Barotrauma

Overview

Barotrauma is physical injury to body tissue caused by a difference in pressure between a gas-filled space inside the body and the pressure of the surrounding water or air. The body contains several air-filled spaces, including the middle ear, the sinuses, the lungs, and the digestive tract. Normally these spaces equalize pressure through small passages, but when the outside pressure changes faster than the body can adjust, the imbalance stretches, compresses, or tears the surrounding tissue.

The most familiar form is ear barotrauma, the uncomfortable blocked or popping sensation many people notice when an airplane descends or when driving down a mountain. Most cases are mild and resolve on their own. However, barotrauma can also be serious, particularly during scuba diving, where rapid pressure changes can injure the lungs or push gas into the bloodstream. Understanding how to equalize pressure helps prevent most problems.

Symptoms

Symptoms depend on which air-filled space is affected and how severe the pressure difference is. Ear and sinus barotrauma are by far the most common.

• Ear barotrauma: A feeling of fullness or blockage, muffled hearing, popping, ear pain, ringing in the ear, and sometimes dizziness.
• Sinus barotrauma: Pain or pressure over the cheeks, forehead, or around the eyes, sometimes with a nosebleed.
• Lung (pulmonary) barotrauma: Chest pain, shortness of breath, coughing, and sometimes coughing up blood. This usually relates to diving.
• Severe cases: Severe vertigo, hearing loss, confusion, weakness, or fainting may indicate a ruptured eardrum, inner-ear injury, or gas bubbles entering the bloodstream.

Symptoms that involve the chest, severe breathlessness, neurological changes, or fainting after a dive are medical emergencies.

Causes

Barotrauma occurs whenever the pressure inside an air-filled body space cannot keep up with a change in outside pressure. Common triggers include:

• Air travel: Rapid changes in cabin pressure during takeoff and especially descent.
• Scuba diving: Pressure rises quickly as a diver descends and falls again on ascent; this is the setting for the most serious injuries.
• Driving in mountains or riding fast elevators in tall buildings.
• Blast injuries from explosions.
• Mechanical ventilation and certain medical procedures involving positive pressure.

The eustachian tube, a narrow channel connecting the middle ear to the back of the nose, normally equalizes ear pressure. Anything that blocks this tube, such as a cold, allergies, or sinus congestion, makes barotrauma much more likely because the ear cannot vent the pressure.

Risk Factors

• Flying or diving with a cold, sinus infection, or allergic congestion
• A blocked or poorly functioning eustachian tube
• Rapid descents while flying or diving
• Sleeping during airplane descent, so swallowing and yawning do not happen naturally
• Young children, whose eustachian tubes are narrower
• Inexperience with equalization techniques during diving

Diagnosis

Barotrauma is usually diagnosed from the history and symptoms, especially when they begin during or right after flying or diving. A clinician may:

• Examine the eardrum with an otoscope, looking for redness, fluid, bleeding, or a tear.
• Perform a hearing test if hearing loss or persistent muffling is present.
• Order imaging, such as a CT scan, for suspected sinus or lung involvement.
• Assess for signs of more serious diving injuries, including arterial gas embolism, when neurological symptoms are present.

Most mild ear and sinus cases need no testing beyond a physical examination.

Treatment

Mild barotrauma often resolves without specific treatment as pressure gradually equalizes. Helpful measures include:

• Equalizing techniques: Swallowing, yawning, chewing gum, or gently exhaling against a pinched nose with the mouth closed (the Valsalva maneuver) to open the eustachian tube.
• Decongestants and antihistamines: To reduce congestion when allergies or a cold are involved.
• Pain relief: Over-the-counter pain relievers for discomfort.
• Treating infection: Antibiotics if a middle-ear or sinus infection develops.

A ruptured eardrum often heals on its own over several weeks but should be evaluated. Serious diving-related barotrauma, especially suspected gas embolism or lung injury, is an emergency that may require oxygen, hospital care, and treatment in a recompression (hyperbaric) chamber.

Prevention

• Avoid flying or diving when you have a cold, sinus infection, or significant nasal congestion
• Swallow, yawn, or chew gum during airplane takeoff and descent; stay awake while descending
• Use a decongestant or saline spray before flying if you are prone to ear problems, when appropriate
• For infants, offer a bottle, pacifier, or feeding during ascent and descent
• When diving, descend and ascend slowly and equalize ear pressure early and often
• Get proper training before scuba diving and never hold your breath while ascending

When to See a Doctor

See a doctor if ear pain, hearing loss, or a blocked feeling lasts more than a few hours to days after travel, or if you develop drainage or bleeding from the ear. Seek emergency care immediately for:

• Chest pain, severe shortness of breath, or coughing up blood after diving
• Severe dizziness, confusion, weakness, or fainting following a dive
• Sudden, complete hearing loss

These can signal lung injury or gas entering the bloodstream and require urgent treatment.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Airplane ear — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Barotrauma.
3. Divers Alert Network (DAN). Ear and sinus barotrauma.
4. National Institute on Deafness and Other Communication Disorders (NIDCD). Ear infections and the middle ear.