Otic barotrauma: Difference between revisions
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==Background== | ==Background== | ||
*Also known as "ear squeeze" during scuba diving or air | *Also known as "ear squeeze" - generally seen during scuba diving or air travel | ||
==Clinical Features== | ==Clinical Features== | ||
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====Middle Ear==== | ====Middle Ear==== | ||
*Results from inability to equalize middle ear pressure | *Results from inability to equalize middle ear pressure | ||
*Pain, fullness, vertigo, conductive hearing loss, TM rupture | *[[earache|Pain]], fullness, [[vertigo]], conductive [[hearing loss]], [[TM rupture]] | ||
====Inner Ear==== | ====Inner Ear==== | ||
*Results from forceful | *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 | **Pressure difference between middle ear and inner ear can rupture oval or round window | ||
*Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo | *Sudden onset of sensorineural [[hearing loss]], [[tinnitus]], severe [[vertigo]] | ||
*Must be lacking in any other neurologic signs (otherwise consider infarction) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Ear DDX}} | {{Ear DDX}} | ||
== | {{Barotrauma types}} | ||
* | |||
==Evaluation== | |||
*Generally clinical | |||
*Webber and Rinne for middle ear barotrauma | |||
**Conductive hearing loss expected | |||
==Management== | ==Management== | ||
====Middle Ear==== | ====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==== | ====Inner Ear==== | ||
* | *Elevate head of bed | ||
* | *Advise patient to not blow nose | ||
* | *Antivertigo medications (e.g. [[meclizine]]) | ||
*ENT consult | *ENT consult | ||
==Disposition== | ==Disposition== | ||
* | *Generally may be discharged | ||
*Resolution usually in 5-7 days, but can take up to 2 weeks | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Environmental]] | ||
[[Category:ENT]] | [[Category:ENT]] |
Revision as of 21:29, 2 March 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
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