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Barotrauma

(Ear Barotrauma, Barotitis Media, Ear Popping, Ear Pressure, Airplane Ear; Sinus Barotrauma, Aerosinusitis, Barosinusitis; Pulmonary Barotrauma, Pulmonary Overpressurization Syndrome)

How to Say It: ba-roh-TRAW-mah

Definition

Barotrauma is pain or tissue damage due to a change in pressure. It happens when pressure outside the body is different from pressure inside the body. This leads the air inside the body to shrink or swell.

Pressure changes may affect the:

  • Middle ears (most common)
  • Sinuses
  • Lungs (most serious)

Causes

Barotrauma is caused by:

  • Sudden or severe changes in pressure
  • Blockages in the ears, sinuses, or lungs

Risk Factors

Things that raise the risk of this problem are:

Blockages in the inner ear can raise the risk of barotrauma. They may be caused by:

  • Allergies or colds
  • Middle ear infections
  • Problems in the eustachian tube—a small tube that connects the middle ear to the throat
  • Cleft palate or lip

Things that raise the risk of sinus barotrauma are:

Lung problems or damage may raise the risk for barotrauma in the lungs.

Other things that may raise the risk are:

Symptoms

Symptoms of barotrauma depend on the areas affected.

In the ears, it may cause:

  • Discomfort or pain in one or both ears
  • A clogged or pressured feeling in the ears
  • Lightheadedness
  • Ringing in the ear— tinnitus
  • Temporary hearing loss
  • Rarely, bleeding from the ear

In the sinuses, it may cause:

  • Sinus pressure and/or pain
  • A feeling of fullness in the head
  • Nosebleeds
  • Headaches or tooth pain

In the lungs, it may cause:

  • Breathing problems
  • Chest pain or a feeling of fullness
  • Pain that spreads to the neck and/or shoulders
  • Lightheadedness
  • Confusion, seizure, loss of consciousness, or coma

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will look in the ears for irritation or damage.

If the lungs could be affected, tests may be:

Treatment

Treatment depends on the area affected. Barotrauma in the lungs is serious. It needs care right away.

Treatment options for barotrauma may be:

  • Easing pressure in the ear by:
    • Chewing gum
    • Yawning
    • Gently breathing through the nose while pinching the nostrils
  • Medicines to ease a stuffy nose and sinuses, such as:
    • Decongestant nasal sprays
    • Oral decongestants
    • Oral antihistamines
  • Pain medicines
  • Antibiotics—to treat infections from bacteria
  • Surgery to ease pressure in the ears—if other methods do not work

Lung barotrauma is treated right away with oxygen. It is given through a face mask or a tube under the nose.

Prevention

To reduce the risk of this problem:

  • When flying:
    • Ease pressure—with ear plugs, chewing gum, yawning, or mouth breathing
    • With a cold or sinus problems—cancel the flight or take a decongestant
  • Before diving:
    • Get trained and certified
    • Follow safety guidelines
RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

Divers Alert Network
https://www.diversalertnetwork.org

CANADIAN RESOURCES:

Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org

Health Canada
https://www.canada.ca

REFERENCES:

Barotrauma. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/injury-during-diving-or-work-in-compressed-air/barotrauma. Accessed March 1, 2021.

Diving precautions and prevention of diving injuries. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/injury-during-diving-or-work-in-compressed-air/diving-precautions-and-prevention-of-diving-injuries. Updated July 2017. Accessed March 1, 2021.

Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/ears-and-altitude. Accessed March 1, 2021.

Evaluation and management of middle ear trauma. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/evaluation-and-management-of-middle-ear-trauma. Accessed March 1, 2021.

Rozycki SW, Brown MJ, et al. Inner ear barotrauma in divers: an evidence-based tool for evaluation and treatment. Diving Hyperb Med. 2018;48(3):186-193.

Last reviewed January 2021 by EBSCO Medical Review Board Marcin Chwistek, MD  Last Updated: 3/1/2021