Barotrauma: Causes, Symptoms and Treatment

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Overpressure injury or barotrauma is mainly a problem to novice divers. Diving physician Catherine de Maeyer tells us how you can recognise, treat and especially prevent them.

17-03-2016 -  by Kevin Van der Straeten


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Overpressure injury or barotrauma is mainly a problem to novice divers. Diving physician Catherine de Maeyer tells us how you can recognise, treat and especially prevent them.


Hi Catherine.  


Hi Kevin.  


Welcome back to our studio. Last time we talked about decompression accidents. Today's topic is - let me take a look - barotraumata. But what is that exactly?  


In barotrauma you can recognise 2 words: 'Baro' which is a Greek word for pressure, and 'trauma': accident or damages. So barotraumata are accidents caused by pressure and in most of the cases overpressure. And so it can happen in every organ that is filled with air. And the crucial physics law in the barotraumata is the Law of Boyle and Mariotte, which states that at a constant temperature the multiplication of pressure and volume is a constant. So it means that if you have a 10 litre bottle filled with air, and you go down to 10 meters, the hydrostatic pressure will multiply by 2, so the volume of the bottle will drop and will be divided by two. So the multiplication has to be a constant and that's the physics law.  


And what can that cause in our body?  


Well, if we take as an example the ears... The ear is composed of three parts: The outer ear, then you have the eardrum, you have the middle ear and you have the inner ear, where the equilibrium organ and the hearing organ is located. But so this middle ear with the ear drum is filled with air, and so if you have a pressure difference, then that can cause a rupture in the eardrum. And that's not good, so if you go down, if you start your dive, you really always have to equilibrate, and what is that? Well, if you go down the hydrostatic pressure will rise, so you will have a higher pressure outside the middle ear, and then you will breathe the air, but the pressure in the middle ear is the same as the one at surface level, if you haven't equilibrated. so you have to pull open the Eustachian tube. It's a connection between the throat and the middle ear. So if you pull it open, you will allow pressure to equilibrate between the middle ear and the throat. So that's very important: if you start the dive, even after the first meter, equilibrate the ears. Because if you don't do it, the eardrum will rupture.  


That's the pain we all start  feeling when going down.  


And it can happen at 2-3-4 meters, so it's really a pity if it happens to you.  


But it's not only the ears.  


No, the ears are important, but you also have the diving mask that you put on. It's filled with air. If you would start your dive and you wouldn't equilibrate by exhaling in the mask, then you will get an overpressure outside the mask and underpressure inside the mask, and of course the glass of the mask will not change its shape, so it can really cause troubles in the tissue around the eyes, so you really get this red shape around the eyes, which is not nice to see, but it's rather harmless. But other problems can be caused in the lungs. If you for example finish your dive and get up too fast, you're inhaling air, but if you get up, the outside pressure and the hydrostatic pressure will go down. The Law of Boyle and Marriotte says: multiplication of pressure and volume is a constant, so pressure goes down, but the volume alveoli, which are small sacks filled with air in the lungs, will really expand and so you will have to allow this expanded air to leave the body. If you don't do that, if you go up too fast or if you don't exhale while going up, then you will really badly damage the lungs, which are really crucial organs.  


Yeah, we kind of need them.  


Yeah, you'll really have a big problem.  


Of course, most of these issues can be prevented by doing the things you need to do, or if you start feeling pain to stop the dive and go back safely. but what happens if you do have a lung accident or something like that? What's the next step then?  


Well, as you mentioned: prevention is very important, and especially for the young diver, the diver that doesn't have a lot of dives in his book, those divers are really very susceptible for barotraumata, because most barotraumas happen in the -10 to surface level range. So that's the range where the beginners are, so really prevention is important. So equilibration of the ears, equilibration of the mask, really has to become a reflex. But if you have this barotrauma of for example the lungs... Well, most of the time it's pretty obvious that there's something wrong, because people can't breathe normally. They really breathe like they're hyperventilating. Blood will come out of the mouth, because alveoli are damaged. So you really have to get to the hospital and you have to call 112 or 911, because it can get very bad.  


Okay Catherine, thank you for explaining the risks and see you next time.  




And you at home: thank you for watching our show. I hope to see you next week!


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