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Ear barotrauma

Definition

Ear barotrauma is discomfort and possible damage in the ear due to pressure differences between the inside and outside of the eardrum.

Alternative Names

Barotitis media; Barotrauma; Ear popping; Pressure-related ear pain; Eustachian tube dysfunction

Causes, incidence, and risk factors

The air pressure in the middle ear is usually the same as the air pressure outside of the body. The eustachian tube is a connection between the middle ear and the back of the nose and upper throat.

Swallowing or yawning opens the eustachian tube and allows air to flow into or out of the middle ear, keeping the air pressure on both sides of the eardrum equal. If the eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum. This can cause barotrauma.

Many people experience barotrauma at some time. Barotrauma commonly occurs with altitude changes, such as flying, scuba diving, or driving in the mountains. If you have a congested nose from allergies, colds, or an upper respiratory infection, you are more likely to develop barotrauma.

Blockage of the eustachian tube could also be present before birth (congenital), or it may occur because of swelling in the throat.

Symptoms

If the condition is severe or prolonged:

  • Ear pain
  • Feeling of pressure in the ears (as if underwater)
  • Moderate to severe hearing loss
  • Nosebleed

Signs and tests

During an inspection of the ear, the health care provider may see a slight outward bulge or inward pull of the eardrum. If the condition is severe, there may be blood or bruising behind the eardrum.

Severe barotrauma may be difficult to tell apart from an ear infection.

Treatment

To relieve ear pain or discomfort, first try to open the eustachian tube and relieve the pressure.

  • Chew gum
  • Inhale, and then gently exhale while holding the nostrils closed and the mouth shut
  • Suck on candy
  • Yawn

When flying, do not sleep during the descent. Use these measures frequently to open the eustachian tube. Allow infants and children to nurse or sip a drink during descent.

Divers should descend and ascend slowly. Diving while you have allergies or a respiratory infection is dangerous, because barotrauma may be severe.

If self-care attempts do not relieve your discomfort within a few hours, or if the barotrauma is severe, you may need medical intervention.

Medications recommended may include:

  • Antihistamines
  • Decongestants taken by mouth or by a nose spray
  • Steroids

These medications may relieve nasal congestion and allow the eustachian tube to open. Antibiotics may prevent ear infection if barotrauma is severe.

If the tube will not open with other treatments, surgery may be necessary. A surgical cut is made in the eardrum to allow pressure to become equal and fluid to drain (myringotomy). However, surgery is rarely necessary.

If you must make frequent altitude changes or you are susceptible to barotrauma, you may have tubes surgically placed in the eardrum. This is not an option for scuba diving.

Expectations (prognosis)

Barotrauma is usually noncancerous (benign) and responds to self-care. Hearing loss is almost always temporary.

Complications

Calling your health care provider

Try home care measures first. If you cannot relieve the discomfort of barotrauma in a few hours, call for an appointment with your health care provider.

Call your provider if you have barotrauma and new symptoms develop, especially:

Prevention

You can use nasal decongestants or antihistamines before altitude changes. Try to avoid altitude changes while you have an upper respiratory infection or allergy attack.

Talk to your doctor about using decongestants if you plan to scuba dive.

References

O’Reilly RC, Sando I. Anatomy and physiology of the eustachian tube. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 131.

Arts HA. Sensorineural hearing loss in adults. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 149.

Byyny RL, Shockley LW. Scuba diving and dysbarism. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 141.


Review Date: 8/30/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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