Ear Barotrauma: Causes, Symptoms, Treatment, Recovery, Prevention

Ear Barotrauma or Ear Pressure Injury is a condition where there is discomfort and potential damage to the ear due to the changes in the pressure between the inside and outside of the eardrum. The Eustachian tube connects the middle of the ear to the nose and throat. Its function is also to help regulate and balance the pressure of the ear. When there is any blockage of the Eustachian tube, then patient can experience what is known as ear barotrauma. Ear barotrauma occurring occasionally is quite common, particularly where there has been a change in the altitude, such as during flying, climbing mountains, scuba diving etc. Patients having frequent colds or allergies with congested noses can also experience ear barotrauma frequently. Ear barotrauma or ear pressure injury is quite a harmless condition; however, if it occurs frequently, then it may cause complications. So, if the ear barotrauma progresses from acute (occasional) to chronic (recurring), then it is important to seek medical help.

• Patient feels uncomfortable pressure within the ear or it can be a feeling general discomfort in the ear.
• Patient can experience dizziness.
• There may be difficulty in hearing or mild hearing loss.
• A feeling of fullness or stuffiness is felt in the ear.

• Pain in the ear.
• Pressure feeling in the ears, which feels as if the patient is underwater.
• There can be moderate to severe difficulty in hearing or hearing loss.
• Nosebleeds can occur.
• There can be an injury to the ear drum.

Symptoms will recede once treatment is sought. The hearing loss occurring from ear barotrauma is almost always reversible and temporary.

Blockage in the Eustachian tube is one of the common causes for ear barotrauma. The air pressure present in the middle ear is commonly the same that of the air pressure which exists outside our body. As mentioned before, the eustachian tube connects the middle ear and upper throat and posterior nose. When a person yawns or swallows, then this action opens the Eustachian tube and causes air to flow into or out of the middle ear, which in turn helps in equalizing the pressure or equilibrium on both the sides of the ear drum. If there is blockage in the Eustachian tube, then the air pressure present in the middle ear becomes different from the air pressure present on the outside of the eardrum. This causes ear pressure injury or barotrauma.

Many individuals have experienced ear barotrauma at some point in their lives. Ear barotrauma commonly occurs if there have been changes in the altitude, such as seen in flying, on the mountains, scuba diving etc. Congested nose from colds, allergies or an upper respiratory infection can also cause ear barotrauma. The Eustachian tube can be blocked before birth, which is known as congenital. Blockage of Eustachian tube can also occur due to throat swelling.

Ear barotrauma occurring during the ascent or descent of the airplane is known as airplane ear. Diving ear barotrauma is caused by diving as a person experiences increased pressure underwater when compared to land. Middle ear barotrauma is more common in divers, as there are drastic changes in the pressure underwater. To avoid diving ear barotrauma, patient should slowly ascend/descend when diving.

Anything which can cause blockage in the eustachian tube increases the risk for having ear barotrauma. Some of the risk factors include colds, allergies and active infections of the ear. Infants and young children are at an increased risk for developing ear barotrauma, as children and infants have a smaller eustachian tube, which is also positioned more horizontally thus increasing the tendency of getting blocked easily.

Young children and infants are more susceptible to ear barotrauma because their eustachian tubes are straighter and smaller when compared to the adults and equalization of air pressure becomes more difficult due to this. If your child or infant is displaying signs of discomfort, pain distress or agitation during a change in altitude, then the chances are that the child is suffering from ear barotrauma. For preventing ear barotrauma in infants during altitude changes, they can be fed or given something to drink during the flight etc.

Medical exam is done to rule out an ear infection. Most of the times, ear barotrauma can be detected by a physical exam. Otoscope is used to look closely inside and can reveal changes in the eardrum occurring as a result of pressure change due to which the eardrum is seen pushed slightly inward or outward from its normal position. The doctor can also squeeze air into the ear (insufflation) to check for buildup of fluid or blood behind the eardrum. If significant findings are not found on physical exam, then patient’s history of when and how the symptoms have started will help in making the correct diagnosis.

No treatment: Majority of the patients with ear barotrauma or ear pressure injury usually do not need treatment, as the condition often heals on its own without any medical intervention. Most of the patients recover completely from ear barotrauma without any permanent hearing disability.

Self-Care Measures: Some self-care methods can be undertaken for immediate relief from the effects of air pressure on the ears such as chewing gum, sucking on candy, yawning, practicing breathing exercises.

Medications: In case of cold or allergies, which have lead to ear barotrauma patient is prescribed decongestants or antihistamines. In case of ear infection or inflammation which has led to ear barotrauma, patient is prescribed an antibiotic or a steroid.

Surgery for Ear Barotrauma/Ear Pressure Injury: Surgery may be needed to prevent permanent damage to the eardrum in chronic or severe cases of ear barotrauma or in patients where symptoms are not responding to the above methods. In case of patients with chronic ear barotrauma, ear tubes (grommets or tympanostomy tubes) can help. Ear tubes are small cylinders which are kept through the eardrum in order to help stimulate the airflow into the middle of the ear. Ear tubes are more commonly used in children to prevent ear infection due to ear barotrauma. Patients suffering from chronic ear barotrauma and who frequently change altitudes, such as traveling, flying or trekking often will have the ear tubes in place for about six to 12 months.

Another surgical option comprises of making a tiny slit into the eardrum, so that there is better equalization of the air pressure. This also helps in removing any fluid, which is present in the middle ear. This slit often heals quickly and is not considered a permanent solution.

Ear barotrauma is commonly a temporary situation. However, if it is recurrent or becomes chronic and left untreated, then patient can experience complications such as:

• Ruptured eardrum.
• Recurring pain in ear.
• Ear infections.
• Hearing loss.
• Vertigo and chronic dizziness.
• Bleeding from nose and ears.

Medical treatment should be immediately sought if the patient is experiencing pain in the ear or decreased hearing. If the symptoms persist or recur, then it means that the patient has severe or chronic ear barotrauma.

The recovery process of the patient depends on the nature or the severity of the ear barotrauma. Majority of the cases of ear barotrauma will spontaneously resolve and need no treatment. Most of the patients who suffer from ear barotrauma make a complete recovery without any permanent hearing disability. During the recovery phase, patients should avoid substantial pressure changes such as experienced during a flight or when diving. If the ear barotrauma occurs as a result of respiratory infection or allergies, then treating the underlying cause resolves the ear barotrauma. The recovery period of mild to moderate cases is about two weeks. Some patients can have a ruptured eardrum due to ear barotrauma, which can take about two months for healing. In severe cases, it can anywhere between six to 12 months for complete recovery after surgery is done.

The risk of having ear barotrauma can be reduced by taking decongestants or antihistamines before flying on a plane or scuba diving. Other measures which can be undertaken to prevent ear barotrauma include:

• Divers should descend slowly when scuba diving.
• If symptoms of ear barotrauma are felt, then yawning, swallowing or chewing can help relieve them.
• When ascending in altitude, one should exhale through the nose to prevent ear barotrauma.
• Earplugs should be avoided when flying or diving.