Incidence and severity of middle ear barotrauma in recreational scuba diving

This prospective observational study was designed to assess the incidence and severity of middle ear barotrauma associated with repetitive recreational scuba diving.

Eleven healthy adult experienced scuba divers were observed performing repetitive daily scuba diving over a 15 day period. Otoscopy and tympanometry were performed on days 0, 3, 7, 11 and 15. Participants averaged 41 dives during the study period. Mild otalgia occurred at some point in 23% of ears and subsequently resolved in all but one despite continued diving. Eight-two per cent of ears demonstrated otoscopic evidence of middle ear barotrauma by day 3, and all exhibited barotrauma by day 11. Tympanic membrane perforation, hemotympanum, or evidence of inner ear barotrauma did not occur. Tympanometry revealed a significant decrease in middle ear pressures but no evidence of middle ear effusions. Gross measurements of otologic acuity and conduction remained normal. No complications or sequelae were noted at three month follow-up.

Otoscopic evidence of middle ear barotrauma and tympanometric evidence of eustachian tube dysfunction developed rapidly in a group of experienced scuba divers performing repetitive recreational diving. Symptoms were minimal and infrequent. No serious otologic dysfunction was noted despite continued repetitive diving, and it is possible that middle ear barotrauma at the degrees observed represents a more benign disorder than has been previously assumed.