q mismatching seen during exercise at altitude may be related to pulmonary hypertension.

Susceptibility to high-altitude pulmonary edema in Madison and Hilltop rats. I. Ventilation and fluid balance

1995 ◽  
Vol 78 (6) ◽  
pp. 2279-2285
Author(s):  
G. L. Colice ◽  
Y. J. Lee ◽  
J. Chen ◽  
H. K. Du ◽  
G. Ramirez ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Minute Ventilation ◽  
Plasma Renin ◽  
Barometric Pressure ◽  
Simulated Altitude ◽  
Sprague Dawley ◽  
Lung Water ◽  
Fluid Handling ◽  
High Altitude Pulmonary Edema

The pathogenesis of high-altitude pulmonary edema (HAPE) is not well understood. Ventilation and fluid-handling abnormalities at high altitude (HA) may play a role in HAPE. Because ventilatory and cardiopulmonary responses to chronic HA exposure in the Hilltop (H) strain of Sprague-Dawley rat are different from those in the Madison (M) strain, it was hypothesized that these strains would have different susceptibilities to developing HAPE. M and H rats were studied at sea level (SL) and in a hypobaric chamber after 9 and 12 h at a simulated altitude of 24,000 ft (barometric pressure = 295 mmHg) and 1, 12, and 24 h at a simulated altitude of 18,000 ft (barometric pressure = 380 mmHg). Both strains developed HAPE, but the M rat was more susceptible to HAPE, as demonstrated by a higher mortality rate from hemorrhagic pulmonary edema after 9 h at 24,000 ft and an earlier increase in lung water after exposure to 18,000 ft. Minute ventilation was similar in both strains at HA, but arterial PO2 was significantly higher in the M rat. Both strains had a significant decrease in fluid intake and negative sensible water balance at HA. No changes in plasma renin activity, aldosterone concentrations, antidiuretic hormone levels, and atrial natriuretic peptide levels were found at HA. The increased susceptibility of the M rat to HAPE is therefore not explained by ventilation or fluid-handling abnormalities.

scholarly journals Physiology and Medicine at High Altitude: The Exposure and the Stress

2018 ◽  
Vol 3 (3) ◽  
pp. 203 ◽  
Author(s):  
Anil Gurtoo
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Hemoglobin Concentration ◽  
Barometric Pressure ◽  
Extreme Environment ◽  
Incidence Rates ◽  
Oxygen Requirement ◽  
Classic Model ◽  
Mountain Sickness ◽  
High Altitude Illness

<p>Increase in altitude causes decrease in atmospheric barometric pressure that results in decrease of inspired<br />partial pressure of oxygen, a source for stress and pose a challenge to climbers/trekkers or persons posted on<br />high altitude areas. This review discusses about the high altitude sickness, their incidence rates, pathophysiology<br />and the classic model of acclimatisation, which explains about how oxygen requirement in extreme environment<br />is achieved by complex interplay among pulmonary, hematological and cardiovascular processes. The acute<br />high altitude illness (AHAI) is basically composed of two syndromes: cerebral and pulmonary that can afflict<br />un-acclimatised climbers/trekkers. The cerebral syndrome includes acute mountain sickness (AMS) and high<br />altitude cerebral oedema (HACO) and pulmonary syndrome typically refers to high altitude pulmonary oedema<br />(HAPO). The core physiological purpose, according to the classic model is centered upon the optimisation of<br />increased delivery of oxygen to the cells through a coherent response involving increased ventilation, cardiac<br />output and hemoglobin concentration with aim to increase the oxygen flux across the oxygen cascade, which<br />will help in preventing the development of majority of high altitude illness.</p>

Submucous Resection: The Treatment of Choice in the Nose-Ear Distress Syndrome

1979 ◽  
Vol 65 (3) ◽  
pp. 123-130
Author(s):  
W. D. McNicoll ◽  
S. G. Scanlan
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Distress Syndrome ◽  
Ambient Pressure ◽  
Barometric Pressure ◽  
Eustachian Tube Dysfunction ◽  
Royal Navy ◽  
Tube Dysfunction ◽  
The Relationship ◽  
Submucous Resection

AbstractThe combination of nasal septal deviation and Eustachian tube dysfunction, in the absence of any other pathology, constitutes the Nose-Ear Distress Syndrome. We have undertaken a clinical assessment of the relationship between uncomplicated deviation of the nasal septum and Eustachian tube dysfunction in naval personnel who are serving in environments of primarily increased barometric pressure.One hundred and twenty candidates to the submarine, diving and aircrew branches of the Royal Navy who presented with the nose-ear distress syndrome were initially surveyed. None were able to equilibrate their middle ear pressures at an increased ambient pressure of 3 metres of water. Submucous resection was performed on 116, of whom 110 (94.83%) were able to equilibrate their middle ear pressures at an increased ambient pressure of 9 metres of water post-operatively.Xenon 113 scintigraphy was performed on a further 25 recruits to delineate the post-nasal airflow. This investigation was performed pre- and post-operatively. Pre-operatively, scintigraphy showed the presence of turbulence in the post-nasal space, while post-operatively the turbulence was absent. All the candidates were unable to equilibrate their middle ear pressures pre-operatively, but after submucous resection 24 (96%) were able to equilibrate their middle ear pressures at an increased barometric pressure of 9 metres of water.

Sign in / Sign up

Export Citation Format

Share Document