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
- Outer ear
- 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