Barotrauma – Never mind the sharks, guard your ears!

This morning I saw a very interesting case of Barotrauma whilst covering an ENT clinic. Mr Naui has been diving in a 10meter pool as part of his SCUBA training five days ago and whilst he was doing bounces (quick up and down movements at three meter depths) he suddenly experienced severe ear ache on the right. He suffered a significant decrease in his hearing, some vertigo and some mild tinnitus on the right.  He has seen his GP the next day that referred to the emergency ENT. His audiogram today looked like this:

 

 audiogram

 

Mr Naui reported that his hearing has subjectively improved since the incident and although the GP noted a tympanic perforation on Sunday, none was visible today. His vertigo also improved.

 

I discussed this patient with the ENT consultant who said Mr Naui clearly had cochlear damage (given the sensory-neural hearing loss,tinnitus and vertigo) likely caused by the a dislocation and rupture of the Reissner’s membrane and/or basilar membrane. He also said it could be inner ear decompression disease which is the result of a gas bubble forming in the inner ear. According to the consultant a fistula is unlikely as all his symptoms are improving and his hearing isn’t fluctuating. He prescribed Mr Naui steroids and antihistamine in an effort to decrease inflammatory changes and increase the delivery of oxygen. He will be reviewed in a few days but the consultant says his hearing loss is likely to remain significant at the high frequencies.

 

I then googled “Barotrauma” and came across this a very interesting summary of Barotrama of the middle and the inner ear http://www.bcm.edu/oto/grand/32395.html

 

According to this article, Mr Naui certainly didn’t have inner ear decompression sickness (IEDS) as:

1)     its commonly seen after dives at extreme depths when divers use helium/oxygen mixture and Mr Naui was diving at only at 3 meter depths

2)     Mr Naui didn’t have any central neurological signs

3)     Inner ear decompression sickness patients needs recompression immediately.  The hearing can return to near normal levels if treated immediately.

 

I wonder if Mr Naui will pursue diving as a hobby after this incident.

 

Until next time,

 

Dezi Belle

 

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