Ear Barotrauma (Airplane Ear)

Overview

Ear barotrauma is an injury that occurs as a result of a sudden difference in air pressure between the inner and outer sides of the eardrum. This condition can cause stretching, swelling, and in some cases tearing of the eardrum. It most commonly occurs during airplane travel or while diving.

Ear barotrauma is frequently seen in people exposed to pressure changes. The air pressure in the middle ear cavity must be balanced with the pressure in the external environment. This balancing occurs through a channel called the Eustachian tube. The Eustachian tube creates a connection between the ear and the back of the nose and normally equalizes pressure.

However, if the Eustachian tube is blocked or not functioning properly, pressure cannot be equalized. When external pressure increases or decreases, the eardrum is pulled inward or bulges outward. This condition can lead to discomfort, pain, and hearing problems.

Ear barotrauma is usually mild and resolves on its own within a few hours or days. However, in some cases the eardrum can tear, infection can develop, or permanent hearing loss can occur. For this reason, if symptoms are severe or continue for a long time, a doctor should be consulted.

Ear barotrauma can occur at any age but is more common in children. The reason for this is that children's Eustachian tubes are narrower and more horizontal. Risk increases in people with upper respiratory tract infections such as colds, flu, or allergies.

Symptoms

The symptoms of ear barotrauma can range from mild discomfort to severe pain. The most common symptom is a feeling of fullness or blockage in the ear. This feeling results from the pressure difference in the eardrum and is usually temporary.

The most common symptoms are:

• Feeling of fullness or blockage in the ear. It feels as though the ear is plugged with cotton. This is the most common symptom and may be the only symptom in mild cases.
• Ear pain. Can range from mild discomfort to sharp pain. Pain increases during sudden pressure changes. It becomes particularly pronounced during the takeoff and landing phases of an airplane.
• Mild hearing loss. Sounds are heard as muffled or as if coming from far away. This condition results from restricted movement of the eardrum.
• Ringing in the ear. This condition, also known as tinnitus, manifests as ringing, buzzing, or humming in the ear.
• Dizziness. If the balance system is affected, a feeling of mild dizziness or imbalance may occur. This symptom is usually mild.
• Discharge from the ear. When the eardrum tears, clear or bloody fluid may come from the ear. This condition indicates a more serious injury and requires urgent evaluation.

Symptoms usually begin during or immediately after a pressure change. In mild cases they resolve within minutes or hours. However, if there is eardrum damage, symptoms can continue for days.

When to See a Doctor

See a doctor in the following situations:

• If there is severe or prolonged ear pain
• If there is discharge from the ear
• If hearing loss lasts longer than a few hours
• If you are experiencing severe dizziness or loss of balance
• If symptoms do not improve within a few days
• If high fever develops (may be a sign of infection)

Discharge from the ear or sudden hearing loss requires urgent evaluation.

Causes

The underlying cause of ear barotrauma is the inability of air pressure in the middle ear cavity to be balanced with external environmental pressure. Under normal conditions the Eustachian tube provides this balancing, but if it is blocked or swollen, pressure cannot be equalized.

Situations that cause pressure changes include:

• Airplane travel. This is the most common cause. When an airplane takes off, external pressure decreases and air in the middle ear expands. During landing, external pressure increases and the eardrum is pulled inward. Problems are more common during landing.
• Diving. As you dive into water, water pressure increases and the eardrum is pushed inward. As you surface, pressure decreases. If pressure equalization is not done regularly during diving, barotrauma develops.
• Ascending to high altitude. During mountaineering or ascending to heights by cable car, air pressure decreases. Rapid altitude changes can cause problems.
• Explosion or sudden pressure changes. Rarely seen but can cause severe barotrauma.

Conditions that cause blockage or swelling of the Eustachian tube:

• Upper respiratory tract infections. Colds, flu, or sinusitis cause swelling and blockage of the Eustachian tube. Airplane travel in this condition significantly increases the risk of barotrauma.
• Allergies. Nasal swelling disrupts the functioning of the Eustachian tube.
• Nasal polyps or adenoid enlargement. Can cause blockage of the Eustachian tube, especially in children.
• Exposure to cigarette smoke. Cigarettes disrupt the function of the Eustachian tube.
• Exposure to pressure changes while sleeping. Sleeping on an airplane causes the Eustachian tube to remain passive and increases the risk of barotrauma.

Diagnosis

Ear barotrauma is usually diagnosed through history and physical examination. Your doctor will ask when symptoms began and whether you have recently traveled by airplane or gone diving.

The diagnostic process typically includes:

• Detailed history. Questions are asked about when you were exposed to pressure changes, when symptoms began, and how long they lasted. Risk factors such as colds or allergies are evaluated.
• Otoscopy. Your doctor looks at your eardrum using a lighted instrument called an otoscope. They check whether there is redness, swelling, inward retraction, or a tear in the eardrum. Sometimes fluid accumulation can be seen behind the eardrum.
• Tympanometry. This is a test that measures the movement of the eardrum. Slight pressure is applied to the ear and how the eardrum responds is recorded. This test can show fluid accumulation in the middle ear or Eustachian tube blockage.
• Hearing test (audiometry). If there is hearing loss, this is done to determine how much loss there is at which frequencies.
• Nasal endoscopy. The inside of the nose and Eustachian tube opening are evaluated with a small camera. Polyps, adenoids, or other blockages can be detected.

In most cases a simple examination is sufficient for diagnosis. Advanced tests are usually done if complications are suspected or symptoms are prolonged.

Treatment

Treatment of ear barotrauma varies depending on the severity of the condition. In mild cases, special treatment is usually not needed and symptoms resolve on their own. In more serious situations, medical intervention may be necessary.

Treatment options include:

• Watchful waiting. This is the most common approach in mild barotrauma. Symptoms usually resolve on their own within a few hours or days. During this time, natural maneuvers such as yawning, chewing gum, or swallowing can help.
• Valsalva maneuver. You close your nose and mouth and gently blow. This maneuver helps open the Eustachian tube and equalize pressure. However, it should not be done too forcefully because it can damage the eardrum or increase the risk of infection.
• Toynbee maneuver. You close your nose and swallow. This is also a method that helps with pressure equalization.
• Decongestant nasal spray or pills. Helps open the Eustachian tube by reducing nasal swelling. Suitable for short-term use. If used for a long time, it can have a rebound effect.
• Antihistamines. Used to reduce nasal swelling if there is an allergy.
• Pain relievers. Pain relievers such as ibuprofen or paracetamol relieve ear pain.
• Antibiotics. If the eardrum has torn or infection has developed, antibiotic treatment may be necessary. If there is discharge from the ear, antibiotics must be started.
• Tympanostomy tube placement. In recurrent barotrauma or chronic Eustachian tube blockage, a small tube is placed in the eardrum. This tube helps with pressure equalization by providing continuous airflow. Can be considered especially in people who fly or dive frequently.
• Surgery. In very rare situations, surgical removal of structures causing blockage such as adenoids or polyps may be necessary.

During treatment, water sports, diving, and airplane travel should be avoided. These activities can be dangerous until the ear is completely healed.

Complications

Ear barotrauma usually heals without complications. However, problems can develop in some cases:

• Eardrum perforation. Severe pressure difference can cause tearing of the eardrum. This condition manifests with sudden severe pain, discharge from the ear, and sudden hearing loss. Small tears usually heal on their own but large tears may require surgical repair.
• Middle ear infection. Bacteria can enter the middle ear through a torn eardrum causing infection. Fever, severe pain, and purulent discharge are signs of infection.
• Permanent hearing loss. Rarely seen but if there is permanent damage to the eardrum or damage to the middle ear ossicles, hearing loss can be permanent.
• Recurrent barotrauma. After the initial barotrauma heals, the Eustachian tube can remain more sensitive and problems can be experienced again with repeated pressure changes.
• Inner ear barotrauma. Very rare but a serious complication. If the inner ear is damaged, severe dizziness, loss of balance, and sudden hearing loss can occur. This condition requires urgent evaluation.

Preventing Ear Barotrauma

Ear barotrauma can be largely prevented with simple precautions.

Precautions during airplane travel:

• Stay awake during takeoff and landing. Sleeping causes the Eustachian tube to remain passive.
• Chew gum or suck on candy. Chewing and swallowing movements help open the Eustachian tube.
• Yawn and swallow frequently. These movements help equalize pressure.
• For babies and young children, breastfeed or give a bottle during descent. Sucking and swallowing movements provide pressure equalization.
• Perform the Valsalva maneuver while the plane is descending. However, apply it gently.

If you have a cold or allergies:

• If possible, postpone the flight or dive. Flying or diving when the Eustachian tube is blocked significantly increases the risk of barotrauma.
• If you absolutely must travel, use a decongestant one hour before the flight.
• Take an antihistamine.

Precautions during diving:

• Descend and ascend slowly when entering and exiting the water.
• Equalize pressure frequently. Apply the Valsalva or Toynbee maneuver every few meters.
• If you cannot equalize pressure, never force yourself to go deeper. Surface and try again.
• Do not dive if you have a cold, flu, or allergies.

General precautions:

• Stay away from cigarettes. Cigarettes disrupt the function of the Eustachian tube.
• Treat your allergies.
• If your child has an adenoid problem, consult your doctor.

Living with Ear Barotrauma

After experiencing ear barotrauma, most people recover completely. However, certain points should be considered to reduce the risk of recurrence.

• Wait for complete healing. Even if symptoms pass, do not travel by airplane or dive until the ear is completely healed. Your doctor should examine your ear and confirm that it has healed.
• Identify triggers. Note in which situations you experienced barotrauma. Be more careful in similar situations in the future.
• Treat upper respiratory tract infections. When you have a cold or flu, definitely get treatment and do not expose yourself to pressure changes until you recover.
• Keep your allergies under control. Use medication regularly and stay away from allergens.
• Use preventive techniques. Apply pressure equalization maneuvers before and during airplane travel or diving.
• If you travel frequently, consider ear protectors. Special earplugs slow pressure changes, giving the Eustachian tube more time for equalization.
• If you have a child, be careful. Children are more prone to barotrauma. During airplane travel, make sure your child chews gum or drinks fluids.

Preparing for Your Appointment

What you can do:

• Note when you were exposed to pressure changes (airplane travel, diving, etc.)
• Write down when symptoms began and how they progressed
• Specify whether you recently had a cold, flu, or allergies
• List all medications you are taking
• Mention if you have had ear problems before
• Write your questions down in advance

Questions you can ask your doctor:

• Is there damage to my eardrum?
• How long will it take to heal?
• When can I travel by airplane or dive?
• Do I need to use medication?
• What is my risk of complications?
• How can I prevent this in the future?
• Does an ear tube need to be placed?

Your doctor may ask you:

• When did symptoms begin?
• Have you recently traveled by airplane or gone diving?
• Is there pain in the ear? How severe?
• Is there discharge from the ear?
• Are you experiencing hearing loss?
• Have you recently had a cold or allergies?
• Have you experienced ear barotrauma before?
• Do you fly or dive frequently?