Aero-otitis - Barotrauma

What Is It?

Barotrauma refers to injuries caused by an increase in air or water pressure, such as those that occur during airplane flights or scuba diving. Barotrauma of the ear is common. Generalized barotraumas, also called decompression sickness, affects the entire body.

Your middle ear consists of the eardrum and the space behind it. The only connection between your middle ear and the “outside world” is a thin canal called the Eustachian tube. This connects your ear with the back of your mouth. When you swallow, you may notice a small “click” in your ears — this is a bubble of air being moved through the Eustachian tube. These bubbles are constantly moving into the middle ear, where they balance the ear’s inner pressure. Ear barotrauma can occur when these tubes become blocked or partially blocked.



On an airplane, barotrauma to the ear — also called aero-otitis or barotitis — can happen as the plane descends for landing. Barotrauma of the ear also can happen when scuba divers descend. The pressure change can create a vacuum in the middle ear that pulls the eardrum inward. The distorted shape of the eardrum can cause pain and muffle sounds. Your ear will feel stuffed and you may feel as if you need to “pop” it.

In more severe cases of barotrauma, the middle ear can fill with clear fluid as the body tries to equalize the pressure on both sides of the eardrum. This fluid is drawn out of blood vessels in the lining of the inner ear, and can only drain if the Eustachian tube is open. Fluid behind the eardrum is called serous otitis media. Although it is not infectious, it can create pain and hearing difficulty similar to a middle-ear infection. The eardrum can rupture in severe cases of ear barotrauma, causing bleeding or leaking of fluid from the ear that can result in hearing loss.

Barotrauma is the most common medical problem reported by air travelers. It is much more likely to happen to people who have colds, allergies or infections at the time they are flying. It is common in children because their Eustachian tubes are narrower than those of adults and are therefore more easily blocked.

Barotrauma in the lungs also can occur, but this is not seen in air travelers. It occurs, rarely, in divers who hold their breath, which causes the diaphragm to move abruptly in a “gasping” effort. This form of barotrauma creates a vacuum in the lungs and can result in bleeding into the lung tissue. A more common form of barotrauma in the lungs is caused by the mechanical ventilation systems used in hospital intensive-care units. In this case, air sacks (alveoli) in the lungs may be ruptured or scarred due to high air pressure within the lungs. Ventilator-associated barotrauma is a complex medical concern.


Common symptoms of ear barotrauma include:

  • Ear pain
  • A sensation that the ears are stuffed
  • A need to “pop” your ears by swallowing, yawning or chewing gum

More severe signs include:

  • Extreme pain in the ear
  • Dizziness
  • Bleeding or fluid coming from the ear (this can indicate a ruptured eardrum)
  • Hearing loss

Barotrauma of the lungs associated with scuba diving can result in coughing up blood after diving, though this is rare.


Mild cases of ear barotrauma are easily self-diagnosed and do not require a doctor’s evaluation. If you are uncertain about your symptoms or if your symptoms last a long time, a doctor can examine your inner ear to see if the eardrum is pulled inwards, indicating unbalanced pressure. Clear fluid behind the eardrum can sometimes be difficult to see, but if it is present, your eardrum will not move well in response to a puff of air that your doctor will squeeze into your ear canal. A perforated eardrum is easily diagnosed by viewing the ear through a device called an otoscope.

Expected Duration

Symptoms usually occur only during the change in pressure, and perhaps for a short time afterward. More severe cases, including serous otitis media, can last longer, perhaps weeks or months. Perforations of the eardrum often heal on their own, but this can take weeks and can result in decreased hearing until fully healed. Perforations that persist after two months may require surgery.


To prevent barotrauma, your Eustachian tubes must stay open. If you have a cold, ear infection or allergy, you may want to reschedule airplane travel until you are better. You can test to see if the illness or allergy will cause barotrauma during the flight by riding in an elevator. Take the elevator to the top floor of a tall building. On the way down, try to make your ears “pop” by swallowing, chewing gum or yawning. If your ears will not pop, it may be better to reschedule your flight.

If you or your child must fly with a cold, infection or allergy, take a decongestant about one hour before your flight. Continue taking the medication during the flight according to the package directions. You can also use a decongestant nasal spray. Do not take antihistamines unless they are needed for allergies; antihistamines can thicken mucus and other secretions, which increases the risk of a blocked Eustachian tube.

During a flight, drink plenty of water or juice and avoid caffeine and alcohol. Make sure you are awake for the landing so you can “pop” your ears if necessary. (If you request it, a flight attendant will wake you.) Infants should be kept awake during a flight’s descent and can be given a bottle or pacifier to suck on to help keep their Eustachian tubes open. Keep the child upright as the plane descends.


If you experience the symptoms of barotrauma during a flight, there are several things you can do:

  • Chew gum or suck on hard candy.
  • If you don’t have gum or candy, yawn and swallow frequently.
  • If these methods don’t work, pinch your nose closed, inhale through your mouth, and then try to push the air out through your nose while keeping it pinched shut. Don’t push hard, and stop as soon as your ears pop. If you are too forceful during this exercise you can tear your eardrums, so do it carefully.

Most cases of persistent barotrauma of the ear can be treated with decongestants. In some cases, it may be necessary for an ear, nose and throat doctor to make a small incision in the eardrum to equalize the pressure and drain the fluid. If you have a ruptured eardrum, you need to keep water out of your ear to prevent infection. A perforation of the eardrum that has not healed after two months may require surgical repair.

When To Call A Professional

If you experience severe pain, bleeding or drainage of fluid from your ears, see a doctor; you may have a ruptured eardrum. If you have ear pain or hearing difficulty that persists after flying or diving, it may be helpful to have a doctor evaluate the problem.


Most cases of barotrauma get better quickly and without complications.


Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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