Ear barotrauma causing bilateral hemotympanum and hearing impairment.
Mask Squeeze causing epistaxis and subconjunctival hemorrhage
Treated prophylactically (per DAN recommendations) with 10 days of amoxicillin 500mg TID; started 5 days after diving incident.
Also treated with oral decongestants (pseudoephedrine BID) per DAN recommendations.
Patient was followed weekly to ensure resolution of hemotympanum and return of normal hearing.
He was allowed to participate in collegiate level football practice and games during his recovery period.
DAN recommended if the hemotympanum failed to progressively resolve, and/or hearing to return to normal, then he would need ENT consultation for possible tympanostomy with evacuation of blood.
10 days post-dive his hearing in the right ear was almost back to normal and left ear was improving. On exam the hemotympanum was mostly resolved on right and had pooled to dark blood in inferior aspect of TM on left. Subconjunctival hemorrhage had resolved.
By 3 weeks post-dive his hearing had returned to normal in both ears. Right TM was clear and left TM still showed a small amount of resolving blood. Bilateral external canals were normal.
By 5 weeks post-dive both TMs appeared WNL and patient was released from scheduled follow-up.
This was an interesting in case in that his failure to equalize pressure in the mask and middle ears caused barotrauma to both eyes and ears. He was lucky that everything resolved without complications.
A key learning point is the availability of Duke University's "Divers Alert Network" dive medicine experts.
This case highlights the various effects of barotrauma in divers, particularly those with less experience. The Divers Alert Network is indeed an excellent resource, both by telephone and online (http://www.diversalertnetwork.org)
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