title: Middle ear barotrauma in a tourist-oriented, condensed open-water diver certification course: incidence and effect of language of instruction.
abstract: BACKGROUND
  In Professional Association of Diving Instructors (PADI) Open Water Diver certification courses that cater to tourists, instruction is often condensed and potentially delivered in a language that is not the candidate's native language.
  
  
  OBJECTIVE
  To assess the incidence of middle ear barotrauma (MEBt) in open-water diver candidates during a condensed four-day certification course, and to determine if language of instruction affects the incidence of MEBt in these divers.
  
  
  METHODS
  The ears of participating diving candidates were assessed prior to commencing any in-water compression. Tympanic membranes (TM) were assessed and graded for MEBt after the confined and open-water training sessions. Tympanometry was performed if the candidate had no movement of their TM during Valsalva. Photographs were taken with a digital otoscope.
  
  
  RESULTS
  Sixty-seven candidates participated in the study. Forty-eight had MEBt at some time during their course. MEBt was not associated with instruction in non-native language (adjusted odds ratio = 0.82; 95% confidence intervals 0.21-3.91). There was also no significant association between the severity of MEBt and language of instruction.
  
  
  CONCLUSIONS
  Open-water diver candidates have a high incidence of MEBt. Education in non-native language does not affect the overall incidence of MEBt.
authors.affiliation: School of Marine and Tropical Biology, James Cook University, Townsville, IMB 23, Emergency Department 100 Angus Smith Drive, The Townsville Hospital, Douglas, Queensland, Australia, 4814, Phone: +61-(0)7-4433-1111, E-mail: denise.blake@health.qld.gov.au.
authors.forename: Denise F
authors.initials: DF
authors.lastname: Blake
authors.affiliation: Emergency Department, The Townsville Hospital, Townsville, School of Medicine, James Cook University, Townsville, Queensland, Australia.
authors.forename: Clinton R
authors.initials: CR
authors.lastname: Gibbs
authors.affiliation: Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Commons
authors.affiliation: Mount Isa Centre for Rural and Remote Health, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Australia.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000175:diagnosis / Q000453:epidemiology*; D002568:Certification / Q000592:standards*; D003144:Communication Barriers; D004242:Diving / Q000293:injuries* / Q000706:statistics & numerical data; D004432:Ear, Middle / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D007802:Language; D008297:Male; D010781:Photography; D012307:Risk Factors
keywords: Barotrauma; instruction – diving; middle ear; risk factors; training; education