Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Corresponding author: Dr Oskari H Lindfors, Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Centre, Helsinki University Hospital, PO Box 263, FI-00029 HUH, Helsinki, Finland,
Diving Hyperb Med. 2021 Dec 20;51(4):328-337. doi: 10.28920/dhm51.4.328-337.
Inner ear barotrauma (IEBt) and inner ear decompression sickness (IEDCS) are the two dysbaric inner ear injuries associated with diving. Both conditions manifest as cochleovestibular symptoms, causing difficulties in differential diagnosis and possibly delaying (or leading to inappropriate) treatment.
This was a systematic review of IEBt and IEDCS cases aiming to define diving and clinical variables that help differentiate these conditions. The search strategy consisted of a preliminary search, followed by a systematic search covering three databases (PubMed, Medline, Scopus). Studies were included when published in English and adequately reporting one or more IEBt or IEDCS patients in diving. Concerns regarding missing and duplicate data were minimised by contacting original authors when necessary.
In total, 25 studies with IEBt patients (n = 183) and 18 studies with IEDCS patients (n = 397) were included. Variables most useful in differentiating between IEBt and IEDCS were dive type (free diving versus scuba diving), dive gas (compressed air versus mixed gas), dive profile (mean depth 13 versus 43 metres of seawater), symptom onset (when descending versus when ascending or surfacing), distribution of cochleovestibular symptoms (vestibular versus cochlear) and absence or presence of other DCS symptoms. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma could not be reliably assessed in this context, being insufficiently reported in the IEDCS literature.
There are multiple useful variables to help distinguish IEBt from IEDCS. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma require further study as means of distinguishing IEBt and IEDCS.
内耳气压伤（IEBt）和内耳减压病（IEDCS）是与潜水相关的两种气压性内耳损伤。这两种情况都表现为耳蜗前庭症状，导致鉴别诊断困难，并可能导致（或导致不适当的）治疗延迟。
这是一项关于 IEBt 和 IEDCS 病例的系统评价，旨在确定有助于区分这些疾病的潜水和临床变量。搜索策略包括初步搜索，然后是系统搜索，涵盖三个数据库（PubMed、Medline、Scopus）。当以英文发表并充分报告一个或多个 IEBt 或 IEDCS 潜水患者时，研究被纳入。当需要时，通过与原始作者联系，可以最大限度地减少对缺失和重复数据的担忧。
共纳入了 25 项关于 IEBt 患者（n = 183）和 18 项关于 IEDCS 患者（n = 397）的研究。最有助于区分 IEBt 和 IEDCS 的变量是潜水类型（自由潜水与水肺潜水）、潜水气体（压缩空气与混合气体）、潜水剖面（平均深度 13 米与 43 米海水）、症状发作（下降时与上升或浮出水面时）、耳蜗前庭症状的分布（前庭与耳蜗）以及其他 DCS 症状的有无。在这种情况下，难以进行中耳平衡的症状或符合中耳气压伤的发现不能可靠地评估，因为 IEDCS 文献中报道不足。
有多个有用的变量可以帮助区分 IEBt 和 IEDCS。难以进行中耳平衡的症状或符合中耳气压伤的发现需要进一步研究，作为区分 IEBt 和 IEDCS 的手段。
