What is ear barotrauma?

Ear barotrauma is a type of ear damage. It is caused by pressure differences between the inside of the ear and the outside of the ear. It can cause pain and sometimes lifelong (permanent) hearing loss.

The middle ear is an air-filled space between the inner and outer parts of the ear. It contains 3 small bones that help transmit sound. It also contains the opening of the eustachian tube, which connects to an area behind the nose. This tube stays closed most of the time.

For your hearing to work normally, the pressure inside the middle ear has to match the air pressure in your environment. If the external pressure is greater or less than the middle ear pressure, the eustachian tube should open. This equalizes the pressure between the middle ear and the outside.

Sometimes the eustachian tube can’t open normally when there are changes in pressure. When that happens, the difference in pressure can damage the eardrum. The eardrum separates the outer and middle ear. This might cause bleeding or other damage to the outer, middle, or inner ear.

People of all ages can have ear barotrauma. It is common in scuba divers. Air travel is also a common cause of ear barotrauma.

What causes ear barotrauma?

Ear barotrauma results from a pressure imbalance between the inside of the ear and the outer environment. This pressure imbalance only happens in certain circumstances, such as:

• Scuba diving

• Air travel

• Hyperbaric oxygen therapy for wound healing

• Exposure to an explosive blast

But most people in these situations don’t develop ear barotrauma. This condition happens when there is also a problem with the eustachian tube. Anything that causes inflammation or fluid buildup in the area around the tube may cause it to not open normally. These may include factors, such as:

• Allergies

• Sinus congestion

• Having a cold or other infection

• Anatomical abnormalities

• Exposure to irritants, such as tobacco smoke

• Certain hormonal changes (for instance, during pregnancy)

Who is at risk for ear barotrauma?

Any activity that causes large changes in the external pressure carries a risk of ear barotrauma. For instance, military staff are more at risk from ear barotrauma due to explosions. You will have an increased risk if you have any of the above factors that can cause problems with the eustachian tube. Not using the correct scuba diving method can also raise your risk for ear barotrauma.

What are the symptoms of ear barotrauma?

The most common symptoms of ear barotrauma may include:

• Feeling of pressure in the ear

• Ear pain

• Dizziness

• Feeling like you have a blocked ear

• Bleeding from the ears or into the middle ear

• Ringing in your ears

• Hearing loss

You might have only mild symptoms, or your symptoms might be more severe. A feeling of pressure in the ear is often a first symptom. Ear pain and hearing loss may occur over time if the pressure difference badly damaged your ear.

Some situations that cause ear barotrauma may also damage the lungs and sinuses. These might cause additional symptoms, such as pain of the face or shortness of breath.

The symptoms of ear barotrauma may seem like other health conditions or problems. Always see your healthcare provider for more information.

How is ear barotrauma diagnosed?

Your healthcare provider can diagnose ear barotrauma with a health history and physical exam. This may include an exam of the ear, as well as hearing and balance tests. Your provider can only make this diagnosis if you recently had changes in external pressure, such as from a recent scuba dive or an airplane flight. Your primary healthcare provider might first diagnose you and then refer you to an ear, nose, and throat healthcare provider (ENT or otolaryngologist) for treatment.

How is ear barotrauma treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

You may not need any treatment if you get ear barotrauma. Most injuries heal on their own with time, and most people’s symptoms will go away. But your eardrum might not heal normally if a blast caused the injury.

You might need medicines for your ear barotrauma. These might include:

• Nasal steroids and decongestants to reduce congestion around the eustachian tube opening

• Antibiotics if an infection develops

• Pain medicine

You might need surgery if your ear barotrauma is severe. Your healthcare provider might reconstruct the eardrum or the opening into the inner ear. Sometimes a tiny cut (incision) is made in the eardrum. In rare cases, placing a ventilation tube in the eardrum may be advised

Your healthcare provider may also advise complete bed rest and keeping your head raised for some time.

What are possible complications of ear barotrauma?

Often the symptoms following ear barotrauma go away with time. But it sometimes causes symptoms that don’t go away, such as:

• Dizziness

• Ringing in the ears

• Hearing loss (which may need a hearing aid)

Following your healthcare provider’s advice about possible surgery or bed rest may help reduce your risk of these complications.

What can I do to prevent ear barotrauma?

You can do things to help prevent ear barotrauma. If you are congested from a cold or allergies, you may want to delay flying or scuba diving. Or you can take medicine, such as a decongestant or antihistamine. These may help your ears equalize more easily and prevent ear barotrauma.

You can use certain methods to open the eustachian tube during pressure changes, such as:

• Swallowing often

• Pinching your nose, closing your mouth, and then acting as if you were going to breathe out through your nose

• Chewing gum or candy

• Using special ear plugs when flying

Ventilation tubes are another choice for some people whose eustachian tubes don’t work well or for those who need to fly often. They may also benefit you if you need hyperbaric oxygen therapy for wound healing. A surgeon places these tubes in the eardrum, and they prevent future pressure differences. (Ventilation tubes can't prevent ear barotrauma caused by diving.)

Living with ear barotrauma

If you are a diver, don’t dive again until your injury has fully healed. Diving again too soon can cause reinjury. Your healthcare provider will tell you when it's safe for you to dive again. You should also not fly until your provider says it's OK.

Key points about ear barotrauma

• Ear barotrauma is a type of ear damage caused by pressure differences between the middle ear and the outer ear.

• Scuba diving and air travel are common causes of ear barotrauma.

• This condition occurs when there is also a problem with your eustachian tubes.

• Symptoms can include ear pain, ear pressure, ringing in the ears, dizziness, ear bleeding, and hearing loss.

• Symptoms are often short-term (temporary). But some don't go away.

• Treatment may include medicines or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.