SCUBA Medicine for Otolaryngologists: Part II. Diagnostic, Treatment, and Dive Fitness Recommendations.

Abstract

Challenge current practices and misconceptions in treating recreational SCUBA (Self-contained underwater breathing apparatus) divers. Differentiate patients who are fit to dive and those with relative and absolute contraindications. Redefine the standard of care for fitness to dive parameters based on the most up-to-date evidence. We conducted a review of the available medical and diving literature in English, German, Spanish, Italian, Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers. The databases of PubMed, Ovid Medline, and Cochrane library, as well as available textbooks, were queried for relevant data. Current recommendations regarding fitness to dive are overly prohibitive given the available evidence. Insufficient evidence currently exists to justify the level of certainty with which some recommendations have been made previously. This is particularly true with regard to postsurgical patients, including those who have undergone stapedectomy or skull base repairs. Updated treatment guidelines, particularly those regarding the timely differentiation of barotrauma and decompression sickness, as well as clearance for return to diving following surgery or trauma, are presented herein. Current guidelines for otorhinolaryngologists governing the diagnosis and treatment of SCUBA divers are lacking and in some instances founded on insufficient evidence. We present an up-to-date, comprehensive guide for otorhinolaryngologists to utilize going forward. Laryngoscope, 130:59-64, 2020.