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Health & Diving
Ears & Diving

Ears & Diving

Facial Baroparesis

Facial baroparesis is reversible paralysis of the facial nerve due to increased pressure in the middle ear when ascending in an airplane or from scuba diving.

Mechanisms


The facial nerve is a cranial nerve that controls the muscles of the face. On its way from the muscle to the brain it passes through the channel in the wall of the middle-ear space. Pressure changes in that space normally have little or no effect on the nerve.

In some people, the canal of facial nerve misses the bony wall and is separated from the middle-ear cavity by only a thin membrane. If such a person experiences an overpressure in the middle ear equal or greater to the capillary pressure, circulation to the facial nerve stops, the facial nerve loses its functionality and facial muscle is paralyzed (facial baroparesis). This can happen while flying or diving. Fortunately, the pressure in the middle ear returns to normal soon after the exposure, restoring the circulation to the nerve and enabling its functionality. Facial baroparesis tends to recur with flying or repeated diving.

Manifestations

Symptoms include numbness, paresthesia, weakness or even paralysis of the face. Decreased sensation and a facial droop can be seen, generally on one side of the face.

Management

Facial baroparesis usually is discovered postdive. Even when its duration is brief and it resolves spontaneously, the patient should be evaluated by a physician to exclude other possible causes such as stroke, infection, trauma or decompression sickness.

In rare instances of protracted facial baroparesis, treatment may be necessary. There is experimental evidence that overpressure lasting more than 3.5 hours may cause permanent damage. Divers who continue to experience facial numbness and drooping should see a physician within three hours.

Fitness to Dive

This condition is self-limiting and resolves spontaneously within hours, but it can recur with diving or flying. Return to diving may be considered when symptoms have completely resolved and have been determined to be the result of facial barotrauma.

Prevention

Learn gentle but effective equalization techniques. Do not dive with congestion.

Further Reading

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