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March 2018

Otorhinolaryngology and Diving—Part 1: Otorhinolaryngological Hazards Related to Compressed Gas Scuba Diving: A Review

Author Affiliations
  • 1Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
  • 2Duke Skull Base Center, Duke University School of Medicine, Durham, North Carolina
  • 3Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
  • 4Department of Otolaryngology, Addenbrooke’s Hospital, Cambridge, England
  • 5currently in private practice, Munich, Germany
  • 6City, University of London, London, England
JAMA Otolaryngol Head Neck Surg. 2018;144(3):252-258. doi:10.1001/jamaoto.2017.2617

Importance  Scuba diving is becoming increasingly popular. However, scuba diving is associated with specific risks; 80% of adults and 85% of juvenile divers (aged 6-17 years) have been reputed to have an ear, nose, or throat complaint related to diving at some point during their diving career. Divers frequently seek advice from primary care physicians, diving physicians, and otorhinolaryngologists, not only in the acute setting, but also related to the long-term effects of diving.

Observations  The principles underpinning diving-related injuries that may present to the otorhinolaryngologist rely on gas volume and gas saturation laws, and the prevention of these injuries requires both that the diver is skilled and that their anatomy allows for pressure equalization between the various anatomical compartments. The overlapping symptoms of middle ear barotrauma, inner ear barotrauma, and inner ear decompression sickness can cause a diagnostic conundrum, and a thorough history of both the diver’s symptoms and the dive itself are required to elucidate the diagnosis. Correct diagnosis and appropriate treatment result in a more timely return to safe diving.

Conclusions and Relevance  The aim of this review is to provide a comprehensive overview of otorhinolaryngological complications during diving. With the increasing popularity of diving and the frequency of ear, nose, or throat–related injuries, it could be expected that these injuries will become more common and this review provides a resource for otorhinolaryngologists to diagnose and treat these conditions.

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