Definition

Barotrauma is discomfort in the ear resulting from rapid changes in surrounding pressure, such as air pressure or water pressure. This condition can cause ear pain, a sensation of blockage similar to having cotton in the ears, and hearing difficulties. Barotrauma often occurs during certain activities, such as flying on an airplane and underwater diving.

Barotrauma can be particularly painful in infants and young children due to their underdeveloped ears. The condition can manifest suddenly or persist over time. While it is usually not serious, prolonged barotrauma can lead to complications.

Causes

The middle ear is an air-filled cavity containing small bones and the eardrum, connected to the back of the nose by the eustachian tube. The air passing through the eustachian tube helps equalize the pressure in the middle ear with the ambient pressure. Issues such as blockage or inflammation in the eustachian tube can lead to pressure differences, trapping air in the middle ear, and causing pain or a sensation of fullness.

Barotrauma often occurs during activities such as:

• Airplane takeoff and landing. Rapid altitude changes during ascent or descent of an airplane can cause pressure imbalances between the middle ear and the external environment
• Mountain climbing or rapid descent. Changes in altitude while climbing or descending mountains, or driving in high-altitude areas, can also cause pressure imbalances between the middle ear and the external environment
• Scuba diving. Increased underwater pressure at greater depths could affect the middle ear, necessitating a slow descent to prevent rapid pressure changes that could affect the ears
• Using elevators or lifts
• Middle ear diseases or blockages

Risk factor

Ears are sensitive to pressure fluctuations, but barotrauma is generally rare. The risk of barotrauma will increase if you have certain conditions affecting the normal function of the eustachian tubes, such as:

• Nasal congestion
• Respiratory tract infections
• Allergies
• Abnormalities or variations in the shape or size of the ear canal
• Smoking habits or exposure to irritants
• Hormonal changes (e.g., during pregnancy)
• Exposure to loud explosions (e.g., in military settings or war)
• Diving without proper equipment

Symptoms

Symptoms of barotrauma vary depending on the severity and duration of the condition. Initially, one might experience ear discomfort or a sensation of fullness in the ear, which could worsen over time.

When barotrauma is caused by changes in air pressure, such as during airplane travel, diving, or mountain driving, symptoms typically resolve on their own once the ambient pressure normalizes.

Mild symptoms may include:

• Hearing difficulty or mild hearing loss
• Muffled sounds due to the eardrum's inability to vibrate and transmit sound properly
• Lightheadedness or dizziness
• Sensation of fullness or discomfort in the ears

Moderate to severe symptoms occur often due to underlying diseases or blockages in the middle ear, may include:

• Eardrum damage
• Fluid or blood discharge from the ear
• Severe ear pain
• Persistent sensation of fullness or pressure in the ear, akin to being underwater
• Moderate to severe hearing loss

Diagnosis

To diagnose barotrauma, a doctor will inquire about your recent activities and symptoms, particularly those related to pressure fluctuations. The examination includes checking the ears, including the ear canal and eardrum, for signs of infections or barotrauma. Additionally, the doctor may examine the nose and throat to identify any underlying conditions causing the symptoms.

During the ear examination, the doctor will look for signs of blockage, swelling, redness, or bleeding. Signs of barotrauma that can be examined include the eardrum bulging, or it may be pushed outward slightly.

Management

For mild symptoms, therapy is typically unnecessary as they usually resolve on its own. However, several techniques can assist in opening the eustachian tubes, allowing air to flow into or out of the middle ear to balance pressure. These techniques include:

Chewing gum, sucking on candy, swallowing, yawning, and blowing your nose. These actions help open the eustachian tubes. The "pop" sound in the ear signifies that the eustachian tube has opened.

Taking decongestant drugs (cold medicine), antihistamines, or both. These medications are particularly useful for individuals with nasal congestion and/or allergies, as they help open the eustachian tubes.

Descending slowly while diving. Stop descending when the ear feels uncomfortable to allow time for the pressure in the ear and ambient pressure to equalize.

Avoiding ear drops and keeping the ears clean. This prevents infection during the healing period. If an infection occurs, a doctor may prescribe antibiotics.

Therapy aims to address the underlying conditions for severe symptoms. Surgery is an option, albeit rare, and involves placing a small device in the ear to help reduce pressure and improve symptoms. This device is often used in children with hearing loss due to recurrent infections or fluid buildup in the middle ear. The healing time varies based on the severity of the symptoms.

Complications

In some cases, barotrauma can cause a ruptured eardrum, which may take several months to heal. While a ruptured eardrum can often heal on its own, surgical intervention might be required if it does not heal properly.

Prevention

To alleviate discomfort, you can employ the following techniques:

• Descend slowly while diving in the mountains or high-altitude areas
• Exhale through the nose when ascending from an underwater dive
• Chew, yawn, suck or swallow a candy
• Stay awake during airplane takeoff and landing

When to see a doctor?

Barotrauma usually resolves on its own upon returning to an area with average altitude, often eliminating symptoms before a person seeks medical attention. However, you should consult a doctor if the symptoms become severe, such as persistent severe pain or discharge of fluid or blood from the ear. Additionally, frequent or prolonged symptoms warrant a medical consultation.