Citation

Mallen JR, Roberts DS. Laryngoscope 2019; ePub(ePub): ePub.

Affiliation

Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1002/lary.27867

PMID

30776099

Abstract

OBJECTIVES: Introduce pertinent self-contained underwater breathing apparatus (SCUBA) physiology and corresponding terminology. Appreciate the scope of diving and related otolaryngological injury. Illustrate pathophysiologic mechanisms for diving injuries. Summarize strategies for ear, paranasal sinus, and lung barotrauma prevention, including medical optimization and autoinsufflation techniques.

METHODS: We conducted a review of the available medical and diving literature in English, German, Spanish, Italian Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers. The databases of PubMed, Ovid Medline, and the Cochrane library, as well available textbooks, were queried for relevant data.

RESULTS: Divers are subjected to large pressure gradients within the first few meters of descent. This can lead to gas embolism formation as well as barotrauma secondary to gas expansion/compression in potential closed spaces such as the middle ear, paranasal sinuses, and lungs. Physicians can minimize the risk of injury by counseling patients regarding proper equalization and descent/ascent techniques, and optimizing sinonasal and eustachian tube function. The use of decongestants is controversial.

CONCLUSIONS: Diving is an increasingly popular sport with predominantly otolaryngologic manifestations of injury and disease. Treating SCUBA divers requires a firm understanding of how physiology is altered underwater. This review presents the relevant background information using illustrations to understand the environmental forces acting on divers and how to prevent injury. Laryngoscope, 2019.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

Language: en

Keywords

Self-contained underwater breathing apparatus; alternobaric vertigo; barotrauma; decompression sickness; diving; perilymphatic fistula