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
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.