Otic barotrauma


  • Also known as "ear squeeze" - generally seen during scuba diving or air travel

Clinical Features

Middle Ear

Inner Ear

  • Results from forceful valsalva against an occluded eustachian tube, or rapid descent in diving or aviation
    • Pressure difference between middle ear and inner ear can rupture oval or round window
  • Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo
  • Must be lacking in any other neurologic signs (otherwise consider infarction)

Differential Diagnosis

Diving Emergencies

Ear Diagnoses




Barotrauma Types


  • Generally clinical
  • Webber and Rinne for middle ear barotrauma
    • Conductive hearing loss expected
  • TEED grading system for middle ear barotrauma
0Symptoms without otologic findings
1Erythema and mild retraction of the tympanic membrane
2Erythema of the tympanic membrane with mild or spotty hemorrhage within the membrane
3Gross hemorrhage throughout the tympanic membrane
4Grade 3 changes pluse hemorrhage within the middle ear (hemotympanum)
5Free blood in the middle ear plus perforation of the tympanic membrane


Middle Ear

  • Decongestants and topical nasal vasoconstrictors
  • Consider antibiotics if tympanic membrane rupture
    • Remember to use medications such as ofloxacin suspension that will be safe in the middle ear
  • Urgent audiology required if sensorineural hearing loss, rather than conductive hearing loss

Inner Ear

  • Elevate head of bed
  • Advise patient to not blow nose
  • Antivertigo medications (e.g. meclizine)
  • ENT consult


  • Generally may be discharged with ENT follow up
  • Resolution usually in 5-7 days, but can take up to 2 weeks

See Also


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