![]() ![]() The data extracted from the final 41 studies included the study design, the study setting, and the number and general characteristics of all applicable patients. Therefore, we carried out a systematic literature review to both elucidate and elaborate the differentiation between IEBt and IEDCS. Taking this into account, a systematic review with differently refined inclusion and exclusion criteria might provide additional information on the subject. In addition, the review of the literature primarily focused on IEBt, with significantly less attention given to IEDCS characteristics.[ The tool consists of: 1) H − hard to clear 2) O − onset of symptoms 3) O − otoscopic exam 4) Y − your dive profile 5) A − additional symptoms and 6) H − hearing. Although the tool is convenient, there are some limitations in the literature review on which it is based, including the inclusion of non-original studies (e.g., review articles), the inclusion of studies with neither IEBt nor IEDCS patients (e.g., studies examining otoacoustic emission testing or studies examining diving-related injuries in general), and the inclusion of patients with inner ear injuries resulting from non-diving related activities (e.g., inner ear injuries after head trauma). Recently, based on a review of the relevant literature, the ' HOOYAH tool' has been created to assist in the differentiating between IEBt and IEDCS. These difficulties in differential diagnosis have been repeatedly discussed in previous literature, and progress in differentiating between the two conditions has been made. Whereas IEBt ultimately results from mechanical damage due to a pressure gradient between the middle and the inner ear, IEDCS results from bubble formation from dissolved gas either within the venous blood with subsequent arterialisation of bubbles and distribution to the labyrinthine artery, or within the membranous labyrinth itself. Although the physiology and pathophysiology of IEBt and IEDCS are distinctly different, both conditions may manifest similarly, presenting as symptoms of cochlear (hearing loss, tinnitus) and/or vestibular (vertigo, nausea and vomiting) involvement. These similarities can cause difficulties in differentiating between IEBt and IEDCS, possibly delaying (or leading to inappropriate) treatment. Inner ear barotrauma (IEBt) and inner ear decompression sickness (IEDCS) are the two dysbaric inner ear injuries associated with diving. ![]()
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