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ENT Problems

This page is compiled and maintained by
Ernest S Campbell, MD, FACS

Table of Contents
ENT Anatomy
ENT Guidelines for the Medical Exam of the Diver
Symptoms of Ear Dysfunction
Temporary Ear Dysfunction in Diving
Chronic Ear Dysfunction in Diving
Tinnitus
Intracranial Difficulties due to Barotrauma


Link to Ear Problems
Dr. Fred Bove's excellent web site

Equalizing Techniques
An article by Allen Dekelboum, MD
Download zip

Download PDFFree Download


Sensori-neural Hearing Loss and HBO2 Therapy
Allen M. Dekelboum, MD
Download PDFFree Download

ENT Anatomy


The Ear

The external ear canal is a blind tube ending with the ear drum. The cerumen, or wax, is slightly acid and has a protective function. The ear drum has evolved to vibrate with sound waves in the air which is present on both sides. Herein lies the problem with diving --the air-filled space inside the ear drum has to have pressure equalized as a diver goes down and up in the water column. This can only be accomplished without pain and damage by air passing back and forth through the Eustachian tubes. These tubes are easily blocked by problems in the back of the nose.


Middle Ear


Inner ear
   The inner ear consists of fluid-filled bony channels in the temporal bone and has  nerve cells that are concerned with balance and hearing. These structures are separated from the middle ear by windows with very thin membranes, the round and oval windows, that are subject to rupture by excessive Valsalva maneuver with trying to clear the ears.

Link to ENT Anatomy

ENT Guidelines for the Medical Examination of Scuba Divers

Ear
History
Absolute Contraindications Relative Contraindications
1. Manage as decompression sickness with prompt recompression when encountered early after a dive.
2. Switch back to helium-oxygen if the problem is due to switching to air in decompression from a deep exposure.
3. Recompression to 3 ATM deeper than the depth at which the symptoms occurred or to table depths suitable for the treatment of neurological decompression sicikness.
4. Fluid replacement, oxygen administration with avoidance of anticoagulants, low-molecular weight dextran, steroids, aspirin and salicylates should be accomplished.
5. Diazepam (Valium), 5 to 15 mg is effective in relieving the vertigo, nausea and vomiting.
6. Documentation of otoneurologic symptoms as soon as possible.
7. No return to diving if permanent inner ear dysfunction ensues.


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