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Barotrauma of the Ear

Barotrauma of the Ear

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Updated July 12, 2009

Barotrauma of the Ear

Anatomy of the Ear

Photo © A.D.A.M.

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.

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, diving, or any other activity which involves significant altitude changes.

Barotrauma occurs when there is a dysfunction of the Eustachian tube and/or the tympanic membrane and air between the middle and outer ear are not equalized. The most common cause of this is flying, and is therefore also sometimes referred to as airplane ear. One common example of a condition that might result in a Eustacian tube dysfunction is congestion due to an upper respiratory infection.

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

Symptoms

  • pressure in the ear
  • pain
  • bruising and/or bleeding of the tympanic membrane
  • fluid in the middle ear
  • rupture of the tympanic membrane
  • hearing loss
  • vertigo
  • tinnitus

Diagnosis

Diagnosis of barotraumata involves an accurate patient history along with a physical examination of the ear.

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 occuring. 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 barotraumata. 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.

Source:

Vernick, D.M. Ear Barotrauma.www.uptodate.com, October 2007. (subscription required).

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