Ear Barotrauma

What is ear barotrauma?

Ear barotrauma is a type of ear damage. It is caused by pressure differences between the inside of the ear and the outside of the ear. It can cause pain and sometimes permanent hearing loss.

The middle ear is an air-filled cavity between the inner and outer parts of the ear. It contains 3 small bones that help transmit sound. It also contains the opening of the eustachian tube, which connects to an area behind the nose. This tube stays closed most of the time.

For your hearing to work normally, the pressure inside the middle ear has to match the air pressure in your environment. If the external pressure is greater or less than the middle ear pressure, the eustachian tube should open. This equalizes the pressure between the middle ear and the outside.

Sometimes, the eustachian tube can’t open normally when there are changes in pressure. When that happens, the difference in pressure can damage the eardrum. The eardrum separates the outer and middle ear. This might cause bleeding or other damage to the outer, middle, or inner ear.

People of all ages can experience ear barotrauma. It is common in divers. Air travel is also a common cause of ear barotrauma.

What causes ear barotrauma?

Ear barotrauma results from a pressure imbalance between the inside of the ear and the outer environment. This only happens under specific circumstances, like:

• Scuba diving
• Air travel
• Hyperbaric oxygen therapy for wound healing
• Exposure to an explosive blast

Most people in these situations don’t develop ear barotrauma. It happens when there is also a problem with the eustachian tube. Anything that causes inflammation or fluid buildup in the area around the tube may cause it to not open normally. These may include factors such as:

• Allergies
• Sinus congestion
• Having a cold or other infection
• Anatomical abnormalities
• Exposure to irritants like tobacco smoke
• Certain hormonal changes (for example, during pregnancy)

What are the risks for ear barotrauma?

Any activity that causes large changes in the external pressure carries a risk of ear barotrauma. For example, military staff are more at risk from ear barotrauma due to explosions. You will have an increased risk if you have any of the above factors that can cause problems with the eustachian tube. Not using proper scuba diving technique can raise your risk for ear barotrauma.

What are the symptoms of ear barotrauma?

The most common symptoms of ear barotrauma may include:

• Sensation of pressure in the ear
• Ear pain
• Dizziness
• Feeling like you have a blocked ear
• Bleeding from the ears or into the middle ear
• Ringing in your ears
• Hearing loss

You might have only mild symptoms, or your symptoms might be more severe. Sensation of pressure in the ear is often a first symptom. Ear pain and hearing loss may eventually follow if the pressure difference badly damaged your ear.

Some situations that cause ear barotrauma may also damage the lungs and sinuses. These might cause additional symptoms, like pain of the face or shortness of breath.

The symptoms of ear barotrauma may look like other medical conditions or problems. Always see your healthcare provider for more information.

How is ear barotrauma diagnosed?

Your healthcare provider can diagnose ear barotrauma with a medical history and physical exam. This may include an exam of the ear, as well as hearing and balance tests. Your doctor can only make this diagnosis if you recently experienced changes in external pressure, like from a recent scuba dive or an airplane flight. Your primary healthcare provider might first diagnose you and then refer you to an ear, nose, and throat doctor (otolaryngologist) for treatment.

How is ear barotrauma treated?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle specific medications, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Ideally, you should take steps to prevent ear barotrauma from happening at all.

You may not need any treatment if you get ear barotrauma. Most injuries heal on their own with time, and most people’s symptoms will go away. However, your eardrum might not heal normally if a blast caused the injury.

You might need medications for your ear barotrauma. These might include:

• Nasal steroids and decongestants, to reduce congestion around the eustachian tube opening
• Antibiotics, if an infection develops
• Pain medicine

You might need surgery if your ear barotrauma is severe. Your healthcare provider might reconstruct the eardrum or the opening into the inner ear. Sometimes, a tiny incision is made in the eardrum. Rarely, placing a ventilation tube in the eardrum may be recommended

Your healthcare provider may also recommend complete bed rest with elevation of the head for some time.

What are the complications of ear barotrauma?

Often, the symptoms following ear barotrauma go away with time. Ear barotrauma sometimes causes some symptoms that don’t resolve, like:

• Dizziness
• Ringing in the ears
• Hearing loss (which might require use of a hearing aid)

Following your healthcare provider’s recommendation about possible surgery or bed rest may help reduce your risk of these complications.

What can I do to prevent ear barotrauma?

You can take steps to help prevent ear barotrauma. If you are congested from a cold or allergies, you may want to postpone flying or scuba diving. Or, you can take medicine such as a decongestant or antihistamine. These may help your ears equalize more easily and prevent ear barotrauma.

You can use certain methods to open the eustachian tube and during pressure changes, such as:

• Swallowing frequently
• Pinching your nose, closing your mouth, and then acting as if you were going to breathe out through your nose
• Chewing gum or candy
• Using special ear plugs when flying

Ventilation tubes are another option for some people whose eustachian tubes don’t work well or for those who need to fly frequently. It may also benefit you if you need hyperbaric oxygen therapy for wound healing. A surgeon places these tubes in the eardrum, and they prevent future pressure differences. (Ventilation tubes cannot prevent ear barotrauma caused by diving.)

Living with ear barotrauma

If you are a diver, don’t dive again until your injury has fully healed. Diving again too soon can cause reinjury. Your healthcare provider will tell you when it is safe for you to dive again. You should also avoid flying until your healthcare provider says it is OK.

Key points

Ear barotrauma is a type of ear damage caused by pressure differences between the middle ear and the outer atmosphere.

• Scuba diving and air travel are common causes of ear barotrauma.
• Having a problem with your eustachian tubes may increase your risk of ear barotrauma.
• Ear barotrauma can cause ear pain, ringing in the ears, hearing loss, and other symptoms.
• Usually, but not always, these symptoms are temporary.
• You might need medications or surgery to treat your ear barotrauma.
• Many cases of ear barotrauma are preventable.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.