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. 2017 Jun;47(2):97-109.
doi: 10.28920/dhm47.2.97-109.

Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care

Devon M Livingstone  1 , Kristine A Smith  2 , Beth Lange  2
Affiliations

Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care

Devon M Livingstone et al. Diving Hyperb Med. 2017 Jun.

Abstract

Scuba diving is a popular recreational and professional activity with inherent risks. Complications related to barotrauma and decompression illness can pose significant morbidity to a diver's hearing and balance systems. The majority of dive-related injuries affect the head and neck, particularly the outer, middle and inner ear. Given the high incidence of otologic complications from diving, an evidence-based approach to the diagnosis and treatment of otic pathology is a necessity. We performed a systematic and comprehensive literature review including the pathophysiology, diagnosis, and treatment of otologic pathology related to diving. This included inner, middle, and outer ear anatomic subsites, as well as facial nerve complications, mal de debarquement syndrome, sea sickness and fitness to dive recommendations following otologic surgery. Sixty-two papers on diving and otologic pathology were included in the final analysis. We created a set of succinct evidence-based recommendations on each topic that should inform clinical decisions by otolaryngologists, dive medicine specialists and primary care providers when faced with diving-related patient pathology.

Keywords: Barotrauma; Decompression sickness; ENT; Head and neck; Injuries; Medical conditions and problems; Review article.

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Figures

Figure 1
Figure 1
Implosive mechanism of inner ear barotrauma and perilymphatic fistula: a successful forced Valsalva manoeuvre (a) communicates excessive pressure to the middle ear space, distending the tympanic membrane, causing implosion of the round window (b) and subluxation of the stapes footplate (c)
Figure 2
Figure 2
Explosive mechanism of inner ear barotrauma and perilymphatic fistula; a failed forced Valsalva manoeuvre due to a blocked Eustachian tube (a) in the setting of a relative vacuum within the middle ear space (b) causes elevation of CSF pressure (c); this increased pressure is communicated to the inner ear, resulting in round window rupture (d) and intracochlear hemorrhage
See this image and copyright information in PMC

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