Otic barotrauma

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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

Scuba 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