Man reported hearing a loud pop in her ear followed by a sudden sharp pain while diving to see coral. Upon resurfacing, she experienced tinnitus and muffled hearing. When she cleaned her ear with a cotton swab, she noticed blood. Two weeks later, she visited the Tam Anh General Clinic in District 7. An otoscopy revealed a perforation in the anterior-inferior quadrant of her left eardrum. Her tympanic cavity (the space behind the eardrum) was dry. A hearing test confirmed conductive hearing loss. Her nose and throat showed no abnormalities.

Doctor Nguyen Tri Minh Tri, from the ENT unit, explained that Man's perforated eardrum was caused by barotrauma, leading to hearing loss. Underwater, the surrounding pressure increases. For every 10 meters of depth, the pressure doubles compared to the surface. The middle ear, an air-filled cavity behind the eardrum, cannot self-regulate pressure. During diving, if the air pressure in the middle ear isn't equalized quickly enough (usually by swallowing or gently blowing while pinching the nose), the external pressure exceeds the internal pressure. This causes the eardrum to stretch inward, resulting in pain. If the pressure difference is too significant, the eardrum can tear or perforate.

The doctor cleaned Man's ear, prescribed medication, and scheduled a follow-up appointment after two weeks. He assessed that the perforation hadn't caused a middle ear infection and could heal naturally with proper care. To aid the healing process, Man was advised to keep her ear dry, use earplugs while showering, avoid swimming, and minimize exposure to dust and sick individuals.

If the perforation doesn't heal on its own, or if there's persistent ear inflammation or hearing loss, surgery might be necessary to repair the eardrum. Fortunately, Man's eardrum healed well, and after a follow-up appointment, she was monitored for two more weeks.

Doctor Tri consults with Man. Photo: Tam Anh General Clinic, District 7

Doctor Tri consults with Man. Photo: Tam Anh General Clinic, District 7

Symptoms of eardrum perforation due to barotrauma typically include acute ear pain, conductive hearing loss, tinnitus, and possibly bleeding from the outer ear. Some individuals may experience brief dizziness due to stimulation of the inner ear's balance mechanism, especially if the damage extends to the oval or round window. If seawater or contaminated water enters the middle ear through the perforation, it can cause an acute middle ear infection. Without prompt treatment, this can lead to chronic middle ear infections with perforation, mastoiditis (infection of the mastoid bone), persistent hearing loss, or deafness.

While diving, sudden pressure changes can cause eardrum perforation, swelling, and fluid buildup. If cold seawater enters the ear through the perforation, it can trigger acute dizziness due to stimulation of the vestibular system. In severe cases, inner ear fluid leakage can occur due to rupture of small structures like the round or oval window.

Doctor Tri advises individuals planning to dive to learn proper ear equalization techniques to prevent injuries caused by pressure changes. If symptoms such as tinnitus, hearing loss, ear pain, or dizziness occur after diving, individuals should consult an ENT specialist promptly for diagnosis and treatment.

Uyen Trinh