Ear barotrauma

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

Definition
A condition of discomfort in the ear caused by pressure differences between the inside and the outside of the eardrum.

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, equalizing the air pressure on both sides of the eardrum. If the eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum, causing barotrauma.

Many people experience barotrauma at some time. Barotrauma commonly occurs with altitude changes, such as with flying, scuba diving, or driving in the mountains. If you have a congested nose from allergies, colds, or upper respiratory infection, barotrauma is more likely. Blockage of the eustachian tube could also be congenital or may occur because of swelling in the throat.

Symptoms

     
  • ear discomfort or pain in one or both ears  
  • hearing loss, slight  
  • sensation of fullness or stuffiness in the ears  
  • dizziness

If severe or prolonged:

     
  • hearing loss, moderate to severe  
  • feeling of pressure in the ears (as if underwater)  
  • nosebleed  
  • ear pain

Signs and tests
During an inspection of the ear, the doctor may see a slight outward bulge or inward retraction of the eardrum. If the condition is severe, there may be blood behind the eardrum. Severe barotrauma may be difficult to distinguish from ear infection.

Treatment

To relieve ear pain or discomfort, first attempt to open the eustachian tube and relieve the pressure. Suck on candy, chew gum, or yawn. Or inhale, then gently exhale while holding the nostrils closed and the mouth shut.

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

Divers should descend and ascend slowly. Diving is dangerous during respiratory infections or allergies because barotrauma may be severe.

If self-care attempts are unsuccessful at relieving discomfort within a few hours, or if barotrauma is severe, medical intervention may be necessary.

Medications recommended may include decongestant nasal sprays, oral decongestants, or oral antihistamines. 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. An incision is made in the eardrum to allow pressure to equalize and fluid to drain (myringotomy). However, surgery is rarely necessary. Occasionally, tubes will be surgically placed in the eardrum if frequent altitude changes are unavoidable or if susceptible to barotrauma.

Expectations (prognosis)

Barotrauma is usually benign and responsive to self-care. Hearing loss is almost always temporary.

Complications

     
  • ruptured or perforated eardrum  
  • acute ear infection  
  • loss of hearing in the ear(s)

Calling your health care provider
Home care measures should be attempted first. If the discomfort of barotrauma is not relieved within a few hours, call for an appointment with the health care provider.

Call the health care provider if new symptoms develop in a person with barotrauma, especially fever, severe ear pain, or drainage from the ear.

Prevention
Nasal decongestants or antihistamines may be used before altitude changes. Try to avoid altitude changes during upper respiratory infections or attacks of allergies.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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