Monday, April 5, 2010

What is Barotrauma?

Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment. The most common examples of barotrauma occur in air travel and scuba diving. Although the degree of pressure changes are much more dramatic during scuba diving, barotraumatic injury is possible during air travel.

Barotrauma can affect several different areas of the body, including the ear, face and lungs. Here we will focus on barotrauma as it relates to the ear.

What are the Symptoms of Barotrauma?

Symptoms of barotrauma include “clogging” of the ear, ear pain, hearing loss, dizziness, ringing of the ear (tinnitus), and hemorrhage from the ear.

Dizziness (or vertigo) may also occur during diving from a phenomenon known as alternobaric vertigo. It is caused by a difference in pressure between the two middle ear spaces, which stimulates the vestibular (balance) end organs asymmetrically, thus resulting in vertigo. The alternobaric response can also be elicited by forcefully equalizing the middle ear pressure with the Politzer maneuver, which can cause an unequal inflation of the middle ear space.

What Causes Barotrauma?

Barotrauma is caused by a difference in pressure between the external environment and the internal parts of the ear. Since fluids do not compress under pressures experienced during diving or flying, the fluid-containing spaces of the ear do not alter their volume under these pressure changes. However, the air-containing spaces of the ear do compress, resulting in damage to the ear if the alterations in ambient pressure cannot be equalized. Rarely, barotrauma may be the result of hyperbaric oxygen therapy. Slow compression hyperbaric oxygen therapy is associated with a lower risk of otoc barotraumas than traditional hyperbaric oxygen therapy.

Barotrauma can affect the outer, middle, or inner ear.

How is Barotrauma Diagnosed?

Diagnosis is initially based on careful history. If the history indicates ear pain or dizziness that occurs after diving or an airplane flight, barotrauma should be suspected. The diagnosis may be confirmed through ear examination, as well as hearing and vestibular testing.

How is Barotrauma Treated?

For outer ear barotrauma, the treatment consists of clearing the ear canal of the obstruction, and restricting diving or flying until the blockage is corrected and the ear canal and drum return to normal.

For middle ear barotrauma, treatment consists of keeping the ear dry and free of contamination that could cause infection. Topical nasal steroids and decongestants may be started in an attempt to decongest the eustachian tube opening. The presence of pus may prompt the use of appropriate antibiotics. Most tympanic membrane perforations due to barotrauma will heal spontaneously. If the eustachian tube demonstrates chronic problems with middle ear equalization, the likelihood of recovery is drastically reduced.

Prevention of air barotraumas to the middle ear has been attempted with dasal decongestants or vasoconstrictors with mixed results. “Pressure equalizing” ear plugs claiming to prevent in-flight barotrauma are available in many airports for purchase. A trial evaluating the effect of these earplugs to placebo found them to have no effect on barotrauma.

For inner ear barotrauma, treatment consists of hospitalization and bed rest with the head elevated 30 to 40 degrees. Controversy exists whether this type of injury needs immediate surgery. Once healed, a diver should not return to diving until hearing and balance function tests are normal.

this information is taken directly from American Hearing Research Foundation. More information can be obtain at its website.

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