Barotrauma
Background
- Barotrauma = tissue injury caused by pressure changes, typically during diving (descent or ascent) or air travel
- Affects gas-filled spaces: middle ear, sinuses, lungs, GI tract
- Most common form: middle ear barotrauma (ear squeeze) during descent
- Most dangerous form: pulmonary barotrauma during ascent → pneumothorax, pneumomediastinum, arterial gas embolism
Types
Barotrauma Types
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
Middle Ear Barotrauma (Most Common)
- Occurs during descent (failure to equalize pressure through eustachian tube)
- Ear pain, hearing loss, tinnitus, vertigo
- Exam: TM hemorrhage, hemotympanum, or TM rupture
- Management: decongestants, analgesics; ENT follow-up for TM rupture
Sinus Barotrauma
- Frontal sinus most commonly affected
- Facial pain/pressure, epistaxis
- Management: decongestants, analgesics; antibiotics if sinusitis develops
Pulmonary Barotrauma
- Occurs during ascent (gas expansion per Boyle's law), especially with breath-holding
- Can cause: pneumothorax, pneumomediastinum, subcutaneous emphysema, arterial gas embolism (AGE)
- AGE: most serious complication — gas enters pulmonary vasculature → cerebral/coronary embolism
- Presents within minutes of surfacing: sudden LOC, stroke-like symptoms, seizures, cardiac arrest
- Management: 100% O2, supine positioning, emergent hyperbaric oxygen therapy
- Pneumothorax: manage per standard protocol (may need chest tube — avoid needle decompression only if diving-related and hyperbaric treatment available)
GI Barotrauma
- Abdominal pain, bloating from gas expansion during ascent
- Rarely significant unless diving with obstruction
Dental Barotrauma
- Tooth pain from gas-filled spaces in dental work
- Usually self-limited
Evaluation
- History: timing (descent vs. ascent), diving profile, symptoms
- Otoscopic exam for middle ear
- CXR: pneumothorax, pneumomediastinum
- CT head if concern for AGE with neurologic symptoms
- ABG if respiratory compromise
Management
- Arterial gas embolism: 100% FiO2, IV fluids, supine position, contact nearest hyperbaric chamber immediately
- Decompression sickness: see Decompression sickness — also treated with hyperbaric oxygen
- Pneumothorax: standard management; 100% O2 helps resorb gas
- Ear barotrauma: decongestants, analgesics, no diving until healed
Disposition
- Admit: pulmonary barotrauma, arterial gas embolism, decompression sickness (transfer to hyperbaric facility)
- Discharge: uncomplicated ear/sinus barotrauma with ENT follow-up, no diving until cleared