O’Neill Grading System

The O’Neill grading system is a way to categorise the severity of middle-ear barotrauma (MEBT). It is simple and is intended to provide consistency in diagnosis with sufficient details to direct treatment.
Grade 0: Eustachian Tube Dysfunction
Grade 0: Eustachian Tube Dysfunction
- Baseline photo depicting anatomical appearance of the tympanic membrane (TM) before exposure to pressure
- Symptoms with no anatomical change (no trauma) from baseline

Grade 1 Barotrauma
- Erythema increased from baseline
- Fluid or air trapping (visible bubble) in the middle-ear space

Grade 2 Barotrauma
- Any bleeding noted within the tympanic membrane or middle-ear space
- Perforation

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