 It refers to damage occurring in the ear from

pressure changes affecting the air spaces or the

pneumatized part of the of the skull .
 In the ear: Inability of the Eustachian tube to
respond to pressure changes which naturally
occurring due to changes of altitude.

 In the nose: edema or incomplete canalization of

the sinus Ostia
 Boyles phenomena: In contrast temperature the
volume of the GAS V is inversely proportional
to the pressure.

 In High altitude , Increased pressure causes

decreasing volume.
Clinical manifestation:

 1) Vertigo
 2) Hearing loss
 3) Pain due to either negative pressure or from
TM rupture.
It occurs in scuba diving with blocked external canal
as, cerumen, ear plugs, canal stenosis.
Clinical manifestation
1) 3 p: pain, petichal he, plebs
2) TM rupture
1) first symptom is pressure feeling

2) Tympanic membrane is medially pushed

leading to pain

3) Blood vessels rupture with mucosal tear

4) Lastly vertigo.
 1) Water enter external ear : Caloric stim

 2) Alternobaric Vertigo

 A) Gradual increase in middle ear pressure relative to the ambient (atmosphere

or water) pressure results in transient (Often last for only 10 15 minutes) vertigo,
hearing loss, and tinnitus.

 B) Alternobaric vertigo is most prominent in divers while in ascent to the surface

and in fliers during ascent of the aircraft. Both are conditions of decreasing
ambient with normal ear and obstructed eustachian tube.

 Less common but very serious

 1) Implosive force at Oval window, &round window.

 Due to sudden pressure changes from valsalva

 11) Explosive force Due to sudden rise in csf pressure.

1) SNHL
2) Labyrinthine Fistula
 These disorders have become common as a consequence of
the increased use of mixed gas (Oxy-helium) for deep water
diving. Often experienced by those diving to depths greater
than 100 m.

Pathogenesis:
 Caused by the formation of gas bubbles in the body.
 These occur as a result of rapid reduction in atmospheric
pressure, such as experienced by the diver who ascends too
rapidly.
 Air bubbles within the intra-labyrinthine fluids and within
blood vessels cause the damage to the inner ear.
 Inflammation of one or more of the paranasal
sinuses as a result of expossure to ambient
pressure changes as during descent from
mountainous regions, descent of unpressurized
aircraft, or during scupa diving.
  
 When a normal sinuses exposed to pressure changes
 The ambient pressure surrounding the sinus cavity
decreases, and the air in the sinuses expands and
equalizes through the natural ostium.
 In individual with compromised sinus ventilation, eg.
URTI, free pressure equalization will not be allowed.
Frontal sinuses are most often affected,
followed by maxillary sinuses, ethmoid
sinuses are infrequently affected as isolated
events
unusual, but they may include:
• Pneumo-cephalus
• Subcutaneous emphysema
o
Orbital complications; hematoma, cellulitis, abscess.
o
Complications associated with paranasal sinusitis
 Removing the pressure gradient, eg. in case of diving,
returning to the surface. During flight, Valsalva
maneuver may be helpful, specially after topical
decongestion.

 Pain killer

 Decongestants.

 Prophylactic antibiotics, as blood and transudate provide

a rich medium for bacterial growth.
 ESS. It can be considered if conservative
measures fail to relieve pain, or if pain and
pressure do not resolve over 24 hours. It also
may be considered later to control underlying
condition, especially in recurrent cases.

 Frontal sinus trephination has had variable

efficacy.