. (See also Overview of Diving Injuries Overview of Diving Injuries More than 1000 diving-related injuries occur annually in the United States; > 10% are fatal. Similar injuries can befall workers in tunnels or caissons (watertight retaining structures used... read more .)
Risk of barotrauma (often called "squeeze" by divers) is greatest from the surface to 10 m (33 ft). Risk is increased by any condition that can interfere with equilibration of pressure (eg, sinus congestion, eustachian tube blockage, structural anomaly, infection) in the air-containing spaces of the body.
Ear barotrauma Ear and Sinus Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the ear (causing ear pain, hearing loss, and/or vestibular symptoms) or the sinuses... read more constitutes about two thirds of all diving injuries.
In divers who inspire even a single breath of air or other gas at depth and do not let it escape freely during ascent, or when ascent is rapid, the expanding gas may overinflate the lungs, causing pulmonary barotrauma Pulmonary Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. Factors increasing risk of pulmonary barotrauma include certain behaviors (eg, rapid ascent, breath-holding... read more . Lung overinflation occurs mostly in divers breathing compressed air but can occur even in swimming pools when compressed air is inspired at depths 1 m (3 to 4 ft) below the surface (eg, when scuba gear is used there).
Barotrauma can also affect the GI tract (gastrointestinal barotrauma Gastrointestinal Barotrauma Small amounts of air swallowed when diving may expand during ascent (gastrointestinal barotrauma), usually causing self-limited symptoms. (See also Overview of Diving Injuries and Overview of... read more ), teeth (dental barotrauma Dental, Mask, and Eye Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the spaces around teeth, behind a face mask, or underneath hard contact lenses.... read more ), eyes (eye barotrauma Dental, Mask, and Eye Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the spaces around teeth, behind a face mask, or underneath hard contact lenses.... read more ), ears and sinuses (ear and sinus barotrauma Ear and Sinus Barotrauma ), and face (mask barotrauma Dental, Mask, and Eye Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the spaces around teeth, behind a face mask, or underneath hard contact lenses.... read more ).
Symptoms and Signs of Barotrauma
Manifestations depend on the affected area; all occur almost immediately when pressure changes. Symptoms may include ear pain, vertigo, hearing loss, sinus pain, epistaxis, and abdominal pain. Dyspnea and alteration or loss of consciousness can be life threatening and may result from alveolar rupture and pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more .
Some medical disorders, if they cause symptoms at depth, may be disabling or disorienting and thus lead to drowning Drowning Drowning is respiratory impairment resulting from submersion in a liquid medium. It can be nonfatal (previously called near drowning) or fatal. Drowning results in hypoxia, which can damage... read more (see table ). Secondary infection is sometimes a late complication.
Diagnosis of Barotrauma
Clinical evaluation
Imaging tests
Diagnosis is primarily clinical; imaging tests can sometimes confirm barotrauma. Sometimes patients are evaluated for other problems or organ dysfunction.
Treatment of Barotrauma
Symptomatic treatment
Other treatment dependent on specific injury
Most barotrauma injuries require only symptomatic treatment and outpatient follow-up; however, some injuries are life threatening. Potentially life-threatening barotrauma emergencies are those involving pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more or gastrointestinal rupture Gastrointestinal Barotrauma Small amounts of air swallowed when diving may expand during ascent (gastrointestinal barotrauma), usually causing self-limited symptoms. (See also Overview of Diving Injuries and Overview of... read more , particularly in patients who present with any of the following:
Neurologic symptoms or signs, including altered consciousness
Dyspnea
Peritoneal signs
Abnormal vital signs
Initial stabilizing treatment includes high-flow 100% oxygen and, if respiratory failure appears imminent, endotracheal intubation Tracheal Intubation Most patients requiring an artificial airway can be managed with tracheal intubation, which can be Orotracheal (tube inserted through the mouth) Nasotracheal (tube inserted through the nose)... read more . Positive pressure ventilation may cause or exacerbate pneumothorax.
Patients with suspected pneumothorax who are hemodynamically unstable or have signs of tension pneumothorax Treatment require immediate chest decompression with a large-bore (eg, 14-gauge) needle placed into the 2nd intercostal space in the midclavicular line, followed by tube thoracostomy How To Do Tube and Catheter Thoracostomy Surgical tube thoracostomy is insertion of a surgical tube into the pleural space to drain air or fluid from the chest. Pneumothorax that is recurrent, persistent, traumatic, large, under tension... read more 
. Patients with neurologic symptoms or other evidence of arterial gas embolism Arterial Gas Embolism Arterial gas embolism is a potentially catastrophic event that occurs when gas bubbles enter or form in the arterial vasculature and occlude blood flow, causing organ ischemia. Arterial gas... read more are transported to a recompression chamber Recompression Therapy Recompression therapy is administration of 100% oxygen for up to several hours in a sealed chamber pressurized to at least 1.9 (usually 1.9 to 3.0) atmospheres, gradually lowered to atmospheric... read more for treatment as soon as transportation can be arranged.
When stable, patients are treated for the specific type of barotrauma sustained. For patients with inner ear barotrauma Ear and Sinus Barotrauma , prompt surgical treatment of labyrinthine window tears can reverse hearing loss.
Patients treated for severe or recurrent diving-related injuries should not return to diving until they have consulted with a diving medicine specialist.
(See also Diving Precautions and Prevention of Diving Injuries Diving Precautions and Prevention of Diving Injuries Diving is a relatively safe recreational activity for healthy people who have been appropriately trained and educated. Diving safety courses offered by national diving organizations are widely... read more .)
Key Points
Symptomatic treatment is sufficient for barotrauma unless patients have manifestations of potential life-threats (eg, neurologic symptoms, pneumothorax, peritoneal signs, abnormal vital signs) or are suspected of having inner ear barotrauma Ear and Sinus Barotrauma .
Treat patients who have potentially life-threatening injuries with 100% oxygen and other stabilizing measures as necessary.
When patients are stable, treat the specific type of barotrauma sustained.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Divers Alert Network: 24-hour emergency hotline, 919-684-9111
Duke Dive Medicine: Physician-to-physician consultation, 919-684-8111
