Barotrauma and Barotitis

Changes in altitude while flying (or scuba diving) can lead to rapid changes in middle ear pressure, leading to accumulation of serous middle ear fluid or blood. Symptoms may include aural fullness, otalgia, and conductive hearing loss. In most cases the fluid is resorbed, although this may take several weeks. Autoinflation maneuvers (popping the ears) may hasten recovery. Oral and topical decongestants, nasal steroid sprays, or a short course of corticosteroids may be helpful. Antibiotics are indicated only if there are signs of infection. If fluid persists or is troublesome to the patient, a myringotomy allows the fluid to be drained. Tympanos-tomy tube insertion may be indicated for persistent middle ear fluid.

Rarely, a rapid change in middle ear pressure can lead to the creation of a perilymphatic fistula between the inner and middle ear. The patient complains of severe vertigo and hearing loss (sensorineural) (see Vertigo). Urgent ENT consultation is indicated.

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