What causes barotrauma of the ear during scuba diving?

From the Guidelines

Barotrauma of the ear during scuba diving is caused by the compression or expansion of gas-filled body cavities, particularly in the ear, during descent or ascent. This occurs when the pressure change is not equalized, leading to discomfort, pain, or even damage to the ear structures 1.

Key Factors Contributing to Ear Barotrauma

• Pressure changes: The primary cause of ear barotrauma is the inability to equalize the pressure in the ear with the surrounding water pressure during descent or ascent 1.
• Gas-filled cavities: The presence of gas-filled cavities in the ear, such as the middle ear, makes it susceptible to compression or expansion injuries 1.
• Diving techniques: Improper diving techniques, such as rapid descent or ascent, can increase the risk of ear barotrauma 1.

Prevention and Management

• Equalization techniques: Divers can use various equalization techniques, such as the Valsalva maneuver, to equalize the pressure in their ears during descent 1.
• Gradual descent and ascent: Gradual descent and ascent can help reduce the risk of ear barotrauma by allowing the body to adjust to the pressure changes 1.
• Medical screening: Medical screening can help identify individuals with pre-existing conditions that may increase their risk of ear barotrauma, such as eustachian tube dysfunction 1.

From the Research

Causes of Barotrauma of the Ear during Scuba Diving

• Barotrauma of the ear during scuba diving can be caused by the inability to equalize middle ear pressure, leading to trauma to the ear 2
• The risk of barotrauma is increased by factors such as diving depth, diving experience, and number of diving sessions 2
• Middle ear barotrauma (MEB) is a common condition that can occur during hyperbaric oxygen therapy, with a prevalence of 10.04% and incidence of 0.587% 3
• Risk factors for MEB include age older than 55 years, female gender, ear, nose and throat history, and general history such as smoking and obstructive breathing disorders 3
• Inner ear barotrauma (IEBt) can also occur, which includes perilymph fistula, intralabyrinthine membrane tear, inner ear haemorrhage, and other rarer pathologies 4

Pathophysiology of Barotrauma

• The pathophysiology of barotrauma involves the inability of the middle ear to equalize pressure, leading to damage to the ear structures 2
• The Eustachian tube plays a crucial role in equalizing middle ear pressure, and dysfunction of the tube can contribute to barotrauma 2
• The diagnosis of barotrauma can be difficult, and requires careful clinical assessment, pure tone audiometry, and other diagnostic tests such as electronystagmography (ENG) 4

Prevention and Management of Barotrauma

• Prevention of barotrauma involves educating divers on equalizing techniques and providing guidance on safe diving practices 4
• Management of barotrauma involves conservative therapy, and in some cases, exploratory surgery may be indicated for severe or persisting symptoms 4
• Steroids may be used in the treatment of barotrauma, but there is limited evidence to support their use 4