Open AccessInner Ear Disorders in SCUBA Divers: A Review
Author(s) -
Alfonso Scarpa,
Massimo Ralli,
Pietro De Luca,
Federico Maria Gioacchini,
Matteo Cavaliere,
Massimo Re,
Ettore Cassandro,
Claudia Cassandro
Publication year - 2021
Publication title -
the journal of international advanced otology/the journal of international advanced otology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.518
H-Index - 13
eISSN - 2148-3817
pISSN - 1308-7649
DOI - 10.5152/iao.2021.8892
Subject(s) - medicine , decompression sickness , scuba diving , inner ear , middle ear , tinnitus , audiology , vertigo , hearing loss , breathing , surgery , anatomy , decompression , oceanography , geology
Self-Contained Underwater Breathing Apparatus (SCUBA) diving is a popular sport. However, improper diving may injure different organs. The majority of dive-related disorders concern otolaryngology, and may include hearing loss, tinnitus, aural fullness, disequilibrium, and vertigo. Three main inner ear pathological conditions can occur underwater: inner ear barotrauma (IEB), inner ear decompression sickness (IEDS), and alternobaric vertigo (AV). IEB results from inappropriate equalization of middle ear pressure and consequent inner ear injury produced by pressure changes within the middle ear; IEDS is characterized by the formation of gas bubbles within the vessels of the inner ear during rapid ascent; AV typically develops while ascending or performing the Valsalva maneuver and can follow asymmetrical equalization of middle ear pressure transmitted via the oval and round window membranes. The clinical pictures of these pathological conditions are partly superimposable, even if they have specific peculiarities. Before starting SCUBA diving, a fit-to-dive assessment is recommended. It should include an otolaryngologic examination with audiological assessment to evaluate nasal, middle ear, and tubal patency and to minimize the risk of IEB, IEDS, and AV. It is of utmost importance to identify individual risk factors and predisposing pathological conditions that favor inner ear injury before diving, to prevent acute events and preserve auditory and vestibular functions in SCUBA divers. This review aims to provide an overview of the pathological conditions characterized by inner ear injury in SCUBA divers, discussing their pathogenetic mechanisms, diagnostic work-up, and prevention.