O’Neill Grading System

The O’Neill grading system is a way to categorize the severity of middle-ear barotrauma (MEBT). It is simple and is intended to provide consistency in diagnosis with sufficient details to direct treatment.

Grade 0: Eustachian Tube Dysfunction

  • Baseline photo depicting anatomical appearance of the tympanic membrane (TM) before exposure to pressure
  • Symptoms with no anatomical change (no trauma) from baseline

Grade 1 Barotrauma

  • Erythema increased from baseline
  • Fluid or air trapping (visible bubble) in the middle-ear space

Grade 2 Barotrauma

  • Any bleeding noted within the tympanic membrane or middle-ear space
  • Perforation