Cochlear and vestibular dysfunction resulting from physical exertion or environmental pressure changes.

Inner ear damage due to physical exertion or environmental pressure changes has been described only recently. According to Goodhill there are two possible mechanisms of injury: the explosive and the implosive. The former is triggered by increased C.S.F. pressure transmitted to the perilymph space; the latter by increased pressure in the middle ear transmitted to the perilymph space through the two windows. Sudden hearing loss or dizziness, or both, are the main symptoms. The diagnosis will be established by the history, the audiogram, and the electronystagmogram (ENG). The treatment is still controversial. As the formation of a fistula is a real possibility, an exploratory tympanotomy is suggestive on suspected cases. Due to the variety of symptoms every case has to be assessed individually. A detailed history is of utmost importance.