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Evidence‑informed decision aid for fitness‑to‑dive assessment after otologic surgery
Juan Riestra-Ayora1,2, Carlos Fernández-Navarro2, Eduardo Martín-Sanz1,2, Manuel F Salvador-Marín3,4
1 Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
2 Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
3 Department of Hyperbaric Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
4 Department of Medicine, Faculty of Health Sciences, Universitat Jaume I, Castellón de la Plana, Spain
Corresponding author: Dr Juan Riestra-Ayora, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Getafe, Getafe, 28905, Madrid, Spain
ORCiD: 0000-0003-0297-2711
Keywords
Diving; Barotrauma; Cochlear implants; Ear diseases; Ear, middle; Otorhinolaryngologic surgical procedures; Stapedectomy
Abstract
(Riestra-Ayora J, Fernández-Navarro C, Martín-Sanz E, Salvador-Marín MF. Evidence‑informed decision aid for fitness‑to‑dive assessment after otologic surgery. Diving and Hyperbaric Medicine. 2026 30 June;56(2):177−184. doi: 10.28920/dhm56.2.177-184. PMID: 42290578.)
Introduction: Fitness-to-dive after otologic surgery is often approached conservatively, with some procedures historically labelled as absolute contraindications despite limited empirical evidence. The available literature is heterogeneous and includes clinical reports, experimental pressure studies, guidance documents, and manufacturer specifications, leading to uncertainty in clinical counseling. We aimed to characterise the available evidence regarding fitness-to-dive after otologic surgery and to develop an evidence-informed clinical decision aid.
Methods: A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed/MEDLINE, Embase, Scopus, and relevant non-indexed sources were searched. Eligible sources included clinical reports and series, experimental or hyperbaric chamber studies, guidance or consensus documents, and manufacturer statements providing explicit pressure- or depth-related information. Data were charted descriptively by procedure type and evidence stream.
Results: The search identified 324 records; after removal of duplicates and screening, 40 sources were included. The evidence base was predominantly non-comparative. Across procedures, recommendations emphasised postoperative stability and reliable pressure equalisation rather than surgical history alone. Canal wall down mastoidectomy was consistently portrayed as incompatible with diving, whereas selected middle ear reconstructions and stapes surgery were commonly described as potentially compatible in appropriately selected individuals. For cochlear implantation, guidance was mainly conditional and based on hyperbaric testing, limited clinical diving reports, and manufacturer-specified pressure or depth limits. Communication emerged as an additional practical consideration in cases of significant hearing loss.
Conclusions: Relevant evidence is limited and heterogeneous, and does not consistently support blanket prohibitions for all otologic procedures. A function-based, individualised approach is supported, while specific higher-risk scenarios warrant restriction. Prospective registries and standardised outcome reporting are needed to refine procedure-specific recommendations.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
