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Barotrauma

( Ear Barotrauma , Barotitis Media, Ear Popping, Ear Pressure, Airplane Ear; Sinus Barotrauma , Aerosinusitis, Barosinusitis; Pulmonary Barotrauma , Pulmonary Overpressurization Syndrome)

Definition

Barotrauma is the pain or discomfort that is felt with a difference in air or water pressure between the outside environment and the inside of the body.
Any part of the body that contains air can be sensitive to these pressures:
The Ear
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Causes

Normally air moves easily between outside and inside of the ear, sinuses, and lungs, helping to maintain a balance of pressure. Imbalances may be created with:
The imbalance of pressure causes the air inside your body to shrink or swell. This is what can cause pain and damage.

Risk Factors

Activities that can expose someone to significant pressure changes include:
The inner ear is connected to outside air through tubes to keep inner and outer pressure balanced. Blockages and congestion in these tubes increase the risk of ear barotrauma because the inside pressure is not allowed to change to match the outside pressure. These tubes may be blocked or limited by:
Similarly, blockages in the sinuses will block the flow of air from outside to inside the body. Sinuses may be impaired by:
Pulmonary barotrauma may be more likely in those with damage from previous or current lung conditions.
Other factors that may affect the ability for air spaces in the body to work properly include:

Symptoms

Symptoms will depend on what areas are affected.
Ear barotrauma may cause:
Complications include long-term or permanent hearing loss, ear infection , or a perforated eardrum .
Sinus barotrauma may cause:
Pulmonary barotrauma may cause:
Potential complications can include pneumothorax and stroke .

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done to look for irritation or tissue damage. Barotrauma may be suspected based on your recent activities, such as air travel or scuba diving.
Ear structures will be visually examined
Suspected pulmonary barotrauma may be evaluated with:

Treatment

Pulmonary barotrauma is serious and needs immediate medical attention. Treatment will depend on the specific lung problem that is present, such as a collapsed lung.
The following measures can also prevent barotrauma. Treatment options include the following:

Measures to Relieve Pressure

Pressure can be relieved with self-care and medications.
Self-Care
To relieve the pressure in the eustachian tube, you can:
  • Suck candy
  • Chew gum
  • Yawn
  • Inhale and gently exhale through your nose while pinching your nostrils shut. This forces air through the blocked eustachian tube and possibly opens it.
Medications
It is important to relieve nasal congestion and open your eustachian tube. Medications to relieve ear and sinus pressure include:
  • Decongestant nasal sprays
  • Oral decongestants
  • Oral antihistamines
Pain relievers can be used if ear or sinus pressure is causing pain. Antibiotics may be used if a bacterial infection is present or possible.

Emergency Care

Emergency medical care may include:
Surgery
Surgery may be necessary to relieve the pressure if your eustachian tube does not open with other treatments. Your doctor will make a small cut in your eardrum to equalize the air pressure. Any fluid blocking the tube may also be removed.
Oxygen Treatment
Oxygen should be given immediately for pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube under the nose.

Prevention

To help reduce your chance of barotrauma during:

Air Travel

  • If you can, postpone your flight if you have a cold or are congested. Use a decongestant if travel can not be delayed.
  • To relieve the pressure during take-off and landing, try:
    • Sucking candy
    • Chewing gum
    • Yawning
    • Breathing with your mouth open
  • Use filtered earplugs to slowly equalize the air pressure against your eardrum.
  • Avoid sleeping during descent because you may not be swallowing enough.
To help your baby through pressure changes, give your baby a pacifier or bottle during landing and take off.

Scuba Diving

  • Get proper training and certification.
  • Make sure all your equipment is working and vented properly.
  • Keep diving depth to level of experience.
  • Follow all breathing guidelines, especially when coming up from a dive.
  • Don’t stay under the water at greater depths long periods of time.
  • Avoid flying or going to a higher altitude for the next 24 hours after diving.
  • Take a decongestant pill or nasal spray a little before diving.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

Divers Alert Network http://www.diversalertnetwork.org

CANADIAN RESOURCES

Canadian Society of Otolaryngology—Head and Neck Surgery http://www.entcanada.org

Health Canada http://www.hc-sc.gc.ca

References

Barotrauma. American Hearing Research Foundation website. Available at: http://american-hearing.org/disorders/barotrauma. Updated October 2012. Accessed November 4, 2014.

Barotrauma. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/injury%5Fduring%5Fdiving%5For%5Fwork%5Fin%5Fcompressed%5Fair/barotrauma.html. Updated May 2013. Accessed November 3, 2014.

Brandt MT. Oral and maxillofacial aspects of diving medicine. Military Medicine. 2004;169:137-141.

Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/ears-and-altitudeearsAltitude.cfm. Updated February 2, 2012. Accessed November 4, 2014.

Newton HB. Neurologic complications of scuba diving. Am Fam Physician. 2001;63(11):2211-2218.

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