Preventing Middle Ear Barotrauma: The Importance of Equalizing Pressure

When scuba diving, one of the most common complications that can arise is middle ear barotrauma, characterized by a conductive hearing loss that usually resolves itself. However, if left untreated, this condition can lead to serious damage and discomfort for divers.

The key to preventing middle ear barotrauma is to achieve eustachian tube patency and function by autoinflation, a simple technique that involves creating a change in pressure as little as 4 feet sea water. This equalization of pressure is crucial in avoiding round window rupture or tympanic membrane rupture, which can occur with as little as 100 millimeters of mercury difference between the external auditory canal and the middle ear.

Fluid pressure within the inner ear equals that of the surrounding water, making it essential to equalize pressure during descent. When a diver fails to do so, the head-down position causes the closure of the sinus ostia or eustachian tube, leading to unequal pressure and an inward bulging of the tympanic membrane.

To prevent middle ear squeeze, divers should dive feet-first, which reduces venous engorgement of the head, sinuses, and eustachian tube. Furthermore, it is essential to equalize frequently during descent by auto-inflation, as negative pressure in the middle ear can retract the ear drum and fill the middle ear with fluid.

The diagnosis of middle ear barotrauma is made on the basis of pain on descent, physical examination showing redness of the tympanic membrane due to hemorrhage, and occasionally free blood in the middle ear cavity. This condition is caused by the inability of the diver to clear the space in the middle ear through the Eustachian tube.

To avoid middle ear barotrauma, divers should be aware of their body's response to pressure changes and take steps to equalize pressure regularly during descent. By following these simple techniques, divers can minimize the risk of this common complication and enjoy a safe and enjoyable diving experience.

Barotrauma ear drips