Normally air moves easily between outside and inside of the ear, sinuses, and lungs, helping to maintain a balance of pressure. Imbalances may be created with:
Sudden or severe changes in surrounding pressure
Blockages in the body's air cavities
The imbalance of pressure causes the air inside your body to shrink or swell. This is what can cause pain and damage.
Activities that can expose someone to significant pressure changes include:
Ascending (going up to the surface) without exhaling freely
Swimming quickly to the surface when diving
Holding your breath when ascending
Underwater diving for an increased period of time
Repeated dives within 24 hours
Flying in an airplane after diving
Having air pockets in equipment (such as masks and dry suits)
—use of a machine to move air into and out of the lungs (associated with pulmonary trauma)
Exposure to shock waves from an explosion
The inner ear is connected to outside air through tubes to keep inner and outer pressure balanced. Blockages and congestion in these tubes increase the risk of ear barotrauma because the inside pressure is not allowed to change to match the outside pressure. These tubes may be blocked or limited by:
Your doctor will ask about your symptoms and medical history. A physical exam will be done to look for irritation or tissue damage. Barotrauma may be suspected based on your recent activities, such as air travel or scuba diving.
Ear structures will be visually examined
Suspected pulmonary barotrauma may be evaluated with:
Pulse oximetry—to measure the amount of oxygen in the blood
Pulmonary barotrauma is serious and needs immediate medical attention. Treatment will depend on the specific lung problem that is present.
The following measures can also prevent barotrauma. Treatment options include the following:
Measures to Relieve Pressure
Pressure can be relieved with self-care and medications.
To relieve the pressure in the eustachian tube, you can:
Inhale and gently exhale through your nose while pinching your nostrils shut. This forces air through the blocked eustachian tube and possibly opens it.
It is important to relieve nasal congestion and open your eustachian tube. Medications to relieve ear and sinus pressure include:
Decongestant nasal sprays
Pain relievers can be used if ear or sinus pressure is causing pain. Antibiotics may be used if a bacterial infection is present or possible.
Emergency medical care may include:
Surgery may be necessary to relieve the pressure if your eustachian tube does not open with other treatments. Your doctor will make a small cut in your eardrum to equalize the air pressure. Any fluid blocking the tube may also be removed.
Oxygen should be given immediately for pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube under the nose.
To help reduce your chances of barotrauma during:
If you can, postpone your flight if you have a cold or are congested. Use a decongestant if travel can not be delayed.
To relieve the pressure during take-off and landing, try:
Breathing with your mouth open
Use filtered earplugs to slowly equalize the air pressure against your eardrum.
Avoid sleeping during descent because you may not be swallowing enough.
To help your baby through pressure changes, give your baby a pacifier or bottle during landing and take off.
Get proper training and certification.
Make sure all your equipment is working and vented properly.
Keep diving depth to level of experience.
Follow all breathing guidelines, especially when coming up from a dive.
Don’t stay under the water at greater depths long periods of time.
Avoid flying or going to a higher altitude for the next 24 hours after diving.
Take a decongestant pill or nasal spray a little before diving.
Barotrauma. American Hearing Research Foundation website. Available at: http://american-hearing.org/disorders/barotrauma. Updated October 2012. Accessed December 21, 2017.
Barotrauma. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/injury-during-diving-or-work-in-compressed-air/barotrauma. Updated July 2017. Accessed December 21, 2017.
Brandt MT. Oral and maxillofacial aspects of diving medicine. Military Medicine. 2004;169(2):137-141.
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 December 21, 2017.
Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/ears-and-altitude. Accessed December 21, 2017.
Newton HB. Neurologic complications of scuba diving. Am Fam Physician. 2001;63(11):2211-2218.
Last reviewed November 2018 by
EBSCO Medical Review Board
Marcin Chwistek, MD
Last Updated: 12/20/2014
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