Barotrauma

What is barotrauma?

Barotrauma refers to injuries caused by increased air or water pressure, such as during airplane flights or scuba diving. Barotrauma of the ear is common. Generalized barotraumas, also called decompression sickness, affects the entire body. 

Your middle ear includes the eardrum and the space behind it. The only connection between your middle ear and the "outside world" is a thin canal called the Eustachian tube. This connects your ear with the back of your mouth. When you swallow, you may notice a small click in your ears. This is a bubble of air being moved through the Eustachian tube. These bubbles are constantly moving into the middle ear, where they balance the ear's inner pressure. Ear barotrauma can occur when these tubes become blocked or partially blocked. 

On an airplane, barotrauma to the ear – also called aero-otitis or barotitis – can happen as the plane descends for landing. Barotrauma of the ear also can happen when scuba divers descend. The pressure change can create a vacuum in the middle ear that pulls the eardrum inward. This can cause pain and can muffle sounds. Your ear will feel stuffed and you may feel as if you need to "pop" it.  

In more severe cases of barotrauma, the middle ear can fill with clear fluid as the body tries to equalize the pressure on both sides of the eardrum. This fluid is drawn out of blood vessels in the lining of the inner ear, and can only drain if the Eustachian tube is open. Fluid behind the eardrum is called serous otitis media. It can create pain and hearing difficulty similar to a middle ear infection. 

The eardrum can rupture (break) in severe cases of ear barotrauma, causing bleeding or leaking of fluid from the ear. A ruptured eardrum can result in hearing loss. In severe cases, it is possible for the pressure to create a leak between the deepest structures of the ear (the fluid-filled bony canals called the cochlea and semicircular canals) and the inner ear space. This deep leak is known as a fistula. If this occurs, the balance center can be affected, resulting in a sensation of spinning or falling called vertigo. This complication may require emergency surgery.  

Barotrauma is the most common medical problem reported by air travelers. It is much more likely to happen to people who have colds, allergies or infections when they are flying. It is common in children because their Eustachian tubes are narrower than those of adults and become blocked more easily.  

Barotrauma in the lungs also can occur, but this is not seen in air travelers. It occurs, rarely, in divers who hold their breath, when the diaphragm moves abruptly in a "gasping" effort. The diaphragm is the main muscle used in breathing. This form of barotrauma creates a vacuum in the lungs and can result in bleeding into the lung tissue. A more common form of barotrauma in the lungs is caused by the mechanical ventilation systems used in hospital intensive care units to help patients breathe. In this case, air sacks (alveoli) in the lungs may be ruptured or scarred due to high air pressure within the lungs. Ventilator-associated barotrauma is a complex medical concern.  

Symptoms of barotrauma

Common symptoms of ear barotrauma include:  

• Ear pain  
• A sensation that the ears are stuffed  
• A need to "pop" your ears by swallowing, yawning or chewing gum 

More severe signs include:  

• Extreme pain in the ear  
• Dizziness (vertigo)  
• Bleeding or fluid coming from the ear, which can mean you have a ruptured eardrum  
• Hearing loss  

Barotrauma of the lungs associated with scuba diving can result in coughing up blood after diving, although this is rare. 

Diagnosising barotrauma

You can diagnose a mild case of ear barotrauma yourself, and you do not need to see a doctor. If you are uncertain about your symptoms or if your symptoms last a long time, a doctor can examine your middle ear with a lighted magnifying tool called an otoscope to see if the eardrum is pulled inward. Clear fluid behind the eardrum sometimes can be difficult to see. If a collection of fluid is not visible, your doctor may squeeze a puff of air into your ear canal. If the eardrum does not move well, you probably have fluid behind the eardrum. A perforated eardrum can be diagnosed by looking at the ear with an otoscope. 

Expected duration of barotrauma

Symptoms usually occur only during the change in pressure, and perhaps for a short time afterward. More severe cases, including serous otitis media, can last longer, perhaps weeks or months. Perforations of the eardrum often heal on their own, but this can take weeks. You may not be able to hear as well until the ear is fully healed. If your perforation has not healed after two months, you may need surgery to prevent permanent hearing loss. 

Preventioning barotrauma

To prevent barotrauma, your Eustachian tubes must stay open. If you have a cold, ear infection or allergy, you may want to reschedule airplane travel until you are better. If you or your child must fly with a cold, infection or allergy, take a decongestant about one hour before your flight. Continue taking the medication during the flight according to the package directions. You also can use a decongestant nasal spray. Antihistamines may also be helpful. Ear plugs have been developed that can slow down the pressure change that affects the ear. These might give your ears some additional time to adjust to pressure changes. These plugs can be used for air travel but they are not useful for diving.  

During a flight, make sure you are awake for the landing so you can "pop" your ears if necessary. (If you ask, a flight attendant will wake you.) Infants should be kept awake during a flight's descent and can be given a bottle or pacifier to suck on to help keep their Eustachian tubes open. Keep the child upright as the plane descends. 

Treating barotrauma

If you experience the symptoms of barotrauma during a flight, there are several things you can do:  

• Chew gum or suck on hard candy.  
• If you don't have gum or candy, yawn and swallow frequently.  
• If these methods don't work, pinch your nose closed, inhale through your mouth, and then try to push the air out through your nose while keeping it pinched shut. Don't push hard, and stop as soon as one ear pops. If you blow too hard, you can tear your eardrums, so do it carefully.  

Most cases of persistent barotrauma of the ear can be treated with decongestants. In unusually persistent cases, an ear, nose and throat doctor may have to make a small incision in the eardrum to equalize the pressure and drain the fluid. If you have a ruptured eardrum, you need to keep water out of your ear to prevent infection. A perforation of the eardrum that has not healed after two months may need to be repaired surgically.  

When to call a professional

If you experience dizziness that includes a feeling of spinning or falling (vertigo) and your symptoms occur right after flying or diving, you need to be evaluated by a doctor immediately because there is a small chance you may need emergency ear surgery. If you have severe pain, bleeding or drainage of fluid from your ears, see a doctor within several days because you may have a ruptured eardrum. If you have mild ear pain or hearing difficulty that continues after flying or diving, you should see a doctor for help if your symptoms are slow to go away. 

Prognosis

Most cases of barotrauma get better quickly without complications. 

Additional Info

American Academy of Otolaryngology Head and Neck Surgery
https://www.entnet.org/