title: Relationship between mastoid pneumatization and middle ear barotrauma in divers.
abstract: OBJECTIVE
  Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers.
  
  
  METHODS
  Prospective, blinded.
  
  
  METHODS
  Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization.
  
  
  RESULTS
  ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2.
  
  
  CONCLUSIONS
  Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.
authors.affiliation: Department of Otolaryngology, Trakya University Faculty of Medicine, Edirne, Turkey. cemuzun@yahoo.com
authors.forename: Cem
authors.initials: C
authors.lastname: Uzun
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Adali
authors.forename: Muhsin
authors.initials: M
authors.lastname: Koten
authors.forename: Recep
authors.initials: R
authors.lastname: Yagiz
authors.forename: Salih
authors.initials: S
authors.lastname: Aydin
authors.forename: Bilge
authors.initials: B
authors.lastname: Cakir
authors.forename: Ahmet R
authors.initials: AR
authors.lastname: Karasalihoglu
mesh_terms: D001469:Barotrauma / Q000175:diagnosis* / Q000453:epidemiology; D004242:Diving; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008416:Mastoid / Q000503:physiopathology / Q000601:surgery*; D008876:Middle Ear Ventilation / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric