Sunday 12 April 2015

ENT Guidelines for the Medical Examination of Scuba Divers

Hi divers, today i will list out absolute and relative contraindication for Ear problem in Scuba Diving

Absolute Contraindications

  • Inability to equalize pressure in the middle ear by auto-inflation. This may be due to a correctable problem such as polyps, nasal septal deviation or coryza in which case the diver can be reevaluated after correction of the problem.
  • Perforation of the tympanic membrane. Until fully healed or successfully repaired with good Eustachian tube function, diving is contraindicated.
  • Open, nonhealed perforation of the TM.
  • Tympanoplasty, other than myringoplasty (Type I)
  • History of stapedectomy. * Recent studies have shown that this is not necessarily true. See this article:.
  • CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear
    barotrauma in scuba and sky divers. These activities may be pursued with
    relative safety after stapes surgery, provided adequate eustachian tube
    function has been established.
  • History of inner ear surgery
  • Status post laryngectomy or partial laryngectomy
  • History of vestibular decompression sickness
  • Radical mastoidectomy (posterior) involving the external canal is disqualifying. (Closed childhood OK)
  • Meniere's disease is disqualifying
  • Labyrinthitis
  • Perilymphatic fistula
  • Cholesteatoma is disqualifying
  • Cerumen impactions -remove before allowing to dive.
  • Stenosis or atresia of the ear canal-disqualifying.
  • Facial paralysis secondary to barotrauma
  • Tracheostomy, tracheostoma
  • Incompetent larynx due to surgery (Cannot close for valsalva maneuver)
  • Laryngocoele  
Relative Contraindications
  • Recurrent otitis externa or media
  • Eustachian tube dysfunction
  • History of Tympanic Membrane perforation
  • Significant hearing loss in one ear
  • Midface fracture
  • Facial nerve paralysis
  • Full mouth prosthetic devices
  • Head and neck radiation
  • Migraine, severe (scotomata, CNS symptoms and stroke after diving)

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