Otic barotrauma

Background

• Also known as "ear squeeze" during scuba diving or air flight

Clinical Features

Perforated TM

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
  • Pressure difference between middle ear and inner ear can rupture oval or round window
• Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo

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
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

Barotrauma Types

• Otic barotrauma
• Pulmonary barotrauma
• Sinus barotrauma
• Mask squeeze
• Barodentalgia (trapped dental air causing squeeze)

Evaluation

• Typically clinical

Management

Middle Ear

• decongestants
• consider antibiotics if typmanic membrane ruptured

Inner Ear

• Head of bed up
• no nose blowing
• antivertigo medications
• ENT consult

Disposition

• Normally outpatient

See Also

• Ruptured tympanic membrane