Barotrauma

Due to changes in pressure
Retraction, redness, dizziness, hearing, tinnitus, discharge
Divided according to location
- Outer ear
  - Canal stenosis from blocked cerumen, foreign body, tight wetsuit
  - Causes relative vacuum – oedema, hemorrhage
  - Advise restricted diving/flying
- Middle ear
  - Disequilibrium between middle ear and ambient pressure
  - Use topical nasal steroids and decongestants
- Inner ear
  - Pressure changes are transmitted from the middle ear to inner ear
  - Inner ear hemorrhage, labyrinth teat, perilympahtic fistula
  - Needs admission/surgery
Innear ear decompression sickness but resemble inner ear barotrauma – but more severe – likely to need recompression

Characteristic features differentiating inner ear barotrauma and inner ear decompression sickness
Inner ear barotrauma	Inner ear decompression sickness
Conductive or mixed hearing loss	Sensorineural hearing loss
Descent or ascent	Ascent
Cochlear symptoms (ie hearing loss predominates)	Vestibular symptoms predominant; right sided
History of forced or difficult Valsalva manoeuvre	Not associated with a history of eustachian tube dysfunction
Low-risk dive profile	Dive profile >15 m, technical diving (helium mixtures), multiple dives over a short period
Isolated inner ear symptoms	Other neurological/dermatological manifestations

Prevention and fitness to dive

Adequate ventilation of the middle ear is essential to the prevention of otological injury.
Divers with conditions predisposing them to ETD should avoid diving, and those who are unable to autoinsufflate the ear underwater should immediately abort the dive.
Controlling the rate of ascent and taking decompression stops will reduce the risk of DCS.
To avoid nitrogen excess, flying is also not recommended within 24 hours following diving.
The use of oral or topical decongestants is discouraged to treat ETD or sinusitis prior to diving as their effects may wear off while underwater, leaving the diver in danger.

Fitness to return to diving depends on residual symptoms and ongoing pathology.
Persisting neurology, especially affecting the vestibular system, is associated with high risk.
An estimated 90% of patients with previous diving-related vestibular dysfunction have ongoing long-term deficits necessitating thorough assessment prior to continuing scuba diving.
Some authors recommend full vestibulocochlear assessment and exclusion of a right-to-left vascular shunt in those who have previously had inner ear DCS