Otic barotrauma

Background

• Also known as "ear squeeze" - generally seen during scuba diving or air travel

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

Scuba Diving Emergencies

• Barotrauma of descent
  • Otic barotrauma
  • Sinus barotrauma
  • Face squeeze
• Barotrauma of ascent
  • Pulmonary barotrauma (pulmonary overpressurization syndrome)
  • Decompression sickness (DCS)
  • Arterial gas embolism
• At depth injuries
  • Oxygen toxicity
  • Nitrogen narcosis
  • Hypothermia
  • Contaminated gas mixture (e.g. CO toxicity)

Ear Diagnoses

• External
  • Auricular hematoma
  • Cholesteatoma
  • Contact dermatitis
  • Ear foreign body
  • Herpes zoster oticus (Ramsay Hunt syndrome)
  • Malignant otitis externa
  • Mastoiditis
  • Otitis externa
  • Otomycosis
  • Tympanic membrane rupture
• Internal
  • Acute otitis media
  • Bullous myringitis
  • Chronic otitis media
  • Mastoiditis
  • Otic barotrauma
• Inner/vestibular
  • Labyrinthitis
  • Meniere's disease
  • Sudden sensorineural hearing loss

Barotrauma Types

• Otic barotrauma
• Pulmonary barotrauma
• Sinus barotrauma

Evaluation

• Generally clinical

Management

Middle Ear

• Decongestants
• Consider antibiotics if typmanic membrane ruptured

Inner Ear

• Elevate head of bed
• Advise patient to not blow nose
• Antivertigo medications
• ENT consult

Disposition

• Generally may be discharged

See Also

• Ruptured tympanic membrane

References

Authors

Ross Donaldson, Michael Holtz, Daniel Ostermayer, Neil Young