Recognizing and Preventing Barotrauma

Barotrauma is a term used to describe pressure-related tissue injuries to the human body. A person may experience barotrauma when pressure changes in the surrounding environment cause air in the body to expand or contract in a manner that damages the surrounding tissue. Scuba divers must be particularly mindful of the risk of barotrauma because of the high pressures they are exposed to when diving.

It is important for dive professionals to know how to recognize barotrauma in divers so you can respond effectively to incidents. Know what symptoms to look out for, how to encourage prevention, and what your emergency action plan should include in the event of barotrauma.

The most common barotrauma divers experience is ear barotrauma. But pressure-related injuries can also occur in any air-containing space, which includes the sinuses, the lungs, and even the diver’s mask. The risks associated with all these types of barotrauma are greatest at shallow depths (from the surface to about 33 feet).

Encourage your divers to use proper equalization techniques early and often. Inform divers about the hazards of pulmonary barotrauma, which can be avoided by always exhaling during ascent to accommodate the expansion of air in the lungs. Divers should also be reminded to equalize their mask to avoid mask squeeze and associated injuries to the face and eyes. Dive professionals may also find it valuable to tell divers to never wear ear plugs or goggles while diving, as these do not allow for equalization and could lead to harmful injuries.

Symptoms of pulmonary barotrauma include chest pain and shortness of breath. In more severe cases, people may also cough up blood or have a bloody froth appear around their mouth. Air in the tissues of the neck may also compress the vocal cords which can cause the pitch or sound of a diver’s voice to change.

Ear barotrauma may be reported to you as a feeling of cold water flooding into the diver’s ear, which may cause vertigo, disorientation, hearing loss, dizziness, and even vomiting. The diver may report that their symptoms eased during the dive, which can be explained by the perforation of the eardrum and any cold water present in the middle ear warming up to body temperature. However, the symptom of hearing impairment resulting from a perforated eardrum will persist after the dive, and the onset of an ear infection hours or days later is very likely.

Sinus barotrauma often presents as facial pain and a headache during descent and feelings of congestion in the face and nose during ascent. It is also possible for a diver to get a bloody nose from sinus barotrauma during ascent and they may also experience impaired vision or facial sensitivity, especially in their cheeks.

Mask barotrauma is another injury that dive professionals can look out for. Divers with mask barotrauma may have excessively red or bloodshot eyes from burst blood vessels. Other symptoms from mask barotrauma may present as a loss of vision or facial bruising.

If you suspect barotrauma, refer the diver to a medical professional for diagnosis and testing. Referring the diver to a medical professional is especially important because many of the symptoms characteristic to barotraumas have significant overlap with other diving related injuries and medical conditions. It is strongly suggested that you refer divers for a professional diagnosis to protect your dive operation as well as to ensure that your divers get the help and care they need.