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Up, Up, and Blown Away
A 28-year-old male presents to the ED with vertigo. He just returned to Denver from The Greater Antilles after a celebratory scuba diving trip. He reports ear pain after his last dive today and upon descending into Denver, he felt a pop with relief of pressure in his right ear and onset of vertigo.. His otoscopic exam is shown in the image below.
Up, Up, and Blown Away
Author: Vincent Giron, DO
Peer-Reviewer: Derek Hatfield, MD
Final Editor: Brandon Godfrey, MD, Will Denq, MD, CAQ-SM, Conner Dixon, MD
A 28-year-old male presents to the ED with vertigo. He just returned to Denver from The Greater Antilles after a celebratory scuba diving trip. He reports ear pain after his last dive today and upon descending into Denver, he felt a pop with relief of pressure in his right ear and onset of vertigo.. His otoscopic exam is shown in the image below.
Figure 1. Image from otoscopy. Courtesy of Glenn C Isaacson, MD, FAAP.
What is the diagnosis?
Tympanic membrane (TM) perforation with sensorineural hearing loss secondary to barotrauma
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Pearl: Barotrauma can present as tinnitus, pressure, pain and hearing loss. Hemotympanum can occur from stretching of tissues and vessels due to the unequal pressures in the external and middle/inner ear. Bleeding into the inner ear and rupture of the round or oval window will cause vertigo and sensorineural hearing loss [2].
References
[1] Brown TP. Middle ear symptoms while flying. Ways to prevent a severe outcome. Postgrad Med. 1994;96(2):135-142.
[2] Clenney TL, Lassen LF. Recreational scuba diving injuries. Am Fam Physician. 1996;53(5):1761-1774.
[3] Moon RE. Treatment of diving emergencies. Crit Care Clin. 1999;15(2):429-456. doi:10.1016/s0749-0704(05)
[4] Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg. 1985;93(3):393-397. doi:10.1177/019459988509300320
[5] Elliott EJ, Smart DR. The assessment and management of inner ear barotrauma in divers and recommendations for returning to diving. Diving Hyperb Med. 2014;44(4):208-222.
[6] Ars B, Dirckx J. Eustachian Tube Function. Otolaryngol Clin North Am. 2016;49(5):1121-1133. doi:10.1016/j.otc.2016.05.003
[7] Parell GJ, Becker GD. Inner ear barotrauma in scuba divers. A long-term follow-up after continued diving. Arch Otolaryngol Head Neck Surg. 1993;119(4):455-457. doi:10.1001/archotol.1993.
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