Barotrauma of the Ear Overview

Woman with ear pain.
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Barotrauma of the ear occurs when the pressure inside of the ear does not match the pressure outside of the ear. Mismatched pressures can cause discomfort, loss of hearing, or injury (a ruptured eardrum). This usually occurs when there are rapid changes in the air pressure of our environment and the ear can't adjust. For example, when you take off in an airplane or come up too quickly while scuba diving.

The structures of the ear are divided into three groups called the external ear, the middle, and inner ear. The external and middle ear are separated by a thin piece of tissue called the tympanic membrane. Also called the eardrum, the tympanic membrane receives sound and carries the vibration to the tiny bones inside the ear. Along with the Eustachian tube, the tympanic membrane plays a role in regulating the pressure inside of the ear.

The Eustachian tube, also called the auditory tube, is normally collapsed but opens when we swallow or yawn allowing outside air to enter the middle ear. This is an automatic response and frequently occurs while we experience rapid changes in ambient pressure traveling up or down steep hills or scuba diving, taking off or landing in an airplane, or participating in any other activity which involves significant altitude changes.

Barotrauma occurs when there is a dysfunction of the Eustachian tube (also called auditory tube dysfunction) and/or the tympanic membrane. When these important structures are unable to perform their function of regulating the pressure inside of the ear pain, bulging or rupture of the eardrum may occur. The most common cause of this is flying, and therefore ear barotrauma is also sometimes referred to as airplane ear.

One common example of a condition that might result in a Eustachian tube dysfunction is congestion due to an upper respiratory infection. Untreated chronic allergies are another common cause of auditory tube dysfunction. In these cases, congestion and inflammation prevent the auditory tube from opening and closing properly.

These underlying conditions causing auditory tube dysfunction can also lead to sinus barotrauma which is related but not exactly the same as barotrauma of the ear. The biggest symptom of sinus barotrauma is a severe headache or pain behind the eyes.

Less commonly barotrauma can occur in patients undergoing hyperbaric oxygen therapy.

Symptoms of Barotrauma of the Ear

  • pressure in the ear
  • ear pain which may get progressively worse than quickly subside when the eardrum ruptures
  • bruising and/or bleeding of the tympanic membrane
  • fluid in the middle ear
  • rupture of the tympanic membrane
  • hearing loss
  • vertigo
  • tinnitus (ear ringing)

Diagnosing Barotrauma of the Ear

Diagnosis of barotrauma involves an accurate patient history along with a physical examination of the ear. Commonly scuba diving or traveling by airplane are causes of ear barotrauma, particularly if the symptoms include dizziness or ear pain. If your doctor suspects barotrauma, they will perform an ear exam. Commonly it will look similar to an ear infection, however, there may be blood that is present in the ear canal.

Treatment

Damage to the tympanic membrane and other structures of the ear require time to heal. Several medications are sometimes used to speed the process (such as antibiotics or steroids) but there is little evidence that these medications are effective. Medications such as analgesics or decongestants can be given to treat pain and discomfort. In rare cases, surgery may be required to repair damaged structures of the ear.

Prevention

Planning for pressure changes is the best way to prevent barotrauma from occurring. When flying, it is helpful for adults to eat, chew gum or suck on candy. This ensures that frequent swallowing occurs. Infants and toddlers should suck on a pacifier, bottle or sippy cup. Special ear plugs have been designed to help prevent barotrauma while flying. They are available over the counter and in many airports. Unfortunately, these ear plugs cannot be used while diving.

Prevention is the best treatment for barotrauma. While incidences of barotrauma usually heal on their own, it is important to see a physician as severe cases can lead to permanent hearing loss. Vertigo and hearing loss are symptoms that should be evaluated by a physician immediately.

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