Middle ear barotrauma causing transient facial nerve paralysis after scuba diving

Middle ear barotrauma is a well known entity with typical injury occurring when diving or ascending in a commercial jetliner. Patients often present with symptoms of acute onset otalgia, hearing loss and sometimes haemotympanum (with or without tympanic membrane perforation). On rare occasions, facial nerve paralysis can occur when the tympanic segment of the facial nerve is dehiscent within the middle ear. We present a case of spontaneously resolving facial nerve palsy associated with middle ear barotrauma following a brief, shallow dive. Prompt and astute diagnosis leads to proper management with simple myringotomy and can prevent unnecessary testing and other misguided treatments.