diving inner ear injury
Introduction
Introduction to diving inner ear injury The disease is also known as Decompressionsickness. In 1973, Smith first described the disease as Caissondise, a change in inner ear damage that rapidly changes pressure in a high-pressure environment. The diver's operation rate is 1%. Generally, when it sinks into the water for 10m, it increases the water pressure of one atmosphere, which is equivalent to applying the pressure of 17~18Mg. Therefore, it is necessary to inhale compressed air or a mixture of inert gas and oxygen during diving to adjust the internal and external pressures of the tympanic cavity and the nasal cavity. If the pressure is too fast or the eustachian tube is dysfunctional, it can develop disease. Those who have diving operations, caissons, special high-altitude flight history, and fail to comply with the decompression regulations, and those with nitrogen bubble compression or vascular embolism symptoms and signs should be considered as decompression sickness. Foreign scholars divide the decompression sickness into light (type I) and heavy (type II). All patients with central nervous system symptoms or circulation, respiratory system are classified as heavy. In fact, about one-third of patients are type I and type II composite cases. basic knowledge Sickness ratio: 0.0012% Susceptible people: no specific population Mode of infection: non-infectious Complications: dizziness, nausea and vomiting, deafness, tinnitus
Cause
Causes of diving inner ear injury
Temporary vestibular dysfunction:
(1) Stimulation of water entering the external auditory canal or middle ear at different temperatures Due to obstruction of the external auditory canal or perforation of the tympanic membrane, there is a time and temperature difference between the water entering the outer ear or the middle ear, which causes a vestibular stimulating effect.
(2) Eustachian tube dysfunction due to eustachian tube dysfunction can not automatically adjust the tympanic air pressure, rising water surface after diving to produce a relatively high pressure state, and cause implosion damage, such as ossicular displacement, window membrane rupture, simple tibia Movement and the like can cause dizziness, and the nucleus of the inner ear of the severe vortex, which damages the bottom of the cochlea, can cause permanent deafness. Ascending or descending divers can cause pressure-changing dizziness. If you return to the original water level, the symptoms will disappear and there will be no permanent damage.
(3) High-pressure neurological syndrome is inhaled with a helium-oxygen mixture when diving into deep water below 150 meters. Dizziness, tremors and psychomotor disorders can occur due to rapid pressure increase, and can quickly return to normal after decompression.
Permanent inner ear damage:
(1) Decompression sickness occurs when shallow diving rises or sinks, and the eustachian tube function is poor under pressure during deep diving, and the eustachian tube is erroneously blown, causing the cerebrospinal fluid and perilymph hydraulic pressure to rise sharply. The tibia is displaced into the tympanic cavity, the vestibular membrane ruptures and the tympanic membrane perforation
(2) Sudden unilateral vestibular failure may occur in stable deep diving. Sundmaker first reported in 1973 that it sneaked into deep water, inhaled a mixture of helium-oxygen gas or three kinds of gas, and suddenly changed to air inhalation, which can cause symptoms in a short period of time. It may be that the added gas increases the concentration of endolymph gas. Caused by osmotic edema, may also enter the body through the increased barrier of inert gas through the tissue barrier, and the original infiltration of nitrogen into the body, released into bubbles after decompression, resulting in internal ear thrombus damage.
(3) The noise generated by the ventilation or compressed gas in the caisson and helmet is as high as 100-120dB, which can cause noise damage to the inner ear.
Prevention
Diving inner ear injury prevention
1. For divers, especially new divers, medical knowledge should be educated to enable divers to understand the causes and prevention methods of decompression sickness.
2. Develop good health habits and establish a reasonable living system. Take adequate rest before work to prevent excessive fatigue; do not drink alcohol and drink less water. Work should be protected from cold and dampness. Immediately after work, take off the wet overalls, drink hot tea, wash the hot water bath, rest in the warm room for more than half an hour to promote blood circulation, so that the excess nitrogen in the body is accelerated.
3, daily should ensure high calorie (generally about 15072 ~ 16747KJ per day), high protein, medium fat diet, and appropriate increase in various vitamins. Recently, domestic rabbits have been tested to show that vitamin E has a certain effect of preventing or alleviating experimental decompression sickness. The reason may be due to preventing or reducing the release of bioactive substances such as serotonin in the storage particles in platelets, and not causing intravascular involvement. Coagulation.
Complication
Diving inner ear injury complications Complications, dizziness, nausea and vomiting, deafness, tinnitus
1. Cerebral thrombosis, hemangioma, hemorrhagic necrotic intestine, colon atresia, congenital absence of duodenum, atresia and stenosis, duodenal vascular compression syndrome.
2. At the same time, it will lead to complications of osteonecrosis. Because of the large amount of air bubbles generated during decompression, the blood vessels in the bones are directly compressed. The bones and blood vessels also have air embolism and thrombus, which may cause local infarction and eventually cause sterility slowly. Ischemic osteonecrosis.
3. Severe decompression sickness can lead to death. This is because large bubbles enter the oxygenated bloodstream into the brain, central nervous system and other major organs.
Symptom
Diving inner ear injury symptoms Common symptoms Deafness, dizziness, dizziness, tremor, ear tympanic membrane, ruptured ear, ear canal, laceration, ear canal, foreign body, auricle abrasion
Those who have diving operations, caissons, special high-altitude flight history, and fail to comply with the decompression regulations, and those with nitrogen bubble compression or vascular embolism symptoms and signs should be considered as decompression sickness. Foreign scholars divide the decompression sickness into light (type I) and heavy (type II). All patients with central nervous system symptoms or circulation, respiratory system are classified as heavy. In fact, about one-third of patients are type I and type II composite cases.
The Ministry of Health of China divides acute decompression sickness into three levels: light, medium and heavy:
1 mild manifestations of skin symptoms such as itching, papules, marble-like markings, subcutaneous hemorrhage, edema, etc.
2 Moderately occurs mainly in muscle joint pain in and around the large joints of the extremities.
3 severely one of the nervous system, circulatory system, respiratory system and digestive system disorders.
Doppler bubble detectors can be used to detect flow bubbles in the great vessels of the precordial area before symptoms occur, called "ultrasound monitoring." Magnetic resonance examination revealed the site of spinal cord damage. The pain symptoms of this disease must be differentiated from general trauma and inflammation. Other diving diseases such as pulmonary barotrauma, acute hypoxia, oxygen poisoning and nitrogen anesthesia must be clearly distinguished from diving decompression sickness.
The routine diagnosis of decompressive osteonecrosis was examined by X-ray examination and divided into three phases according to the X-ray changes of the bone. Can also use 99m for scintigraphy or gamma photography, early detection of some lesions not found on X-ray films, but can not show cystic changes and calcification lesions.
Examine
Examination of diving inner ear injury
Doppler bubble detectors can be used to detect flow bubbles in the great vessels of the precordial area before symptoms occur, called "ultrasound monitoring." Magnetic resonance examination revealed the site of spinal cord damage.
The routine diagnosis of decompressive osteonecrosis was examined by X-ray examination and divided into three phases according to the X-ray changes of the bone. Can also use 99m for scintigraphy or gamma photography, early detection of some lesions not found on X-ray films, but can not show cystic changes and calcification lesions.
Diagnosis
Diagnosis and diagnosis of diving inner ear injury
The pain symptoms of this disease must be differentiated from general trauma and inflammation. Other diving diseases such as pulmonary barotrauma, acute hypoxia, oxygen poisoning and nitrogen anesthesia must be differentiated from diving decompression sickness.
1. Trauma and inflammation: There is a general history of trauma, inflammatory lesions will occur local redness and heat pain, systemic symptoms have fever, fatigue, joint pain. Blood tests showed an increase in white blood cells.
2. Oxygen poisoning: a long history of inhaling 60-200 kPa of oxygen, initially caused by symptoms of tracheal irritation caused by upper respiratory tract infection, such as post-sternal discomfort (stimulation or burning sensation) with mild dry cough, and slowly increased; then There is pain in the back of the chest, and the pain gradually spreads along the bronchial tree to the entire chest, even when inhaling; the pain gradually increases and an uncontrollable cough occurs. Breathing difficulties are also accompanied by rest. Exposure ends at an early stage of symptom onset, and chest pain and cough can be alleviated within hours.
3. Pulmonary pressure injury: only seen in divers, Shen Ji staff, patients undergoing hyperbaric oxygen therapy during the decompression process, inappropriate breath holding, coughing, convulsions (epileptic seizures, brain-type oxygen poisoning) caused the vocal cords to close, resulting in The pressure in the trachea and lungs is excessively dry. The lung tissue will over-expand, causing the alveolar wall, blood vessels, and interstitial tear to cause pneumothorax, mediastinal emphysema, and subcutaneous emphysema. If the gas enters the ruptured blood vessel, gas embolism may occur.
