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This letter originally appeared in Dr. Hoffman's column on allHealth.com. |
Q: My husband was scuba diving a week ago. After he dove the first time, his ear was blocked but got better within 24 hours. The second day he dove, his ear felt "blocked" again afterwards and it has not gone away. He has seen his primary care physician who told him he may have "baro syndrome" and he will see an ENT specialist. I have been unable to find information on this disorder. Can you give me some information on this syndrome and how long it takes to get better?
A: If you did a web search for "baro syndrome," I’m not surprised that you came up with goose eggs. This is an odd way to refer to barotrauma or barotitis (I suspect that these are better search terms.)
"Baro" means pressure (e.g., barometer), so these terms refer to a pressure-related injury of the ear (barotrauma) or pressure-induced inflammation of the ear (barotitis.) Diving is probably the most common circumstance for such an injury, but plane flight and skydiving can also generate the rapid pressure changes that lead to barotrauma.
To understand barotrauma, you unfortunately will have to sit through a little lecture on middle ear anatomy and physiology. Here goes:
The middle ear is an air-filled space located behind the ear drum. On most of its sides, it is bounded by bone. There are three thin membranes within the walls of the middle ear: the ear drum, and two membranes (each much smaller than the ear drum) which separate the middle ear from the inner ear. These two membranes are known as the oval and round windows. Aside from these three membranes and the bony walls of the middle ear, the only other relevant feature of the middle ear is the opening to the Eustachian tube. The Eustachian tube is a muscular/cartilaginous tube that opens into the middle ear and also the roof of the throat, effectively connecting the middle ear space to the outside world. This tube is usually closed, but it opens occasionally to allow air pressure differences between the middle ear space and "outside" to equalize.
If the air pressure in the "outside world" changes very suddenly, as it might for a deep sea diver, sky diver, or passenger in a rapidly-depressurizing airplane, the Eustachian tube may not be able to do its job equalizing the pressure between the middle ear and the "outside world." If the pressure differences are severe enough, a number of different barotraumatic injuries may occur. From least serious to most serious:
– Symptoms related to the pressure difference: pain, "fullness", dizziness, tinnitus, and so forth.
– A build-up of middle ear fluid (this is known as an effusion) resulting in fullness and hearing loss.
– Bleeding into the middle ear (this is known as hemotympanum) again resulting in fullness and hearing loss.
– The ear drum may pop, just as a balloon could pop under similar circumstances. This would result in a hole in the ear drum, some hearing loss, and possible drainage from the ear canal.
– There could be a rupture of the round window or oval window, resulting in damage to the inner ear. This is the most serious injury because it is the most likely one to be associated with irreversible damage.
I cannot tell you how long it will take for your husband to recover because I do not know the severity of his injury. By examining your husband’s ear and by obtaining a hearing test, the ENT will be able to differentiate among the above possibilities and will be able to advise you regarding the time course of his recovery and the possible need for further treatment.
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More information available on other diseases of the ears, nose and throat! |
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