{"id":3562,"date":"2020-08-08T10:00:42","date_gmt":"2020-08-08T14:00:42","guid":{"rendered":"http:\/\/wordpress.world.dan.org\/?post_type=dan_diseases_conds&p=3562"},"modified":"2026-08-03T17:01:56","modified_gmt":"2026-08-03T21:01:56","slug":"middle-ear-equalization","status":"publish","type":"dan_diseases_conds","link":"https:\/\/world.dan.org\/fr\/health-medicine\/health-resources\/diseases-conditions\/middle-ear-equalization\/","title":{"rendered":"\u00c9galisation des oreilles moyennes"},"content":{"rendered":"

L\u2019\u00e9galisation des oreilles moyennes est une comp\u00e9tence de base, essentielle \u00e0 la plong\u00e9e, qui permet d\u2019\u00e9quilibrer la pression dans les sinus et les cavit\u00e9s de l\u2019oreille moyenne avec la pression ambiante. Pour plonger en toute s\u00e9curit\u00e9 et \u00e9viter les blessures de l\u2019oreille moyenne, il est essentiel de comprendre les effets des variations de pression et d\u2019apprendre \u00e0 faire entrer activement de l\u2019air dans les oreilles moyennes par l\u2019interm\u00e9diaire des trompes d\u2019Eustache.<\/p>\n\n\n\n

M\u00e9canismes d\u2019\u00e9galisation<\/h3>\n\n\n\n

Oreille moyenne<\/h4>\n\n\n\n

La cavit\u00e9 de l\u2019oreille moyenne est entour\u00e9e de structures rigides, \u00e0 l\u2019exception du tympan. Lorsque la pression ambiante augmente, la seule fa\u00e7on pour le volume de l\u2019oreille moyenne de diminuer est que le tympan se d\u00e9forme vers l\u2019int\u00e9rieur de cette cavit\u00e9. Une fois que le tympan a atteint sa limite d\u2019\u00e9lasticit\u00e9, il n\u2019est plus possible de r\u00e9duire davantage le volume de l\u2019oreille moyenne. Si la descente se poursuit, la pression dans l\u2019oreille moyenne demeure inf\u00e9rieure \u00e0 celle du milieu environnant. La seule fa\u00e7on de compenser cette diff\u00e9rence de pression est d\u2019ajouter du gaz dans l\u2019oreille moyenne.<\/p>\n\n\n\n

Dans une oreille normale, la trompe d\u2019Eustache, qui relie l\u2019oreille moyenne \u00e0 la cavit\u00e9 nasale, constitue la seule voie permettant d\u2019y faire entrer du gaz. Les trompes d\u2019Eustache sont normalement ferm\u00e9es. Chaque fois que nous avalons ou b\u00e2illons, les muscles de la gorge provoquent une br\u00e8ve ouverture, suffisante pour ventiler l\u2019oreille moyenne et compenser les variations de pression. Rien ne sollicite davantage les oreilles et les trompes d\u2019Eustache que la plong\u00e9e sous-marine et l\u2019apn\u00e9e. <\/p>\n\n\n\n

Descente<\/h4>\n\n\n\n

\u00c0 mesure que le plongeur descend, la pression ambiante augmente de fa\u00e7on lin\u00e9aire, \u00e0 raison d\u2019environ 0,5 psi par pied de profondeur (0,035 bar ou 0,1 kg\/cm\u00b2 par m\u00e8tre). Cette augmentation de pression s\u2019applique aux tissus et aux liquides du corps.\n\nLa loi de Boyle d\u00e9crit la diminution du volume d\u2019un gaz lorsque la pression augmente, \u00e0 quantit\u00e9 (masse) de gaz et temp\u00e9rature constantes.\n\nUne faible diff\u00e9rence de pression peut entra\u00eener une fuite de liquide ainsi qu\u2019un saignement du tympan et de la muqueuse qui tapisse l\u2019oreille moyenne (barotraumatisme de l\u2019oreille selon la classification d\u2019 O’Neill Grade 1<\/strong><\/a>Lorsque la diff\u00e9rence de pression atteint 5 psi (0,35 bar), le tympan peut se rompre chez certains plongeurs. \u00c0 une diff\u00e9rence de pression sup\u00e9rieure \u00e0 10 psi (0,75 bar), la rupture se produit chez la plupart des plongeurs (barotraumatisme de l\u2019oreille selon la classification d\u2019 O’Neill Grade 2<\/a><\/strong>Des variations de pression soudaines et importantes peuvent \u00e9galement provoquer une l\u00e9sion de l\u2019oreille interne.<\/p>\n\n\n\n

Remont\u00e9e<\/h4>\n\n\n\n

Pendant la remont\u00e9e, la pression ambiante diminue. Si le gaz ne peut pas s\u2019\u00e9chapper de l\u2019oreille moyenne, la pression y demeure plus \u00e9lev\u00e9e que dans le milieu environnant.\n\nLorsque la pression dans l\u2019oreille moyenne d\u00e9passe la pression ambiante de 15 \u00e0 80 cm d\u2019eau (cm H\u2082O), ce qui correspond \u00e0 une remont\u00e9e de 15 cm \u00e0 75 cm (6 pouces \u00e0 2,5 pieds), les trompes d\u2019Eustache s\u2019ouvrent et l\u2019exc\u00e8s de gaz s\u2019\u00e9chappe.\n\nSi les deux oreilles ne s\u2019\u00e9galisent pas au m\u00eame rythme et que la diff\u00e9rence de pression atteint environ 66 cm H\u2082O (l\u2019\u00e9quivalent d\u2019une diff\u00e9rence de profondeur d\u2019environ 60 cm d\u2019eau), un vertige alternobarique<\/strong><\/a> peut survenir.\n\nLes infections des voies respiratoires sup\u00e9rieures, le rhume des foins, les allergies, la consommation de drogues par voie nasale, le tabagisme ou une d\u00e9viation de la cloison nasale peuvent compromettre l\u2019\u00e9galisation. <\/p>\n\n\n\n

Techniques<\/h3>\n\n\n\n

Lorsqu\u2019elles sont correctement ex\u00e9cut\u00e9es, les techniques suivantes permettent d\u2019\u00e9galiser efficacement les oreilles moyennes et les sinus chez les plongeurs en bonne sant\u00e9.<\/p>\n\n\n\n

  • \u00c9galisation passive: <\/strong>ne n\u00e9cessite aucun effort; se produit naturellement pendant la remont\u00e9e.<\/li>
  • Ouverture volontaire des trompes d\u2019Eustache: <\/strong>b\u00e2illez ou faites bouger votre m\u00e2choire.<\/li>
  • Man\u0153uvre de Valsalva: <\/strong>pincez les narines et expirez doucement par le nez.<\/li>
  • Man\u0153uvre de Toynbee: <\/strong>pincez les narines et avalez (particuli\u00e8rement utile pendant la remont\u00e9e).<\/li>
  • Man\u0153uvre de Frenzel:<\/strong> pincez les narines, contractez les muscles de la gorge et produisez le son de la lettre \u00ab K \u00bb. K<\/em><\/li>
  • Technique de Lowry: <\/strong>pincez les narines et essayez doucement d\u2019expirer par le nez tout en avalant (combinaison des man\u0153uvres de Valsalva et de Toynbee).<\/li>
  • Technique d\u2019Edmonds: <\/strong>avancez la m\u00e2choire puis effectuez une man\u0153uvre de Valsalva ou de Frenzel.<\/li><\/ul>\n\n\n\n

    Conseils pour l'\u00e9galisation<\/h3>\n\n\n\n
    • Avant la descente, lorsque vous \u00eates en flottabilit\u00e9 neutre et que votre gilet stabilisateur est vide d\u2019air, utilisez doucement l\u2019une des techniques ci-dessus afin de faire entrer de l\u2019air dans vos oreilles moyennes et vos sinus au d\u00e9but de la descente.<\/li>
    • Descendez \u00e0 la verticale, les pieds en premier, afin que l\u2019air puisse remonter naturellement dans les trompes d\u2019Eustache et l\u2019oreille moyenne. Utilisez un bout de descente ou le mouillage pour contr\u00f4ler votre vitesse.<\/li>
    • \u00c9galisez doucement vos oreilles tous les 1 \u00e0 2 m\u00e8tres environ pendant les 3 \u00e0 5 premiers m\u00e8tres de la descente.<\/li>
    • La douleur n\u2019est jamais normale. Si vous ressentez une douleur, c\u2019est que vous \u00eates descendu sans \u00e9galiser suffisamment. Remontez de quelques m\u00e8tres jusqu\u2019\u00e0 ce que la douleur disparaisse.<\/li>
    • Si vous ne sentez pas vos oreilles s\u2019\u00e9galiser, interrompez votre descente et r\u00e9essayez. Il peut \u00eatre n\u00e9cessaire de remonter l\u00e9g\u00e8rement pour diminuer la pression ambiante. \u00c9vitez de faire des va-et-vient verticaux.<\/li>
    • Il peut \u00eatre utile d\u2019incliner l\u2019oreille bloqu\u00e9e vers la surface.<\/li>
    • Si vous \u00eates incapable d\u2019\u00e9galiser, interrompez la plong\u00e9e. Les cons\u00e9quences d\u2019une descente sans \u00e9galisation peuvent g\u00e2cher tout un s\u00e9jour de plong\u00e9e ou entra\u00eener des dommages permanents, voire une perte auditive.<\/li>
    • Si, \u00e0 tout moment pendant la plong\u00e9e, vous ressentez une douleur, un vertige ou une perte soudaine de l\u2019audition, interrompez imm\u00e9diatement la plong\u00e9e. Si ces sympt\u00f4mes persistent, ne replongez pas et consultez un m\u00e9decin.<\/li><\/ul>\n\n\n\n

      M\u00e9dicaments<\/h3>\n\n\n\n
      • Certains plongeurs utilisent des d\u00e9congestionnants (par voie orale ou sous forme de vaporisateurs nasaux) avant la plong\u00e9e afin de r\u00e9duire le gonflement des trompes d\u2019Eustache et des voies nasales. Discutez avec votre m\u00e9decin avant d\u2019utiliser ces m\u00e9dicaments avant une plong\u00e9e et gardez \u00e0 l\u2019esprit que, si leur effet dispara\u00eet pendant l\u2019immersion, un blocage invers\u00e9 (reverse block) peut survenir.<\/li>
      • Soyez prudent avec les vaporisateurs nasaux vendus sans ordonnance. Une utilisation r\u00e9p\u00e9t\u00e9e peut provoquer un effet rebond, entra\u00eenant une congestion accrue et un risque de blocage invers\u00e9 lors de la remont\u00e9e.<\/li>
      • Les d\u00e9congestionnants peuvent \u00e9galement entra\u00eener des effets secondaires. Ne les utilisez pas avant une plong\u00e9e si vous ne les avez jamais pris auparavant et ne savez pas comment votre organisme y r\u00e9agit.<\/li><\/ul>","protected":false},"excerpt":{"rendered":"

        Middle-ear equalization is an essential skill for divers. Understanding how pressure changes affect the air spaces in your ears and sinuses will aid your understanding of how the various equalization techniques work. <\/p>","protected":false},"featured_media":10002,"template":"","dan_diseases_conditions_tags":[],"class_list":["post-3562","dan_diseases_conds","type-dan_diseases_conds","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\nMiddle-Ear Equalization - DAN World<\/title>\n<meta name=\"description\" content=\"Middle-ear equalization is a basic and necessary diving skill. 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