Ear and sinus barotrauma

[Justin Bieber]

Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the ear (causing ear pain, hearing loss, and/or vestibular symptoms) or the sinuses (causing pain and congestion). Diagnosis sometimes requires audiometry and vestibular testing. Treatment, when required, may involve decongestants, analgesics, and sometimes oral corticosteroids or surgical repair of serious inner or middle ear or sinus injuries.
(See also Overview of Diving Injuries and Overview of Barotrauma.)
Diving can affect the external, middle, and inner ear. Typically, divers experience ear fullness and pain during descent; if pressure is not quickly equilibrated, middle ear hemorrhage or tympanic membrane rupture may occur. Inflow of cold water to the middle ear may result in vertigo, nausea, and disorientation while submerged. On examination of the ear canal, the tympanic membrane may show congestion, hemotympanum, perforation, or lack of mobility during air insufflation with a pneumatic otoscope; conductive hearing loss is usually present.
Inner ear barotrauma often involves rupture of the round or oval window, which causes tinnitus, sensorineural hearing loss, vertigo, nausea, and vomiting. The resulting labyrinthine fistula and perilymph leakage can permanently damage the inner ear.
Sinus barotrauma most often affects the frontal sinuses, followed by the ethmoid and maxillary sinuses. Divers experience mild pressure to severe pain, with a feeling of congestion in the involved sinus compartments during ascent or descent and sometimes epistaxis. Pain can be severe, sometimes accompanied by facial tenderness on palpation.
Rarely, the sinus may rupture and cause pneumocephalus with facial or oral pain, nausea, vertigo, or headache. Rupture of a maxillary sinus can cause retro-orbital air with diplopia due to oculomotor dysfunction. Compression of the trigeminal nerve in the maxillary sinus can cause facial paresthesias. Physical examination may detect tenderness in the sinuses or nasal hemorrhage.