OTITIC

BAROTRAUMA
Aero-otitis media / Aviation pressure
deafness
•1783 - Charles  Hydrogen Balloon
•World War I - Sidney Scott
•World War II - Increase of Air power

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Mention anatomy of ET

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 Boyle’s law
• Volume is inversely proportional to
pressure in fixed mass of gas

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 MECHANICS OF
BAROTRAUMA
• As altitude ↑
environmental
pressure ↓

• At 18000 ft pressure
is half that of sea
level, and at 34000 ft
¼
Relationship between
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altitude and barometric pressure
• As depth increases during diving , pressure
increases
• One atmospheric pressure increase for every
10 mtrs

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 MECHANICS OF
BAROTRAUMA
elastin •Medial end is slit like, lies
collapsed, in close proximity to
lymphoid tissue
• Opens on swallowing (pressure
equalises) (effect of tensor & levator
palati)
Ostman
pad of
fat

LEARN DIAGRAM

Cross-section of Cartilagenous part of

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Eustachian tube
 MECHANICS OF
BAROTRAUMA

ASCENT At high altitude ME

pressure is higher
Middle Ear than env pressure,
therefore air from
middle ear escapes
passively along ET
equalising pressures
Nasopharynx

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 MECHANICS OF
BAROTRAUMA
• During descent environmental
pressure is higher than ME
Middle ear
pressure, therefore we need to
DESCENT aerate the ME actively by
VALSALVA manouvre/other
methods
• If the tube does not open and
the pressure gradient
increases beyond 90 mm of Hg,
Nasopharynx tube gets locked
•Similar during deep sea diving &
hyperbaric chamber
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 Aetiology of Otitic Barotrauma

• Healthy subjects
– Rapid descent
– No attempt at auto-inflation
– Sleep; sedation; position
– Effect of alcohol
– Anatomical differences

• Pathological states
– Acute infection  oedema of ET mucosa
– Chronic ET obstruction  infected tonsils/nasal
polypi /allergic rhinitis/ DNS/nasal allergy
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 OTITIC BAROTRAUMA
Clinical Features

• Mild – Fullness/ slight hearing loss

• Moderate – Pain/ deafness/

interstitial hemorrhage/ fluid

• Severe – Severe pain/ deafness/ rupture

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OTITIC BAROTRAUMA- EARLY
Tubal Occlusion

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Findings Grade

Symptoms (pain, nausea, vomiting, etc.) Without changes in the 0

tympanic membrane

Injection of the tympanic membrane (may be most noticeable along I

the handle of the malleus)

Injection plus mild haemorrhage within the tympanic membrane II

Gross haemorrhage within the tympanic membrane III

Free blood in the middle ear (tympanic membrane blue and IV

bulging)

Perforation of the tympanic membrane (commonest in AI quadrant) V

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 Other possible features
• Middle ear
– Ossicular disruption
– Stapes avulsion
– RW membrane rupture
– 7th nerve barotrauma
• Inner ear
– Perilymph fistula
• Implosive mechanism  forceful valsalva  patent ET
 Implosive damage to RW
• Explosive mechanism  forceful valsalva  blocked
ET  ↑ CSF pressure  explosive damage to RW
• Oval window in stapedectomized patients

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 OTITIC BAROTRAUMA
Treatment - Curative
• No flying
• Reascent & gradual descent
• ET catheterisation
• Antibiotics
• Analgesics
• Nasal + oral decongestants
• Myringotomy
• Grommets
• Eliminate septic foci

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 Treatment
• TM rupture  no active management,
remove clots if not healed by 3 mths 
myringoplasty
• Perilymph fistula  Bed rest, head
elevation, labyrinthine sedatives, stool
softeners, cough suppressant,
Acetazolamide

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 Prevention

• Decompression chamber run on enrolment

• Education of aircrew/ divers
• Flying discipline
• Auto-inflation techniques – frenzel’s manouvere for
pilots

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