The Bubble Sign: A Clinical Observation for Suspected Tympanic Membrane Perforation After Deep Freediving: A Case Report

AbstractRapid environmental pressure changes during freediving can create significant mechanical stress on the middle ear and may lead to middle ear barotrauma. Tympanic membrane perforation is an important consequence of this trauma and is usually diagnosed by otoscopic examination. In this case report, we present a diver who developed dizziness after performing a freedive to approximately 50 meters and reported a sensation of a sensation of air leakage from the ear. During the clinical evaluation, the external auditory canal on the symptomatic side was filled with antibiotic ear drops, and the patient was asked to perform a gentle Valsalva maneuver. During the maneuver, air bubbles were observed within the fluid in the external auditory canal. This finding was considered suggestive of tympanic membrane perforation. In environments where diagnostic tools are not immediately available, this simple clinical observation may assist in the early recognition and management of diving-related ear barotrauma. We describe this observation as the “bubble sign”, which may represent a useful clinical observation in diving-related ear barotrauma, particularly in field conditions where diagnostic tools are not immediately available.