Wilderness Medicine, First Aid, and Outdoor Skills
Middle Ear Barotrauma

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
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Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Introduction

Barotrauma is a very common problem among individuals who swim, snorkel, and scuba dive. It is an injury that occurs to the ears, sinuses, or teeth that have cavities due to the pressure gradient from going down deep into the water. Barotrauma due to decent is when the pressure increases and the middle ear or sinuses are “squeezed” under pressure. Many times, it is helpful to equilibrate the pressure by squeezing your nose and breathing out. This helps to do it every four, five, or six feet. Other individuals who have chronic middle ear problems and have some chronic fluid in the middle ear may not be able to do this. They will know very quickly within the first six to twelve feet of water that they cannot clear their ears or “equilibrate” the pressure. If this occurs, they should not dive any further. Usually in barotrauma the pressure is followed by sudden pain and onset to the ear. When looking into the ear, one sees little red dots or you can even see severe rupture of the tympanic membrane, the eardrum. There can be bleeding and discharge from the ear. This can be painful.

In this situation, antihistamines are very helpful, with Pseudoephedrine as a drying agent as well as pain medications. Some individuals even prescribe antibiotics as prophylaxis for infection.

Barotrauma Treatment

Healthcare Provider - Medical Treatment
Barotrauma usually resolves with time. However, in consulting with numerous ENT specialists, the treatment intervention still remains mixed. However, the majority of specialists this author has spoken to do prescribe a generic Amoxicillin, or even a Macrolide for prophylaxis, since there is a nice environment there for an infection.

An audiogram is highly recommended. The patient should be instructed to avoid straining or blowing their nose. If there is any hearing loss, systemic steroids are advised. Should the audiogram reveal a complete hearing loss in the effected ear which is also called "a dead ear", then the patient should be advised that they should never dive again. All patients who have some degree of barotrauma are at a higher risk for future injury.




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