Rupture of the round window membrane.

Area of Science:

• Otolaryngology
• Diving Medicine
• Auditory Neuroscience

Background:

• Sudden sensori-neural deafness (SSNHL) is of significant clinical interest.
• Mechanical disruption of inner ear membranes, particularly the round window membrane, is a postulated cause of SSNHL.
• Inner ear barotrauma is increasingly recognized as a potential etiology for SSNHL in specific populations.

Observation:

• Two cases of experienced divers presenting with SSNHL and vertigo following diving are detailed.
• Both patients experienced difficulty with auto-inflation, attributed to underlying nasal issues.
• Tympanotomy revealed bilateral round window membrane ruptures in the first case and a unilateral rupture in the second.
• A third case of round window membrane rupture following head trauma is also presented.

Findings:

• Surgical repair of the ruptured round window membranes using fat grafts resulted in complete hearing restoration in both primary cases.
• Vertigo symptoms also resolved post-operatively.
• Pre-existing nasal conditions and improper auto-inflation techniques were identified as contributing factors in the diver cases.

Implications:

• This study highlights inner ear barotrauma as a treatable cause of SSNHL in divers.
• Recommendations include pre-dive screening for nasal patency and education on safe auto-inflation techniques.
• Early diagnosis and surgical intervention are crucial for successful outcomes in round window membrane rupture.