To maintain equal pressure on both sides of the tympanic membrane (TM), gas must move freely between the nasopharynx and middle ear. When an upper respiratory infection, allergy, or other mechanism interferes with eustachian tube functioning during changes in environmental pressure, the pressure in the middle ear either falls below ambient pressure, causing retraction of the TM, or rises above it, causing bulging. With negative middle ear pressure, a transudate of fluid may form in the middle ear. As the pressure differential increases, ecchymosis and subepithelial hematoma may develop in the mucous membrane of the middle ear and the TM. A very large pressure differential may cause bleeding into the middle ear, TM rupture, and the development of a perilymph fistula through the oval or round window.
Symptoms of otic barotrauma are severe pain, conductive hearing loss, and, if there is a perilymph fistula, sensorineural hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss (1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more and/or vertigo Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness... read more . Symptoms usually worsen during rapid increase in external air pressures, such as a rapid ascent (eg, during scuba diving Ear and Sinus Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the ear (causing ear pain, hearing loss, and/or vestibular symptoms) or the sinuses... read more ) or descent (eg, during air travel). Sensorineural hearing loss or vertigo during descent suggests the development of a perilymph fistula; the same symptoms during ascent from a deep-sea dive can additionally suggest an air bubble formation in the inner ear.
Treatment of Otic Barotrauma
Methods to equalize pressure (eg, yawning, swallowing, chewing gum)
Routine self-treatment of pain caused by changing pressure in an aircraft includes chewing gum, attempting to yawn and swallow, blowing against closed nostrils, and using decongestant nasal sprays.
If hearing loss is sensorineural and vertigo is present, a perilymph fistula is suspected and middle ear exploration to close a fistula is considered. If pain is severe and hearing loss is conductive, myringotomy is helpful.
Prevention of Otic Barotrauma
A person with nasal congestion due to an upper respiratory infection or allergies should avoid flying and diving. When these activities are unavoidable, a topical nasal vasoconstrictor (eg, phenylephrine 0.25 to 1.0%) is applied 30 to 60 minutes before descent and ascent.