Common Ear Injuries While Diving: Barotrauma On Ascent
Common Ear Injuries While Diving: Barotrauma On Ascent
Common Ear Injuries While Diving: Barotrauma On Ascent
NOTE: No article can give you the same degree of information as an experienced
medical practitioner. DAN suggests all persons with any ear discomfort should be
examined by a trained medical practitioner as soon as possible after the complaint
develops.
No, it’s ear injuries. The most common injury divers experience is some form of
barotrauma to the ear. Barotrauma means injury from pressure (baro = pressure +
trauma = injury). This type of injury occurs for a variety of reasons, but generally it
develops when the pressure in the middle ear is not equal to the pressure of the
outside environment as the diver descends in the water column. (But see
Barotrauma on Ascent) Because of the rapid relative gas volume change as the
diver descends at the beginning of the dive, the first 14 feet / 4.2 meters of the
descent is where the ear is at most risk of injury.
Directly behind the tragus, the cartilaginous prominence in front of the external
opening of the ear, the ear canal curves inwards approximately 24 millimeters in the
average adult. The outer portion of the ear canal contains the glands that produce
earwax (cerumen). The inner portion of the ear is covered by thin, hairless skin.
Pressure on this area can cause pain.
Signs & Symptoms: The ear canal can become inflamed and may partially close.
The external ear canal is red and swollen and may itch. Touching the outer ear may
cause intense pain.
Barotitis Media (middle ear barotrauma): This is by far the most frequently
reported injury among divers. People with barotitis media generally develop
symptoms immediately following the dive, but delays of up to one day or longer have
been reported. When the diver descends, the pressure can cause injury to the middle
ear. This overpressure of the middle ear can cause serious fluid and blood to leak
into the middle ear, partially or completely filling it.
Signs & Symptoms: A feeling of fullness in the ear may develop, like the feeling of
fluid inside the ear. Muffled hearing or hearing loss are other indications of middle
ear barotrauma. On examination with an otoscope (a special device medical
personnel use when examining the ear) fluid may appear behind the tympanic
membrane, causing it to bulge and appear red. In other cases, the eardrum may be
retracted or sunk in. Either condition warrants immediate medical attention.
Treatment: First, diving must stop. Also, changes in altitude—as with flying—must
be considered a concern as well. See a medical practitioner. The combination of
drugs and time will usually allow this injury to heal in a few days, but cases have
lasted up to several months. If you have been on decongestant therapy for seven
days and have experienced little or no relief, it’s time to see your otolaryngologist,
an ear, nose and throat (ENT) specialist.
Otitis Media (middle ear infection): This is not a diving malady, but may look the
same as middle ear barotrauma to a non-dive-trained medical practitioner. Because
the treatments can vary, it is important to realize that an ear problem immediately
following a dive outing usually signals a pressure-related injury rather than an
infection.
Inner Ear Barotrauma: This injury generally occurs when divers attempt to
forcefully equalize their ears. This "hard" blowing over-pressurizes the middle ear
and can result in implosive or explosive damage to the round and oval windows.
Signs & Symptoms: Vertigo, vomiting, hearing loss, loud tinnitus (a ringing or
roaring sound in the ear).
Treatment: Place the injured diver in a sitting head-up position. Get the injured
diver to medical help right away, preferably to someone knowledgeable in diving
medicine since inner ear barotrauma may be difficult to distinguish from inner-ear
decompression sickness.
Tympanic Membrane (TM) Rupture: Barotraumatic injuries to the ear may result
in perforation or rupture of the tympanic membrane. This may occur in as little as 7
feet / 2.1 meters of water.
Signs & Symptoms: Generally there is pain and bleeding from the ear. This may
not always be the case, as a number of dive-related traumatic TM ruptures have
reported no pain at all. Hearing loss and tinnitus may also be present, but not always.
A discharge from the ear of commingled fluid and blood may be a sign of TM rupture.
External Ear Canal Superficial Vessel Rupture: This occurs more often in divers
who wear hoods. Occasionally, the overpressure may rupture a blood vessel inside
the external ear canal, causing some minor bleeding.
Signs & Symptoms: A minute trace of blood trickling from the ear canal. Later, the
injured diver may find drops of blood on his/her pillow or bedclothes.
Treatment: In order to distinguish between this injury and other, more severe
injuries, it is necessary to stop diving and seek evaluation by a medical practitioner.
On a general note, a physician should examine any ear problem that drains purulent
material (pus) or has a foul or disagreeable odor.
SUMMARY
Ear injuries are the most commonly encountered injuries to divers. Permanent
hearing loss may result from barotrauma to the ears. The likelihood of injuries is
reduced by preventive measures such as:
• properly equalizing
• never diving with a cold or other congestion, and
• abstaining from diving if you cannot clear your ears.
Several types of ear injuries can occur. All of these injuries should be examined by a
qualified medical practitioner. If in doubt regarding the practitioner’s knowledge of
diving medicine, bring this article with you or encourage them to call +1-919-684-
2948 and ask for the Medical Department here at DAN for a consult.
Barotrauma on Ascent
Barotrauma of ascent can also occur. It happens when gases in the middle ear
expand with ascent and become blocked, causing tissue damage similar to
barotrauma of descent. This malady is less common, because, in all probability, any
blockage will usually be felt first upon descent by blocking the Eustachian tubes.