Ear Barotrauma

What Is Ear Barotrauma?

Ear barotrauma, also known as airplane ear, is that clogged-up, sometimes painful feeling you get in your ears when the air pressure changes quickly.

It's the biggest health problem for people who fly. And it can be especially painful for babies and young kids because their ears aren't fully developed.

Ear barotrauma also can happen when you ride in an elevator or drive in the mountains. It can happen in the water, too. Scuba divers call it "ear squeeze." As a diver goes deeper underwater, the pressure in the middle ear (the part behind the eardrum) is "squeezed" by the increasing pressure of the water from outside.

The middle ear is an air-filled space formed by bone and the eardrum. It is connected to the back of the nose by a tunnel called the eustachian tube. Outside air passing through the eustachian tube keeps the pressure in the middle ear equal to that of the outside world. If the eustachian tube malfunctions and there’s a pressure difference across the eardrum, pain or ear squeeze happens.

Ear Barotrauma Symptoms

Common symptoms include:

• Stuffed feeling in your ears
• Muffled hearing because your eardrum can't vibrate and make sound the way it should
• Ear pain

If you hear a "pop" in your ears, that's a sign your eustachian tubes are open. If they stay blocked, your middle ear can fill with clear liquid to try to balance the pressure. If your eustachian tubes are closed, it can't drain. In this case, more serious symptoms can happen:

• Extreme ear pain
• Dizziness called vertigo
• A busted eardrum -- fluid or blood leaking from your ear is a sign
• Hearing loss

With a mild case, your symptoms should go away shortly after you get back on land. If they don't or if your symptoms are serious, see your doctor.

Ear Barotrauma Causes and Risk Factors

Your ears are especially sensitive to changes in air and water pressure. Still, most people don’t get ear barotrauma. You may be at risk if you have a problem with your eustachian tube where it doesn’t open normally. Reasons that may cause this include:

• Stuffy sinuses
• A cold or other infection
• Allergies
• The shape and size of your ear canal
• Tobacco smoke or other irritants
• Hormonal changes, such as pregnancy

You’re at a higher risk of ear barotrauma if you’re around loud explosions in the military or scuba dive without proper gear.

Ear Barotrauma Diagnosis

If you feel pain, the doctor will ask you a series of questions. These questions not only help diagnose the ear squeeze, they may detect other potential injuries.

• Did you have problems clearing the ear?
• Did the symptoms begin during descent or ascent?
• How long did the symptoms last?
• Is there a history of ear or sinus infections?

Regardless of why you feel the pain, your doctor will look inside your ears with a tool called an otoscope. They'll check to see if there's fluid behind your eardrum or if it's damaged. If it is, it may take weeks to heal and you might not hear very well. Usually, the only treatment is time.

If it isn't better in 2 months, you may need an operation to prevent lasting hearing loss.

Go to a doctor right away if you feel like you're spinning or falling (vertigo) and your symptoms happen right after flying or diving.

Ear Barotrauma Treatment

Mild symptoms of ear barotrauma usually last a few minutes. If they last longer, you may need treatment for an infection or another problem. Serious damage, such as a burst eardrum, may take a few months to heal. Sometimes you may need surgery to repair the eardrum or the opening into your middle ear.

For a mild case, you can usually treat your symptoms yourself.

• Try to "pop" your ears.
• Chew gum or hard candy.
• Drink water during flights. Swallowing helps keep the eustachian tubes open.

If yours happens when scuba diving, the treatment begins during the dive. If you have fullness or pain, do not go deeper. If ear clearing techniques don’t work, you must return to the surface. Always complete the decompression stops if necessary when returning to the surface.

If the eardrum ruptures, you might be disoriented or vomit, which may lead to panic. Panic may lead to ascending too rapidly. Your dive partner should carefully observe and assist, if needed, during the ascent, making sure all decompression stops are made. On the surface, no objects or eardrops should be placed into the ear. Keep the ear dry.

• Initial treatment involves oral decongestants and nasal spray to help open the eustachian tube. Antihistamines may also be prescribed if an allergy is a contributing factor.
• Pain medications are helpful, and eardrops to relieve pain may be used if the eardrum is not ruptured.
• A ruptured eardrum will need antibiotics by mouth to prevent infections.
• Hearing exams or audiograms may be needed if the eardrum is ruptured or hearing loss is present.
• If you have facial paralysis, your doctor might prescribe oral steroids.

Ear Barotrauma Prevention

You can prevent ear barotrauma by keeping your eustachian tubes open. Ways to do that include:

• Medicine. If you have a cold or allergies, take a decongestant about an hour before you fly. A nasal spray or an antihistamine could help, too.
• Earplugs. Special plugs designed for air travel can slow pressure changes and give your ears time to adjust.

If you're a diver, try these things to protect your ears:

• Equalize your ears before your dive and while going down into the water.
• Go down feet first -- it can make equalizing easier.
• Look up -- extending your neck can open your tubes.
• Get back to the surface slowly if you feel pain -- continuing your dive can injure your ears.
• Don’t dive if you have any sinus or upper respiratory symptoms.

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