Evidence‑informed decision aid for fitness‑to‑dive assessment after otologic surgery

Area of Science:

• Otolaryngology
• Diving Medicine
• Evidence-Based Medicine

Background:

• Fitness-to-dive after otologic surgery is often conservatively managed, with some procedures deemed absolute contraindications lacking strong evidence.
• Existing literature is diverse, including clinical reports, experimental studies, and manufacturer guidelines, creating counseling uncertainty.

Purpose of the Study:

• To characterize evidence on fitness-to-dive post-otologic surgery.
• To develop an evidence-informed clinical decision aid for divers.

Main Methods:

• A scoping review following PRISMA-ScR guidelines was performed.
• Searched databases included PubMed/MEDLINE, Embase, and Scopus, along with other sources.
• Included clinical reports, experimental studies, guidance documents, and manufacturer statements.

Main Results:

• 40 sources were included from 324 records; the evidence was largely non-comparative.
• Canal wall down mastoidectomy is generally contraindicated for diving.
• Middle ear reconstructions and stapes surgery may be compatible; cochlear implant guidance is conditional, often requiring hyperbaric testing.

Conclusions:

• Limited, heterogeneous evidence does not support universal prohibitions for all otologic procedures.
• An individualized, function-based approach is recommended, with restrictions for high-risk scenarios.
• Prospective registries and standardized reporting are needed to refine recommendations.