Ear Barotrauma: Causes, Diagnosis and Treatments
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Ear Barotrauma

What is ear barotrauma?

Highlights

  1. The majority of those who experience ear barotrauma will make a full recovery, with no permanent hearing loss.
  2. Infants and young children are particularly at risk for this condition.
  3. Diving is a common cause of ear barotrauma.

Ear barotrauma is a condition that causes ear discomfort due to pressure changes.

In each ear there is a tube that connects the middle of your ear to your throat and nose. It also helps regulate ear pressure. This tube is called the eustachian tube. When the tube is blocked, you may experience ear barotrauma.

Occasional ear barotrauma is common, especially in environments where the altitude changes. While the condition isn’t harmful in some people, frequent cases may cause further complications. It’s important to understand the differences between acute (occasional) and chronic (recurring) cases so you know when to seek medical treatment.

Ear barotrauma symptoms

Symptoms

If you have ear barotrauma, you may feel an uncomfortable pressure inside the ear. Common symptoms, which occur earlier or in mild to moderate cases, may include:

  • dizziness
  • general ear discomfort
  • slight hearing loss or difficulty hearing
  • stuffiness or fullness in the ear

If it progresses long enough without treatment or the case is particularly severe, symptoms may intensify. Additional symptoms that may occur in these cases include:

  • ear pain
  • feeling of pressure in the ears, as if you were underwater
  • nosebleed
  • moderate to severe hearing loss or difficulty
  • ear drum injury

Once treated, almost all symptoms will go away. Hearing loss from ear barotrauma is almost always temporary and reversible.

Causes of ear barotrauma

Causes

Eustachian tube blockage is one of the causes of ear barotrauma. The eustachian tube helps to restore equilibrium during changes in pressure. For example, yawning normally opens the eustachian tube. When the tube is blocked, symptoms develop because the pressure in the ear is different than the pressure outside of your eardrum.

Altitude changes are the most common cause of this condition. One of the places many people experience ear barotrauma is during an airplane’s ascent or descent. The condition is sometimes referred to as airplane ear.

Other situations that might cause ear barotrauma include:

  • scuba diving
  • hiking
  • driving through mountains

Diving ear barotrauma

Diving is a common cause of ear barotrauma. When you go diving, you are in much more pressure underwater than on land. The first 14 feet of the dive is often the biggest risk for ear injury for divers. Symptoms typically develop immediately or soon after the dive.

Middle ear barotrauma is particularly common in divers, as the pressure underwater changes drastically.

To prevent ear barotrauma, descend slowly while diving.

Risk factors

Risk Factors

Any issue that may block the eustachian tube puts you at risk for experiencing barotrauma. People who have allergies, colds, or active infections may be more likely to experience ear barotrauma.

Infants and young children are also at risk to this condition. A child’s eustachian tube is smaller and positioned differently than an adult’s and it may get blocked more easily. When babies and toddlers cry on an airplane during takeoff or landing, it’s often because they’re feeling the effects of ear barotrauma.

Diagnosing ear barotrauma

Diagnosis

While ear barotrauma may go away on its own, you should contact a doctor if your symptoms include significant pain or bleeding from the ear. A medical exam may be required to rule out an ear infection.

Many times ear barotrauma can be detected through a physical exam. A close look inside the ear with an otoscope can often reveal changes in the eardrum. Due to pressure change, the eardrum may be pushed slightly outward or inward from where it should normally sit. Your doctor may also squeeze air (insufflation) into the ear to see if there is fluid or blood buildup behind the eardrum. If there are no significant findings on physical exam, often the situations you report that surround your symptoms will give clues toward the correct diagnosis.

Ear barotrauma treatment

Treatment

Most cases of ear barotrauma generally heal without medical intervention. There are some self-care steps you can take for immediate relief. You may help relieve the effects of air pressure on your ears by:

  • yawning
  • chewing gum
  • practicing breathing exercises
  • taking antihistamines or decongestants

In severe cases, your doctor may prescribe an antibiotic or a steroid to help in cases of infection or inflammation.

In some cases, ear barotrauma results in a ruptured eardrum. A ruptured eardrum can take up to two months to heal. Symptoms that don’t respond to self-care may require surgery to prevent permanent damage to the eardrum.

Surgery

In severe or chronic cases of barotrauma, surgery may be the best option for treatment. Chronic cases of ear barotrauma may be aided with the help of ear tubes. These small cylinders are placed through the eardrum to stimulate airflow into the middle of the ear. Ear tubes, also known as tympanostomy tubes or grommets, are most commonly used in children and they can help prevent infections from ear barotrauma. These are also commonly used in those with chronic barotrauma who frequently change altitudes, like those who need to fly or travel often. The ear tube will typically remain in place for six to 12 months.

The second surgical option involves a tiny slit being made into the eardrum to better allow pressure to equalize. This can also remove any fluid that’s present in the middle ear. The slit will heal quickly, and may not be a permanent solution.

Ear barotrauma in infants

infants

Infants and young children are particularly susceptible to ear barotrauma. This is because their eustachian tubes are much smaller and straighter and therefore struggle more with equalization.

If your infant is demonstrating signs of discomfort, distress, agitation, or pain while experiencing a change in altitude, it’s likely they’re experiencing ear barotrauma.

To help prevent ear barotrauma in infants, you can feed them or have them drink during altitude changes. For children with ear discomfort, your doctor may be able to prescribe eardrops to help relieve pain.

Potential complications

Complications Icon

Ear barotrauma is usually temporary. However, complications may arise in some people, especially in chronic cases. If left untreated, this condition may cause:

  • ear infections
  • ruptured eardrum
  • hearing loss
  • recurring pain
  • chronic dizziness and feelings of unbalance (vertigo)
  • bleeding from the ears and nose

You should contact your doctor if you have ear pain or decreased hearing. Persistent and recurring symptoms could be a sign of severe or chronic ear barotrauma. You doctor will treat you and give you tips to help prevent any complications.

Recovery

Recovery

There is a range of severities and specific types of ear barotrauma that affect how someone recovers and what that recovery process looks like. The majority of those who experience ear barotrauma will make a full recovery, with no permanent hearing loss.

While recovering, patients should avoid significant pressure changes (like those experienced while diving or on an airplane). Many cases of barotrauma will resolve spontaneously and without any treatment.

If barotrauma is caused by allergies or respiratory infections, it will often be resolved when the underlying cause has been resolved. Mild to moderate cases take an average of up to two weeks for a full recovery. Severe cases can take six to 12 months for a full recovery after surgery.

When barotrauma leads to an infection or if the pain is intense and symptoms are not resolving or are worsening, you should make an appointment to see your doctor.

Preventing ear barotrauma

Prevention

You can decrease your risk of experiencing barotrauma by taking antihistamines or decongestants before scuba diving or flying on a plane. You should always check with your doctor and be aware of possible side effects before taking new medications.

Other steps you can take to prevent or lessen barotrauma include:

  • descend slowly while diving
  • swallow, yawn, and chew when you feel symptoms of barotrauma, which can relieve symptoms
  • exhale through your nose during an ascent in altitude
  • avoid wearing earplugs while diving or flying

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