Sudden hearing loss in divers and fliers

Area of Science:

• Otolaryngology
• Aerospace Medicine
• Neurosurgery

Background:

• Sudden sensorineural hearing loss (SSNHL) is often linked to barotrauma affecting the inner ear, particularly round and oval window fistulae.
• Traditional management for SSNHL includes conservative therapy like bed rest for up to 30 days.
• The efficacy of surgical intervention versus conservative treatment for SSNHL in aviators and divers remains a subject of debate.

Observation:

• Fistulae of the round and oval window membranes are frequently implicated in SSNHL cases related to barotrauma.
• Conservative therapy for SSNHL has historically yielded comparable or better hearing results than surgical exploration.
• High-frequency SSNHL, often accompanied by tinnitus, may not benefit from surgical exploration but could see improvement in vertigo.

Findings:

• Immediate surgical exploration and correction are essential for sudden severe or profound sensorineural deafness in divers and fliers.
• This select group demonstrates excellent hearing improvement following prompt surgical intervention.
• Surgical exploration in cases of high-frequency SSNHL with tinnitus does not typically improve hearing but may alleviate vertigo.

Implications:

• Prompt surgical intervention is crucial for preserving and restoring hearing in aviators and divers experiencing severe SSNHL due to barotrauma.
• Findings challenge the conventional approach, advocating for early surgical management in specific patient populations.
• Further research may refine treatment protocols for different patterns of barotrauma-induced hearing loss.