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The assessment and management of inner ear barotrauma in divers and recommendations for returning to diving


Elliott, EJ and Smart, DR, The assessment and management of inner ear barotrauma in divers and recommendations for returning to diving, Diving and Hyperbaric Medicine, 44, (4) pp. 208-222. ISSN 1833-3516 (2014) [Refereed Article]

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Inner ear barotrauma (IEBt) constitutes a spectrum of pressure-related pathology in the inner ear, with antecedent middle ear barotrauma (MEBt) common. IEBt includes perilymph fistula, intralabyrinthine membrane tear, inner ear haemorrhage and other rarer pathologies. Following a literature search, the pathophysiology, diagnosis, and treatment of IEBt in divers and best-practice recommendations for returning to diving were reviewed. Sixty-nine papers/texts were identified and 54 accessed. Twenty-five case series (majority surgical) provided guidance on diagnostic pathways; nine solely reported divers. IEBt in divers may be difficult to distinguish from inner ear decompression sickness (IEDCS), and requires dive-risk stratification and careful interrogation regarding diving-related ear events, clinical assessment, pure tone audiometry, a fistula test and electronystagmography (ENG). Once diagnosed, conservative management is the recommended first line therapy for IEBt. Recompression does not appear to cause harm if the diagnosis (IEBt vs IEDCS) is doubtful (limited case data). Exploratory surgery is indicated for severe or persisting vestibular symptoms or hearing loss, deterioration of symptoms, or lack of improvement over 10 days indicating significant pathology. Steroids are used, but without high-level evidence. It may be possible for divers to return to subaquatic activity after stakeholder risk acceptance and informed consent, provided: (1) sensorineural hearing loss is stable and not severe; (2) there is no vestibular involvement (via ENG); (3) high-resolution computed tomography has excluded anatomical predilection to IEBt and (4) education on equalising techniques is provided. There is a need for a prospective data registry and controlled trials to better evaluate diagnostic and treatment algorithms.

Item Details

Item Type:Refereed Article
Keywords:barotrauma, diving, ENT, inner ear, pathophysiology, review article, treatment
Research Division:Health Sciences
Research Group:Allied health and rehabilitation science
Research Field:Rehabilitation
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Elliott, EJ (Dr Elizabeth Elliott)
UTAS Author:Smart, DR (Associate Professor David Smart)
ID Code:100398
Year Published:2014
Deposited By:Faculty of Health
Deposited On:2015-05-14
Last Modified:2017-11-03

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