Scuba diving is a sport that presents many risks: in addition to drowning, the most serious accidents, of a neurological or cardiopulmonary nature, are fortunately not the most frequent, unlike barotraumas. The latter represent, with the chemical accidents of decompression or desaturation, one of the two main families of ENT pathologies linked to diving. On the sidelines of the “ENT and Diving” congress (1), Chief Medical Officer Jean Baptiste (2), ENT at the Sainte-Anne Army Training Hospital (HIA) in Toulon, explains the mechanisms involved and recalls the instructions to avoid accidents.
What is a barotrauma?
It is a mechanical accident, linked to the physical constraints of the underwater environment in which the diver evolves. Water pressure increases when going deeper. All body cavities that contain air then need to achieve equilibration. (read below). They are mainly located in the ENT sphere. These are the middle ear behind the eardrum and the facial sinuses. Without this pressure equilibration, the risk for the diver is ear pain up to the perforation of the eardrum or nosebleeds with significant facial pain in the event of a sinus attack. Lesser-known cases of barotrauma to the inner ear (the cochlea responsible for hearing and the vestibule, one of the balance sensors) are more serious and rarer.
What are the symptoms of these inner ear barotraumas?
Tinnitus or very high-pitched whistling in the ears, deafness, balance disorders (rotational vertigo) should alert and imperatively lead to a medical consultation. Indeed, they sign a more serious pathology of the inner ear which is fragile.
These symptoms are the same for decompression accidents or desaturation of the inner ear, the second family of serious ENT accidents in diving.
What causes these decompression sickness?
It is a chemical phenomenon, specific to the dissolution of gases in the blood during scuba diving. The nitrogen present in the body is subject to variations in pressure and dissolution and finds itself in the state of “bubbles” potentially dangerous for the body because they can clog the arteries, and therefore cause a vascular accident. On the ascent, it is thus necessary to do
levels, pauses at different depths, to give the body time to assimilate these nitrogen bubbles until it returns to a dissolved state.
What are the possible consequences of this type of accident?
They can cause neurological accidents with, for example, paraplegia. At the ENT level, the bubbles can destroy the inner ear, leading to hearing loss, tinnitus and more or less severe balance disorders. The sequelae can be permanent and very disabling.
When should you consult?
A simple loud and unusual ringing in the ears can cause paraplegia a few hours later. If we do not know how to judge the severity of a symptom, we call the SAMU who will be able to assess the seriousness of the accident. And it must be done as soon as possible to allow proper care. In 95% of cases, it will be a question of a barotrauma that is not too serious, but it is advisable to diagnose a pathology of the inner ear which would require emergency treatment to avoid sequelae.
What is the role of the hyperbaric chamber in the treatment of these different pathologies?
Desaturation accidents are dealt with in the chamber. This is a dry dive, therefore safe. The principle is to pressurize the patient so that the “bubbles” disappear in order to bring a lot of oxygen to the damaged tissues. Doctors, nurses and technicians from the hyperbaric chamber of the Hyperbaric Medicine and Diving Expertise Service (SMHEP) coordinate and monitor this descent. On the other hand, no box for barotraumas, which would then be aggravated!
1. The Var ENT association chaired by Dr. Tantely Razafimahefa, liberal ENT doctor in Toulon, which brings together liberal and hospital doctors, civilians and soldiers, organized this congress, sponsored by the multiple world apnea champion Stéphane Mifsud , within the Sainte-Anne Army Training Hospital in Toulon. All of the stakeholders in the rescue chain, from diving clubs to doctors, via Cross Med and SAMU rescuers or vestibular physiotherapists were involved.
2. For security reasons, the names of the soldiers are not communicated.
