Full Text:

 

영남의대학술지 Vol.24_No.2 Suppl. P.S57-74, Dec. 2007

Review

스쿠버 다이빙으로 인한 인체의 압력손상

Barotrauma of the Human Body from SCUBA Diving

윤석근
영남대학교 의과대학 이비인후과학교실
책임저자:윤석근, 대구광역시 남구 대명동 317-1, 영남대학교 의과대학 이비인후과학교실
Tel: (053) 620-3783, Fax: (053) 628-7884
E-mail: skymd@med.yu.ac.kr

December 30, 2007

Abstract

As economical and social status are getting better, many ordinary people are interested in well being and leisure sports, the populations enjoying SCUBA diving are increasing recently. The medical problems from SCUBA diving are also increasing. To provide diving knowledge to the medical Drs. for prevention of barotrauma from SCUBA diving and to provide medical knowledge to SCUBA divers for safer diving, author reviews barotrauma of the human body from SCUBA diving. Review includes diving physics, mechanism, clinical manifestations and prevention of barotrama. Pulmonary barotrauma manifests as pulmonary tissue damage, pneumothorax, mediastinal emphysema with or without arterial gas embolism. Arterial gas embolism is one of the most serious and urgent medical problem from SCUBA diving and it need immediate recompression treatment. Barotrauma in the middle ear is the most common medical problem from SCUBA diving, it manifests as Eustachian tube salpingitis, otitis media with effusion. Inner ear barotrauma may lead permanent sensorineural hearing loss. Barotruma also can be occurred in mask,teeth, dry suit, and gastrointestinal tract. Prevention of barotrauma is more important than treatment. Prevention of barotrauma is up to divers, diving instructors and medical Drs. Divers and diving instructors should follow guidelines in diving fitness test, keep physical state always to fit to dive, keep diving skills as sharp and keep physical ability to adjust changeable ocean environment. Medical Drs. are responsible to their decision of medical fitness test, so they should know about diving physic, diving physiology and recent guidelines about medical fitness to dive.

Key Words: Barotruma, SCUBA diving, Diving medicine

References

1. 김인영. 연도별 다이버 인구, 사망자 및 교통사망자 통계. 스쿠버 다이버 2003 Dec;(98):268-9.
2. PADI (USA). The encyclopedia of recreational diving. Santa Ana: The Institute; 1993.

3. Neblett LM. Otolaryngology and sports SCUBA diving. Ann Otol Rhino Laryngol Suppl 1985 Jan-Feb;115(94):1-12.

4. Farmer JC. Diving injuries to the inner ear. Ann Otol Rhino Laryngol Suppl 1977 Jan- Feb;107(86):1-20.

5. Yoon SK, Yoo WJ. Barotrauma of the middle ear in guinea pigs after simulated diving. Kor J ORL 1997 May;40(5):732-8.
6. Yoon SK, Lee KH. Ventilatory function of the eustachian tube in sports scuba divers. Kor J ORL 1995 Jul; 38(7):1017-24.

7. Yoon SK. Otologic barotrauma from SCUBA diving. Kor J ORL 1994 Mar;37(3):421-9.
8. Lee MH, Yoon SK, Song KW. Eustachian tube function in paranasal sinusitis. Kor J ORL 1989 Jun;32(6):1074-9.

9. 해군 해양의학적성훈련원 (한국). 잠수의학. 진해: The Institute; 1998.
10. U.S. Navy (US). U.S. Navy Diving Manual. Volume 1(Air Diving). Revision 3. Flagstaff: The Institute; 1993.

11. NOAA, U.S. Department of Commerce (US). NOAA Diving Manual. Diving for Science and Technology. Flagstaff: The Institute; 2001.

12. Bove AA, editors. Diving medicine. 3rd ed. Philadelphia: W.B. Saunders Company; 1997.

13. Acott C, Gorman D, editors. Diving and hyperbaric medicine. 4th ed. Adelaide(South Australia): Royal Adelaide Hospital; 2000.
14. Edmonds C, Lowry C, Pennefather J, editors. Diving and subaquatic medicine. 3rd ed. Jordan Hill(Oxford): Butterworth-Heinemann Ltd; 1992.

15. Bennette PB, Elliot DH, editors. The physiology and medicine of diving. 4th ed. London: W. B. Saunders Company Ltd; 1994.

16. Shilling CW, Carlston CB, Mathias RA, editors. The physician’s guide to diving medicine. New York: Plenum Press; 1994.
17. Jain KK. Textbook of hyperbaric medicine. 2nd ed. Kirkland(WA): Hogrefe & Huber Publishers; 1996.

18. Kindwall EP, editors. Hyperbaric medicine practice. Flagstaff: Best Publishing Company; 1994.
19. Edmonds C, McKenzie B, Thomas R. Diving medicine for scuba divers. Carnegie, Victoria (Australia): J.L. Publications; 1992.

20. Parker J. The sports diving medical. Carnegie, Victoria(Australia): J.L. Publications; 1994.
21. Lippmann J. Deeper into diving. Carnegie, Victoria(Australia): J.L. Publications; 1990.

22. PADI (US). PADI open water diver manual. Santa Ana: The Institute; 1999.
23. Paparella MM, Shumrick DA, Gluckman JL, editors. Otolaryngology. 3rd Ed. Philadelphia: WB Saunders Company; 1991.

24. Dick AP, Massey EW. Neurological presentation of decompression sickness and arterial gas embolism in sports divers. Neurology 1985 May;35(5):667-71.

25. Neumann TS. Pulmonary considerations I; Asthma; COPD; Need for special testing. In fitness to dive. Proceedings of the Thirty- Fourth Undersea and Hyperbaric Medical Society Workshop, sponsored by NOAA; 1986 May; Bethesda, MD, USA: UHMS Publication No. 70; 1987 May 49-59.

26. Edmonds C. Hearing loss with frequent diving (deaf divers). Undersea Biomed Res 1985 Sep;12(3):315-9

27. Farmer JC. Inner ear injuries in diving- differential diagnosis of inner ear decompression sickness and inner ear barotrauma. Proceedings of 7th International Symposium on Underwater and Hyperbaric Physiology; 1981; Undersea and Hyperbaric Medical Society, Bethesda, MD, USA; 1981:805-10.

28. Molvaer OI, Albrektsen G. Hearing deterioration in professional divers: an epidemiologic study. Undersea Biomed Res 1990 May;17(3):231-46.

29. Brady JI, Summitt JK, Berghage TE. An audiometric survey of Navy divers. Undersea Biomed Res 1976 May;3(1):41-7.
30. Freeman P, Edmonds C. Inner ear barotrauma. Arch Otolaryngol 1972 Jun;95(6):556-63.

31. Abe T, Sasamori S, Oikawa T, Aigami T, Endo Y, Matsuki C. Acute low tone sensorineural hearing loss caused by inner ear barotrauma. Nippon Jibiinkoka Gakkai Kaiho 1989 Sep;92 (9):1381-8.

32. Ashton DH, Watson LA. Inner ear barotrauma: a case for exploratory tympanotomy. Aviat Space Environ Med 1992 Jul;63(7):612-5.

33. Hando M, Yanagita N, Yokoi H. Scanning Electron Microscopic studies on inner ear barotrauma mainly on the damage of cochlear sensory hairs. Nippon Jibiinkoka Gakkai Kaiho 1982 Aug;85(8):941-50.

34. Nakashima T, Itoh M, Watanabe Y, Sato M, Yanagita N. Auditory and vestibular disorders due to barotrauma. Ann Otol Rhinol Laryngol 1988 Mar-Apr;97(2):146-52.

35. Shupak A, Doweck I, Greenberg E, Gordon CR, Spitzer O, Melamed Y, et al. Diving related inner ear injuries. Laryngoscope 1991 Feb; 101 (2):173-9.

36. Miller JM, Axelsson A, McPherson D, Potter W. Mechanisms of aural barotrauma. Proceedings of 7th International Symposium on Underwater and Hyperbaric Physiology; 1981; Undersea and Hyperbaric Medical Society, Bethesda, MD, USA; 1981:811-6.

37. Sun JJ, Wang JB, Wei NR. Histopathological observation on the inner ear barotrauma in guinea pig. J of Tongji Med Univ 1987;7(3): 136-42.

38. Sun JJ, Wang JB, Wei NR. Histopathological observation on the ear barotrauma in guinea pigs. Chinese J of Otolaryng 1988;23(5):261-3.

39. Wilkes MK, Palmer AC, Pearce PC. Cochlear degeneration in minipigs after repeated hyperbaric exposures. Undersea Biomed Res 1989 Mar; 16(2):139-52.

40. Nakashima T, Kaida M, Yanagita N. Round window membrane rupture and inner ear damage due to barotrauma. Acta Otolaryngol Suppl 1992 May-Jun;493:57-62.

41. Nakashima T, Yokoi H, Ito M, Watanabe Y, Sato M, Yanagita N. Auditory and vestibular disorders due to barotrauma. Proceedings of 9th International Symposium on Underwater and Hyperbaric Physiology; 1987; Undersea and Hyperbaric Medical Society, Bethesda, MD, USA; 1987:229-36.

42. Fukuta S, Yokoi H, Ishida K, Yanagita N. Electron microscopic study on inner ear barotrauma; with emphasis on the cochlear damage. Nippon Jibiinkoka Gakkai Kaiho 1991 Jul;94(7):970-9.

43. Zheng XY, Gong JH. : Cochlear degeneration in guinea pigs after repeated hyperbaric exposures. Aviat Space Environ Med 1992 May;63(5):360-3.

44. Goodhill V, Brockman SJ, Harris I, Hantz O. Sudden deafness and labyrinthine window rupture, audio-vestibular observations. Ann Otol Rhinol Laryngol 1973 Jan-Feb;82(1):2-12.

45. McCormick JG, Holland WB, Brauer RW, Holleman IL Jr. Sudden hearing loss due to diving and its prevention with heparin. Otolaryngol Clin of North Am 1975 Jun;8(2): 417-30.

46. Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg 1985 Jun;93(3):393-7.

47. Pullen FW. Perilymphatic fistula induced by barotrauma. Am J Otol 1992 May;13(3): 270-2.
48. Molvaer OL. Alternobaric facial palsy. Med Aeronaut Spat Med Subaquat Hyperbar. 1979; 18:249-50.

49. Becker GD. Recurrent alternobaric facial paralysis resulting from scuba diving. Laryngoscope 1983 May;93(5):596-8.

50. Fagan P, McKenzie B, Edmonds E. Sinus barotrauma in divers. Ann Otol Rhinol Laryngol 1976 Jan-Feb;85(1):61-4.

51. Elliot D. Medical assessment of fitness to dive. Flagstaff(AZ): Best Publishing Company; 1995.