Otic barotrauma: Difference between revisions
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*Webber and Rinne for middle ear barotrauma | *Webber and Rinne for middle ear barotrauma | ||
**Conductive hearing loss expected | **Conductive hearing loss expected | ||
*TEED grading system for middle ear barotrauma | |||
{| class="wikitable" | |||
|- | |||
! Grade !! Description | |||
|- | |||
| 0|| Symptoms without otologic findings | |||
|- | |||
| 1|| Erythema and mild retraction of the tympanic membrane | |||
|- | |||
| 2|| Erythema of the tympanic membrane with mild or spotty hemorrhage within the membrane | |||
|- | |||
| 3|| Gross hemorrhage throughout the tympanic membrane | |||
|- | |||
| 4|| Grade 3 changes pluse hemorrhage within the middle ear (hemotympanum) | |||
|- | |||
| 5|| Free blood in the middle ear plus perforation of the tympanic membrane | |||
|} | |||
==Management== | ==Management== | ||
Revision as of 04:11, 19 July 2020
Background
- Also known as "ear squeeze" - generally seen during scuba diving or air travel
Clinical Features
Middle Ear
- Results from inability to equalize middle ear pressure
- Pain, fullness, vertigo, conductive hearing loss, TM rupture
Inner Ear
- Results from forceful valsalva against an occluded eustachian tube, or rapid descent in diving or aviation
- Pressure difference between middle ear and inner ear can rupture oval or round window
- Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo
- Must be lacking in any other neurologic signs (otherwise consider infarction)
Differential Diagnosis
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Barotrauma Types
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
Evaluation
- Generally clinical
- Webber and Rinne for middle ear barotrauma
- Conductive hearing loss expected
- TEED grading system for middle ear barotrauma
| Grade | Description |
|---|---|
| 0 | Symptoms without otologic findings |
| 1 | Erythema and mild retraction of the tympanic membrane |
| 2 | Erythema of the tympanic membrane with mild or spotty hemorrhage within the membrane |
| 3 | Gross hemorrhage throughout the tympanic membrane |
| 4 | Grade 3 changes pluse hemorrhage within the middle ear (hemotympanum) |
| 5 | Free blood in the middle ear plus perforation of the tympanic membrane |
Management
Middle Ear
- Decongestants
- Consider antibiotics if tympanic membrane rupture
- Remember to use medications such as ofloxacin suspension that will be safe in the middle ear
- Urgent audiology required if sensorineural hearing loss, rather than conductive hearing loss
Inner Ear
- Elevate head of bed
- Advise patient to not blow nose
- Antivertigo medications (e.g. meclizine)
- ENT consult
Disposition
- Generally may be discharged
- Resolution usually in 5-7 days, but can take up to 2 weeks