PANCE Blueprint EENT (9%)

Barotrauma

Patient will present as → a 17-year-old male who returned from a senior class trip to Mexico. While there, they decided to take scuba classes. After 3 days of shallow diving, they attempted their first 100-foot dive. After 5 minutes on their second dive, his equipment failed. He quickly shared the working breathing equipment of his friend and they rose rapidly to the surface in a panic for air. The patient noticed immediate pain in his right ear, which resolved somewhat when he forcefully yawned and heard a "pop." Since then he reports dizziness and hearing loss in the affected ear.

Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume; it affects air-containing areas, including lungs, ears, sinuses, GI tract, air spaces in tooth fillings, and space contained by the diving face mask.

  • Symptoms may include ear pain, vertigo, hearing loss, sinus pain, epistaxis, and abdominal pain. Dyspnea and loss of consciousness are life threatening and may result from alveolar rupture and pneumothorax.

Diagnosis is clinical but sometimes requires imaging tests.

  • On exam will see signs of trauma without signs of infection – redness without building, pus, or effusion.

Treatment is supportive (anti inflammatories) then consider prophylaxis

  • Pseudoephedrine or Afrin can be good for prophylaxis – you must be careful when recommending this to divers, depending on dive times.
  • Risk for overuse – Afrin should not be used for more than 3 days – risk of tachyphylaxis and rhinitis medicamentosa 
Diving is a common cause of barotrauma

Diving is a common cause of barotrauma

Question 1
123. A 19-year-old jumped off the high dive at a local swimming pool and presents to your office complaining of severe right-sided ear pain after landing on that side when he hit the water. You have seen him for this problem for the last 12 weeks, but a small perforation remains in the tympanic membrane. There is no sign of infection. Appropriate treatment at this point consists of
A
Continued observation
Hint:
See E for explanation
B
An audiogram to document hearing
Hint:
An audiogram should be performed after treatment to document the return of hearing.
C
Steroid otic drops
Hint:
See E for explanation
D
Antibiotic eardrops and no water exposure
Hint:
Antibiotic eardrops are indicated only if there has been contamination by water or debris. Oral antibiotics can be used prophylactically to prevent infection but are generally unnecessary.
E
Referral to an ear– nose– throat specialist
Question 1 Explanation: 
Rupture of the tympanic membrane can be caused by placing objects (e.g., cotton swabs, twigs, pencils) in the ear canal, excessive positive pressure applied to the ear (e.g., explosions, loud noises), swimming, diving, or excessive negative pressure (e.g., kiss over the ear); it can be iatrogenically produced by a ventilating tube. Symptoms of traumatic rupture include a sudden severe pain followed by, in some cases, bleeding from the ear. Hearing loss and tinnitus are also usually present. Vertigo suggests damage to the inner ear. Treatment involves gentle removal of debris and blood from the otic canal and use of earplugs to provide protection when bathing or shampooing. Antibiotic eardrops are indicated only if there has been contamination by water or debris. Oral antibiotics can be used prophylactically to prevent infection but are generally unnecessary. Pain medication may be necessary for the first few days. Persistent perforation for more than 10 to 12 weeks is an indication for otolaryngology referral. An audiogram should be performed after treatment to document the return of hearing.
There is 1 question to complete.
Return
Shaded items are complete.
1
Return
Acoustic neuroma (Prev Lesson)
(Next Lesson) Cholesteatoma
Back to PANCE Blueprint EENT (9%)

NCCPA™ Content Blueprint

The Daily PANCE and PANRE

Get 60 days of PANCE and PANRE Multiple Choice Board Review Questions delivered daily to your inbox. It's 100% FREE and 100% Awesome!

You have Successfully Subscribed!