Immediately after forceful Valsalva during diving, a patient develops unilateral hearing loss, tinnitus and pressure-provoked vertigo. What is the safest initial management principle?
Sudden cochleovestibular symptoms after barotrauma raise concern for inner-ear injury. The patient should avoid pressure loading and undergo urgent audiovestibular and specialist assessment; exploration is reserved for selected persistent or progressive cases.
A. Urgent otological assessment with avoidance of straining while a perilymph fistula is considered: Sudden cochleovestibular symptoms after barotrauma raise concern for inner-ear injury. The patient should avoid pressure loading and undergo urgent audiovestibular and specialist assessment; exploration is reserved for selected persistent or progressive cases.
B. Repeat forceful Valsalva to reopen the Eustachian tube: Further pressure may worsen inner-ear leakage.
C. Immediate Epley manoeuvre regardless of findings: The presentation is not typical canalithiasis.
D. Routine discharge without audiometry: Sudden hearing loss requires urgent assessment.
E. Start anticoagulation empirically: There is no established indication and bleeding risk may increase.
If the loss were purely conductive with haemotympanum and no vertigo, middle-ear barotrauma would be more likely.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
Back to the Section 1 bank