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Barotrauma of the Ear

(Barotitis Media; Aerotitis Media)


Taha A. Jan

, MD, Vanderbilt University Medical Center

Reviewed/Revised Jan 2024
Topic Resources

Barotrauma is an injury caused by rapid changes in environmental pressure, as occur during airplane flights or scuba diving. Barotrauma can cause ear pain or damage the eardrum.

The Ears

The eardrum (tympanic membrane) separates the ear canal and the middle ear. If air pressure in the ear canal from outside air and air pressure in the middle ear change rapidly or are unequal, the eardrum can be damaged. Normally, the eustachian tube, which connects the middle ear and the back of the nose, helps maintain equal pressure on both sides of the eardrum by allowing outside air to enter the middle ear. When environmental pressure changes suddenly—for example, during the ascent or descent of an airplane or a deep-sea dive Ear barotrauma (ear squeeze) Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. The lungs, gastrointestinal tract, part of the face covered... read more —air must move through the eustachian tube to equalize the pressure in the middle ear. (See also Barotrauma Barotrauma Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. The lungs, gastrointestinal tract, part of the face covered... read more .)

Ear Pressure

If the eustachian tube is partly or completely blocked because of scarring, a tumor, an infection, the common cold, or an allergy, air cannot move in and out of the middle ear. The resulting pressure difference causes pain and often hearing loss and may bruise the eardrum or cause it to tear (rupture) and bleed. If the pressure difference is very great, the oval window (the entrance into the inner ear from the middle ear) may also rupture, allowing fluid from the inner ear to leak into the middle ear. This type of rupture is called a perilymph fistula. Hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 15% of people in the United States have some degree of hearing loss that affects their... read more Hearing Loss or vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more occurring during descent in a deep-sea dive, particularly if there is vertigo, suggests that such leakage is taking place.

The Eustachian Tube: Keeping Air Pressure Equal

The eustachian tube helps maintain equal air pressure on both sides of the eardrum by allowing outside air to enter the middle ear. If the eustachian tube is blocked, air cannot reach the middle ear, so the pressure there decreases. When air pressure is lower in the middle ear than in the ear canal, the eardrum bulges inward. The pressure difference can cause pain and can bruise or rupture the eardrum.

The Eustachian Tube: Keeping Air Pressure Equal

Treatment of Barotrauma of the Ear

  • Maneuvers to relieve pressure

When sudden changes in pressure cause a sense of fullness or pain in the ear, often the pressure in the middle ear can be equalized and the discomfort can be relieved by several maneuvers. If outside pressure is decreasing, as in a plane ascending, the person should try breathing with the mouth open, yawning, chewing gum, or swallowing. Any of these measures may open the eustachian tube and allow air to pass out of the middle ear. If outside pressure is increasing, as in a plane descending or a diver going deeper underwater, the person should pinch the nose shut, hold the mouth closed, and try to blow gently out through the nose. This maneuver forces air through the blocked eustachian tube.

Occasionally, if people have hearing loss and severe pain, myringotomy may help. For this procedure, an opening is made through the eardrum to allow fluid to drain from the middle ear (see figure )

If people have a perilymph fistula, surgery may be necessary to close the fistula and stop the leak.

Prevention of Barotrauma of the Ear

People who have an infection or an allergy affecting the nose and throat may experience discomfort when they fly in a plane or dive. Such activities should be avoided until the infection or allergy is controlled. However, if these activities are necessary, a decongestant, such as phenylephrine or oxymetazoline nose drops or nasal spray used 30 to 60 minutes before ascent or descent, relieves congestion and helps open the eustachian tubes, equalizing pressure on the eardrums.

Drugs Mentioned In This Article

Generic Name Select Brand Names
4-Way Nasal, Ah-Chew D, AK-Dilate, Anu-Med, Biorphen, Formulation R , Foster & Thrive Nasal Decongestion, Gilchew IR, Hemorrhoidal , IMMPHENTIV, Little Remedies for Noses, Lusonal, Mydfrin, Nasop, Nasop 12, Neofrin, Neo-Synephr, Neo-Synephrine, Neo-Synephrine Cold + Allergy, Neo-Synephrine Extra Strength, Neo-Synephrine Mild, Neo-Synephrine Non-Drowsy Cold + Allergy, Ocu-Phrin, PediaCare Children's Decongestant, PediaCare Decongestant, PediaCare Infants' Decongestant, Sinex Nasal, Sudafed PE, Sudafed PE Children's Nasal Decongestant , Sudafed PE Congestion, Sudafed PE Sinus Congestion, Sudogest PE, Vazculep
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus
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