Barotrauma is ear pain or discomfort caused by pressure changes between the outer environment and the middle ear. This condition is common during activities like flying, scuba diving, or driving in the mountains.
- How it happens: Normally, the Eustachian tube equalizes pressure in the middle ear. If this tube is blocked—by a cold, allergies, or congestion—pressure builds up, causing the eardrum to stretch and resulting in pain.
- Symptoms range from a feeling of fullness and muffled hearing to more severe issues like dizziness, tinnitus, or fluid discharge in serious cases.
- Prevention is key and can be done with simple strategies. Before and during pressure changes, you can chew gum, yawn, or perform the Valsalva maneuver (gently blowing with a pinched nose and closed mouth). It is also recommended to avoid flying or diving with a cold or sinus infection.
- When to see a doctor: While most cases resolve on their own, you should seek medical attention if you experience severe, persistent pain; unresolving hearing loss; or fluid/blood coming from the ear. Prompt treatment helps prevent complications like eardrum damage.
Ear pain (otalgia) can be both worrying and uncomfortable, especially when it occurs during activities such as flying or diving. This pain often results from barotrauma, a condition caused by changes in air or water pressure affecting your middle ear. This guide will help you understand what barotrauma is, why it occurs, its symptoms, and how to cope with it safely.
What is Barotrauma?
Barotrauma is an injury or discomfort in the ear caused by a sudden or significant change in pressure between the outer environment and the middle ear. It typically occurs during activities such as:
- Airplane take-offs and landings
- Scuba diving or snorkeling
- Rapid altitude changes (e.g., mountain driving)
The middle ear normally equalises pressure through the Eustachian tube—a small canal that connects the middle ear to the back of your nose and throat. When this tube is blocked or fails to open properly, pressure builds up in the middle ear, stretching the eardrum and causing pain or damage.
Causes of Ear Barotrauma
The main causes of barotrauma involve difficulty equalising pressure in the middle ear, including:
- Blocked Eustachian tubes: Due to allergies, colds, sinus infections, or congestion.
- Rapid pressure changes: Such as during airplane descent or deep diving.
- Upper respiratory infections: Inflamed nasal passages can restrict pressure equaliaation.
- Anatomical variations: Some people naturally have narrower Eustachian tubes.
- Previous ear injuries or surgeries: Can affect middle ear pressure regulation.
Symptoms to Watch For
Barotrauma can cause a range of symptoms, varying in severity. If you experience any of the following during or after pressure changes, you may have barotrauma:
- Lasting ear pain or discomfort (ranging from mild to severe)
- Feeling of fullness or pressure in the ear
- Temporary hearing loss or muffled hearing
- Ringing or buzzing sounds (tinnitus)
- Dizziness or balance problems
- Fluid or blood discharge (in severe cases)
- Ear popping or clicking sensations
If you experience severe pain, dizziness, or bleeding, it’s important to seek medical advice promptly.
Diagnosing Barotrauma
A healthcare professional can diagnose barotrauma through:
- Physical examination: Using an otoscope to look inside the ear for redness, swelling, or eardrum damage.
- Hearing tests: To assess any temporary hearing loss.
- Medical history: Discussing recent activities like flying or diving, and any symptoms experienced.
- Further testing: In severe or persistent cases, further treatment or specialist referral may be necessary.
Coping Strategies and Prevention Tips
Barotrauma is often preventable and manageable with some simple steps, especially if you know you are prone to pressure-related ear pain.
Before Flying or Diving
- Avoid flying or diving if you have a cold, sinus infection, or severe allergies.
- Use a nasal decongestant spray 30 minutes before takeoff or dive (only as advised by a doctor).
- Stay well-hydrated to keep mucous membranes moist.
- Chew gum, yawn, or swallow frequently during pressure changes to help open the Eustachian tubes.
- Perform the Valsalva maneuver: Gently blow with your nose pinched shut while keeping your mouth closed to equalise pressure.
- Use specially designed earplugs that regulate pressure changes.
During Symptoms
- Stop diving immediately if you feel ear pain underwater.
- Avoid inserting cotton buds or objects in your ear.
- Use over-the-counter pain relief if necessary.
- Consult a healthcare professional if symptoms persist beyond a few days.
When to See a Doctor
Seek medical attention promptly if you:
- Have intense, persistent ear pain.
- Notice hearing loss or ringing that doesn’t improve.
- Experience dizziness or vertigo.
- See fluid or blood coming from the ear.
- Have repeated episodes of barotrauma.
Early treatment helps prevent complications such as middle ear infections or permanent damage.
Barotrauma: Frequently Asked Questions (FAQ)
Barotrauma occurs when the air pressure outside your ear changes quickly, but the pressure inside your middle ear does not equalise. This pressure difference creates a vacuum or bulge that pulls on or pushes the eardrum and middle ear tissues, causing pain or, in severe cases, even small tears.
Most mild cases of barotrauma resolve within a few hours to a couple of days once pressure normalises and any congestion clears. However, if symptoms, especially pain or changes in hearing, persist beyond 3 days, you should consult a doctor.
In rare cases, if barotrauma is left untreated or is very severe, it can cause damage to the eardrum (perforation), middle ear bones, or even the inner ear structures. This can lead to longer-term or permanent hearing problems. Prompt treatment greatly reduces this risk.
Yes, children’s Eustachian tubes are smaller, more horizontal, and more prone to blockage (e.g., from colds or allergies). This makes them more susceptible to barotrauma during activities like flying or diving compared to adults.
No. Diving with congestion (from a cold or allergies) significantly increases the risk of barotrauma because your Eustachian tubes may not open properly. This can lead to painful ear injuries underwater, including eardrum rupture or damage to the inner ear. Always ensure your ears are clear before diving.
