Pressure in the ear, medically referred to as ear barotrauma or otic barotrauma is a type of ear damage. As the name implies, ear barotrauma is caused by pressure differences between the external and internal ears. Too much pressure in the ear can cause pain and in some cases, permanent hearing loss or damage.
Ear barotrauma is experienced when there is a sudden change in atmospheric pressure and the middle ear, or specifically the eustachian tube, cannot quickly reconcile the pressure change in the middle ear to match atmospheric pressure. This leads to a feeling of intense pressure and sometimes pain in the ear(s).
Causes of Ear Barotrauma
As mentioned above, ear barotrauma is a result of an imbalance between the pressure in the inner and outer ears. Such pressure changes may be triggered in certain situations, such as:
-Air travel
-Scuba diving
-Exposure to an explosive blast
-Hyperbaric oxygen therapy for wound healing
Typically, the situations mentioned above do not automatically lead to ear barotrauma. People with problems with the eustachian tube are more susceptible to experience pressure in the ear even without being exposed to the aforementioned conditions.
Inflammation or fluid buildup in the eustachian tube or nearby areas may cause it to not open or close normally. Such factors may cause problems in the eustachian tube that may trigger pressure in the ear:
-Sinus congestion
-Allergies
-Anatomical abnormalities
-Cold or respiratory infection
-Exposure to irritants (i.e tobacco smoke)
-Certain hormonal changes (i.e pregnancy)
Ear Barotrauma Symptoms
Ear barotrauma involves pain and pressure in the ears that isn’t relieved by swallowing or by doing the Valsalva maneuver (pinching the nose while swallowing some water). Dizziness, tinnitus, and hearing loss are also possible symptoms. In severe cases, blood or drainage from the ear canal may occur.
Symptoms of ear barotrauma may vary per individual; some might experience mild symptoms only, while others experience severe symptoms at the onset. Feeling uncomfortable pressure in the ears is usually the earliest symptom of ear barotrauma. Hearing loss and ear pain may occur over time if the pressure difference has badly damaged the ears.
Lungs and Sinuses
Untreated ear barotrauma may cause damage to the lungs and sinuses, leading to additional symptoms such as pain in the face or shortness of breath.
Ear Barotrauma Diagnosis
Ear barotrauma is diagnosed by physical history, examination of the ear, audiological testing, and hearing and balance tests. Specifically, a hearing evaluation that will include immittance testing. This pressure test will see if the eustachian tube is patent (opens and closes when pressure changes are made).
A Eustachian Tube Function (ETF) test will provide additional information and is part of the immittance testing. In addition, a hearing test will also show if the middle ear is involved.
If you recently went scuba diving or boarded an airplane, make sure to mention this to your healthcare provider. Depending on the results of the initial tests, you may be referred to an ear, nose, and throat doctor (ENT or otolaryngologist) for treatment.
How long can ear barotrauma last?
In most cases, ear barotrauma can resolve spontaneously without needing any treatment. If ear barotrauma is caused by respiratory or allergies, it will usually clear up when the underlying cause has been resolved. Mild to moderate cases of ear barotrauma may take an average of two to three weeks for a full recovery period.
Easing Pressure in the Ears: How is ear barotrauma treated?
Treating pressure in the ears will depend on the symptoms, onset, age, and general health of the patient. In some cases, ear barotrauma clears up on its own without any treatment or medication. However, if ear barotrauma was caused by an injury, the eardrum may not heal on its own and medications may be prescribed.
Typically, antihistamines (if appropriate) and nasal spray are used to relieve initial symptoms but if you are diagnosed with barotrauma, otolaryngologic (ENT) follow-up is advised. If an infection is detected, the ENT may prescribe antibiotics and possibly pain medication as well. In some cases, surgical intervention is recommended such as a myringotomy and slitting of the eardrum to insert a pressure equalization (PE) tube.
What can I do to prevent ear barotrauma?
To prevent barotrauma, avoid air travel and scuba diving if you have a cold or sinus infection. Sometimes, taking an antihistamine prior to these activities can help the eustachian tube equalize more easily. Special airplane plugs with filters can also help with equalizing. Chewing gum and swallowing help the eustachian tube to open and close more easily. For those that have chronic aural fullness, a pressure equalization (PE) tube, inserted by an ENT, through the eardrum can help relieve the build-up of pressure.
You can apply certain methods to help open the eustachian tube during pressure changes, such as:
-Swallowing frequently
-Valsalva maneuver
-Chewing gum or candy
-Using special ear plugs when flying
Using ventilation tubes is another option for people who have issues with their eustachian tubes or for those who need to ride a plane frequently. These are also beneficial if you need hyperbaric oxygen therapy for wound healing. Ventilation tubes are surgically placed in the eardrum and are designed to prevent future pressure differences. However, ventilation tubes can’t prevent ear barotrauma caused by diving.
Ear Barotrauma Complications
Ear pain without any ear infection is most often linked to ear barotrauma. This happens when the eustachian tube becomes inflamed due to a recent respiratory infection, common cold, allergies, or sudden pressure changes in the environment (scuba diving, flying an airplane, driving in high altitude areas).
Eustachian tube dysfunction or barotrauma can affect future travel and activities, increasing the risk of a perforated eardrum and permanent hearing loss, and/or tinnitus and vertigo. We highly suggest getting medical attention as soon as you experience any signs of ear pressure that go beyond your comfort zone or pain tolerance.
Some symptoms of ear barotrauma and ruptured eardrums overlap, so it is best to seek emergency medical attention if you experience extreme pain, bloody discharge from the ear, total or partial hearing loss in one ear, or dizziness that leads to vomiting.
For a ruptured eardrum, antibiotic drops may be prescribed if there is evidence of an infection. In most cases, a ruptured eardrum heals on its own.
When to see a doctor?
When the pressure in the ear is becoming too uncomfortable or bothersome, or if the hearing is already affected, a visit to a doctor is highly recommended. Hearing Partners of South Florida has 3 locations in Palm Beach County to serve you.
Living with Ear Barotrauma
Divers are discouraged from diving again until their ear barotrauma has fully healed. Diving without full recovery from ear barotrauma may cause re-injury or further damage and complications. Riding airplanes should also be avoided until the injury has fully healed.
It is best to closely coordinate with your healthcare provider or audiologist and get a medical clearance before deciding to participate in activities that may trigger pressure in the ears.
