Ear Pathology associated with Scuba Diving

The freediving and scuba diving are activities that require a good physical condition and perfect condition of the ear, nose and paranasal sinuses. As is known to those skilled in diving more than 50% of a diver's emerging problems are related to an Otolaryngologist's area of epertise and more than 90% of these problems are related to the ears. 

Normally the air pressure in the ear is equilibrated to atmospheric pressure, by the Eustachian tube, which is normally closed and opens during swallowing, yawning or actively by using the Valsalva Maneuvre.

During scubadiving  the air pressure in the ear may sometimes not be equalised and this leads to overpressure of the middle ear. This will result in barotitis media which is the most frequently reported injury among divers. 

Predisposing factors for barotrauma: 

• Common cold (runny nose) 
• Allergic rhinitis 
• Nasal polyps 
• Septal deviation

External auditory meatus

Pain in the external ear is due to the negative pressure that occurs during the dive, which may result in small hemorrhages in the skin of the ear canal and the eardrum. Treatment is not usually necessary, however, diving should stop until healing is completed. 

Otitis externa is an inflammation of the ear canal caused by bacteria. If the ear remains moist from immersion in the water, this moisture, coupled with the warmth of the body, creates an inviting growth area for many microorganisms, especially opportunistic bacteria.

Middle ear 

Barotrauma of the middle ear is the most common injury reported by divers.
It should be highlighted that the first 10 to 11 meters below the surface, are the critical threshold for the pressure to equalize in the ears. The diver who can not achieve this equalisation in pressure, may encounter severe pain, hearing loss and vertigo either immediately after the dive or even a few days later.

Diving precautions

• Decongestant nasal spray (if the nasal passages are congested) 
• Systemic administration of decongestants 
• Valsalva Maneuvre
• Diving feet first

Reverse barotrauma: occurs when ascending to the surface if the Eustachian tube is blocked and causes:

• severe pain 
• dizziness. 
• bleeding in the ear, 
• trauma to the ear drum  
• permanent hearing loss. 

Inner ear

This injury generally occurs when divers attempt to forcefully equalize their ears. This "hard" blowing over-pressurizes the middle ear and can result in implosive or explosive damage to the round and oval windows. The symptoms caused by inner ear barotrauma are vertigo, vomiting, hearing loss and loud tinnitus.

PREVENTION

Most of these ear injuries can be avoided if the diver is precisely evaluated and screened for any predisposing factors before scubadiving. Emphasis should be placed on a healthy and functional Eustachian tube, nasal cavaties, paranasal sinuses and the nasopharynx.

• This screening examination should include the following tests: otoscopy, audiogram, Valsalva maneuvre, nasal and nasopharyngeal endoscopy.

Preventive measures during the dive include:

1. properly equalizing
2. never diving with a cold or other congestion, and
3. abstaining from diving if you cannot clear your ears.