![]() The mean delay to onset of symptoms was 0.4 h in IEDCS patients. Conversely, the symptoms of IEDCS appeared when ascending (7.6%) or when surfacing (6.8%) in only a minority of cases, developing in most cases shortly after reaching the surface (85.6%). In IEBt patients, the symptoms appeared in all stages of the dive either when descending (18.5%), when ascending (3.3%), when surfacing (32.6%) or after surfacing (45.7%). ![]() Symptoms and findings after the incident dives are presented in Table 2. Quantitative synthesis of the studies is presented in Tables Tables1, 1, ,2 2 and and3, 3, and described below. All studies were case reports, case series or retrospective chart reviews the diagnosis in many cases verified via pure tone audiometry and/or electronystagmography. The 18 IEDCS studies included 397 patients and were published between 19. A minority of the patients (9.1%) were from studies published between 19, and the majority (90.9%) from studies published between 20. All studies were case reports, case series or retrospective chart reviews with the diagnosis in most cases verified via pure tone audiometry, electronystagmography and/or surgical exploration of the tympanic cavity (i.e., exploratory tympanotomy). The 25 IEBt studies included 183 patients and were published between 19. Approximately half (44.3%) of the patients were from studies published between 19, the other half (55.7%) from studies published between 20. Finally, data regarding the continuation of diving activity were also extracted. Data on the relevant findings, the treatment delay, the treatment(s) received and the outcomes at discharge and at follow-up were also extracted, when available. ![]() In addition, data on the relevant dive details were extracted, including the depth and duration of the incident dives, the breathing gases used, and the predisposing factors reported in connection to the incident dives defined as middle ear equalisation difficulties in IEBt patients and any of the generally established DCS risk factors (i.e., consecutive days of diving, multiple dives per day, altitude exposure after the incident dive, uncontrolled ascent from the dive, dehydration or feeling cold during the dive, physical exertion during or after the dive, obesity) in IEDCS patients.ĭata on the development, distribution and laterality of cochleovestibular symptoms were extracted, as well as data regarding symptoms attributable to other DCS manifestations. The data extracted from the final 41 studies included the study design, the study setting, and the number and general characteristics of all applicable patients. Therefore, we carried out a systematic literature review to both elucidate and elaborate the differentiation between IEBt and IEDCS. Taking this into account, a systematic review with differently refined inclusion and exclusion criteria might provide additional information on the subject. In addition, the review of the literature primarily focused on IEBt, with significantly less attention given to IEDCS characteristics.[ The tool consists of: 1) H − hard to clear 2) O − onset of symptoms 3) O − otoscopic exam 4) Y − your dive profile 5) A − additional symptoms and 6) H − hearing. Although the tool is convenient, there are some limitations in the literature review on which it is based, including the inclusion of non-original studies (e.g., review articles), the inclusion of studies with neither IEBt nor IEDCS patients (e.g., studies examining otoacoustic emission testing or studies examining diving-related injuries in general), and the inclusion of patients with inner ear injuries resulting from non-diving related activities (e.g., inner ear injuries after head trauma). Recently, based on a review of the relevant literature, the ' HOOYAH tool' has been created to assist in the differentiating between IEBt and IEDCS. These difficulties in differential diagnosis have been repeatedly discussed in previous literature, and progress in differentiating between the two conditions has been made. ![]() Whereas IEBt ultimately results from mechanical damage due to a pressure gradient between the middle and the inner ear, IEDCS results from bubble formation from dissolved gas either within the venous blood with subsequent arterialisation of bubbles and distribution to the labyrinthine artery, or within the membranous labyrinth itself. Although the physiology and pathophysiology of IEBt and IEDCS are distinctly different, both conditions may manifest similarly, presenting as symptoms of cochlear (hearing loss, tinnitus) and/or vestibular (vertigo, nausea and vomiting) involvement. These similarities can cause difficulties in differentiating between IEBt and IEDCS, possibly delaying (or leading to inappropriate) treatment. Inner ear barotrauma (IEBt) and inner ear decompression sickness (IEDCS) are the two dysbaric inner ear injuries associated with diving. ![]()
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