Diseases of the tympanic membrane - II

Otitic Barotrauma

Mechanism:

1. During descent of the airplane or diving, the person with Eustachian tube obstruction dysfunction fails to open up the Eustachian tube e.g. by swallowing ≫air fails to enter the middle ear to equalize the pressure on both sides of the tympanic membrane ≫ lowering of the air pressure in the middle ear cavity than that of the atmosphere ≫ retraction of the tympanic membrane and middle ear effusion.

2. In rapid descent, the relatively high atmospheric pressure pushes the tympanic membrane medially ≫ rupture of the tympanic membrane.

Predisposing factors:

1. Allergy

2. Adenoid hypertophy.

3. Inflammation (rhinitis or sinusitis)

Clinical picture:

1. Severe ear pain and sense of ear fullness.

2. Deafness, tinnitus.

3. Congested retracted drum.

4. Fluid or hemorrhage in middle ear in severe cases.

5. Tympanic membrane may rupture, bleeding per ear in severe cases.

Treatment:

1. Prophylactic:

1. Avoid flying with nasal obstruction.

2. Avoid sleeping during descent of the airplane (the swallowing action or chewing gum opens the Eustachian tube).

3. Nasal decongestant drops

2. Therapeutic:

1. Middle ear inflation by Valsalva’s method or chewing gum.

2. Myringotomy and aspiration if middle ear effusion occurs.

3. Treatment of tympanic membrane rupture if it occurs.

Category: ENT Notes