Inner ear barotrauma 內耳氣壓傷

(Tintinalli's Emergency Medicine)
Inner ear barotrauma 內耳氣壓傷. 
通常下潛過程用力閉氣造成耳壓突然過大引起
症狀: 單側耳鳴. 聽力喪失, 嚴重暈眩
治療: 有爭議, 會診耳鼻喉科決定. 
手術探查: 立即手術或延遲手術(保守治療無效,嚴重聽力受損,眼震圖明顯異常)
保守治療: 臥床頭部高,藥物治療眩暈,其他預防腦壓突然上升的治療,包括軟便劑, 避免捏鼻子吹氣
如因其他疾病要做高壓氧治療, 需先做緊急耳膜切開術. 

內耳對氣壓傷害也很敏感, 有時候造成長期損傷, 潛水員如果嘗試閉氣用力以平衡中耳壓力, 當耳咽管阻塞時, 壓力差會藉由腦脊髓液CSF沿著前庭, 耳蝸, 中耳空間傳導至內耳, 導致卵圓窗 oval window or 圓窗 round window 破裂. 形成瘻管, 前庭膜撕裂. 如果耳咽管在下潛過程打開, 過度用力閉氣也會導致中耳壓力快速上升. 壓力傳導至內耳也會造成相似損傷. 









The inner ear is also susceptible to barotrauma, occasionally causing significant, long-term damage. If a diver attempts a forceful Valsalva maneuver to equalize the middle ear against an occluded Eustachian tube, the pressure differential between the cerebrospinal fluid, transmitted
through the vestibular and cochlear structures and the middle ear air space, can cause rupture of the oval or round window, fistulization of the window, tearing of the vestibular membrane, or a combination of such injuries. Additionally, if the diver is able to open the Eustachian tube in this situation, a rapid increase in middle ear pressure may occur. This pressure wave is transmitted to the inner ear and can also cause a similar injury.

罹患內耳氣壓傷的潛水員通常會有單側耳鳴. 聽力喪失, 嚴重暈眩,. 
Divers with inner ear barotrauma will generally present with unilateral roaring tinnitus, sensorineural hearing loss, and profound vertigo. 
瘺管測驗可能陽性: 耳膜充氣加壓會導致患側偏向對側
A “fistula test” may be positive—that is, insufflation of the tympanic membrane on the affected side causes the eyes to deviate to the contralateral side. 
通常是下潛過程引起, 潛水員可能會說無法平衡耳壓, 藉此病史可以與其他眩暈區分.  
Because this injury usually occurs on descent and divers will provide a history of difficulty clearing the ears, this condition can usually be easily differentiated from other causes of vertigo, such as inner ear decompression sickness, cerebral arterial gas embolism, or alternobaric vertigo (discussed below).
內耳氣壓傷可能造成恐慌, 迷失方向感, 造成溺水或快速上升, 快速上升過程可能肺部氣壓傷. 潛水員如果有內耳氣壓傷應會診耳鼻喉科. 
Immediate complications of inner ear barotrauma are potential panic or disorientation, leading to possible drowning or a rapid ascent that predisposes the diver to pulmonary barotrauma. Divers with barotraumatic
injuries to the inner ear require urgent otolaryngologic evaluation.
治療方式有爭議, 有些醫師建議立即手術探查, 有些則建議先保守治療(臥床頭部抬高,藥物治療眩暈,其他預防腦壓突然上升的治療,包括軟便劑, 教導病患避免捏鼻子吹氣). 保守治療無效或聽力受損嚴重或眼震圖明顯異常的再手術探查. 
Treatment is controversial, with some authors advocating immediate exploration and others suggesting a trial of bed rest (head upright), medications to control vertigo, and mechanical measures to reduce cerebrospinal fluid pressure spikes (e.g., stool softeners, no nose blowing). These authors reserve exploration for patients whose symptoms do not respond to conservative therapy or patients with severe hearing defects or significant abnormalities on an oculo-nystagmogram. 
因其他問題需高壓氧治療的患者, 如果懷疑有內耳氣壓傷, 應做緊急鼓膜切開術. 以免在高壓氧艙, 因壓力上升造成內耳受傷或淋巴滲漏更嚴重. 
Divers with potential inner ear barotrauma who will be treated with hyperbaric oxygen for decompression sickness or cerebral arterial gas embolism require emergent tympanostomy, because hyperbaric treatment will recreate the same pressure differentials that caused the injury, potentially causing more perilymph leakage and, possibly, worsening the injury.2

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