Otic barotrauma: Difference between revisions

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==Background==
==Background==
*Also known as "ear squeeze" during scuba diving or air flight
*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 Valsalva against an occluded eustachian tube
*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}}


==Diagnosis==
{{Barotrauma types}}
*Typically clinical
 
==Evaluation==
*Generally clinical
*Webber and Rinne for middle ear barotrauma
**Conductive hearing loss expected


==Management==
==Management==
====Middle Ear====
====Middle Ear====
*decongestants
*Decongestants
*consider [[antibiotics]] if [[typmanic membrane ruptured]]
*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====
*Head of bed up
*Elevate head of bed
*no nose blowing
*Advise patient to not blow nose
*antivertigo medications
*Antivertigo medications (e.g. [[meclizine]])
*ENT consult
*ENT consult


==Disposition==
==Disposition==
*Normally outpatient
*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==


==Sources==
==References==
<references/>
<references/>


[[Category:Environ]]
[[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

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

Ear Diagnoses

External

Internal

Inner/vestibular

Barotrauma Types

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

See Also

External Links

References