Failure to equalize pressures between the middle and external ear while diving can result in barotrauma to the tympanic membrane and middle ear. This can be graded based on the otoscopic examination.
Findings
Grade
symptoms (pain, nausea, vomiting, etc.) without changes in the tympanic membrane
0
injection of the tympanic membrane (may be most noticeable along the handle of the malleus)
I
injection plus mild hemorrhage within the tympanic membrane
II
gross hemorrhage within the tympanic membrane
III
free blood in the middle ear (tympanic membrane blue and bulging)
IV
perforation of the tympanic membrane
V
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