Current RMA Instruments
| Reasonable Hypothesis SOP | 86 of 2020 |
| Balance of Probabilities SOP | 87 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 993.0
- ICD-10-AM Codes: T70.0
Brief description
Otitic barotrauma is an injury to the middle or inner ear resulting from the creation of abnormal pressure differences on either side of the eardrum. This mostly results from flying (decreased external pressure) or diving (increased external pressure), with blast injury becoming a more prevalent cause. Symptoms may include ear pressure, otalgia (pain in the ear), tinnitus, hearing loss (see comments below), and occasionally, vertigo.
Confirming the diagnosis
Diagnosis is made based on the history and confirmation of the injury on contemporary physical examination of the ear. Depending on the severity of the injury, physical signs of ear barotrauma are likely to have resolved within seven days (for mild injury) to three months (for a tympanic membrane perforation) following the injury.
For cases with a lack of contemporary diagnostic evidence see the MRCA policy manual section 3.4.5.1 on Limited streamlining approach for Barotrauma claims.
The relevant medical specialist is an Ear, Nose and Throat surgeon.
Additional diagnoses covered by SOP
- Aerotitis media
- Aural barotrauma
- Barotitis media
- Inner ear barotrauma
- Middle ear barotrauma
Conditions not covered by SOP
- Decompression sickness*
- Dysbaric osteonecrosis*
- Persistent hearing loss or tinnitus*
- Pulmonary barotrauma*
- Sinus barotrauma*
* Another SOP applies
Clinical onset
This is an injury. Clinical onset is at the time of the event causing the pressure difference to occur. Symptoms may not be noticed immediately in some circumstances, so the SOP factors allow 24 hours for clinical manifestations to develop.
Clinical worsening
The usual course for otitic barotrauma is for the injury to heal spontaneously over time. If healing has occurred and there is a new episode of barotrauma, this is likely to be a new clinical onset/a separate injury, rather than a worsening.
Comments
Otitic barotrauma can cause injury to the tympanic membrane, round window, oval window, Eustachion tube, and auditory ossicles.
As a result of otitic barotrauma there may be conductive hearing loss and tinnitus, both of which should resolve as the barotrauma injury heals over time. If there is persistent hearing loss and tinnitus these should be separately determined using the relevant RMA SOPs.