Health Library

• Barotrauma most commonly affects the middle ear. The middle ear has a pocket of air that is sensitive to changes in air pressure.
  • You have a thin layer of skin (or membrane) at the end of the ear canal. It vibrates and sends sound to your middle ear. This is called the eardrum.
  • The air pressure inside and outside your ear is normally same. The eustachian tube connects the middle ear and the throat. It works to balance the air pressure on both sides of your eardrum. It allows air to flow into or out of the middle ear.
  • Ear barotrauma happens when the eustachian tube gets blocked. Your body can not balance the air pressure inside and outside the eardrum.
  • Ear barotrauma is usually not severe or dangerous. It is easily treatable. Sometimes there are complications such as loss of hearing , ear infection, dizziness, or a perforated (punctured) eardrum.

• Sinuses are air-filled pockets in the bone around the nose.
  • Sinus barotrauma occurs when there is a difference in pressure between the air in the sinuses and the pressure outside.
  • You may experience pain around your cheek bones or above your eyes.
  • You may also experience headaches.
  • It may lead to severe sinus infection if you also have a cold or nasal congestion.

Pulmonary barotrauma is the injury that is caused when outside pressure is different than the pressure of the air in your lungs.

• Scuba divers swim with canisters of compressed air. It allows them to breathe under water. The lungs may overinflate if a diver has too much compressed air and returns to the surface of the water without properly exhaling. One complication is that the lung could collapse.
• Another complication is decompression sickness. This is also referred to as "the bends."
  • Nitrogen is a chemical dissolved in blood by high pressure. It forms bubbles as pressure decreases (such as when you swim up to the surface when diving). These bubbles may leak out into your bloodstream as air bubbles called air embolisms.
  • Air embolisms can travel to any organ in the body. They are dangerous when they block blood vessels that feed an organ such as the heart, lungs, and the brain.
  • Decompression sickness is classified as Type 1 or Type 2. Type 1 is when the bubbles affect the tissues around joints. Knees, elbows, and shoulders are most often affected. Type 2 is more serious. It involves the central nervous system (brain and spinal cord) or the lung and heart.

• Discomfort or pain in one or both ears
• Feeling as though your ears are clogged
• Feeling of pressure in your ears
• Dizziness
• Hearing loss (temporary)
• Bleeding from the ear (rare)
• Tinnitus

• Sinus pressure and/or pain
• Nasal bleeding
• Headaches
• Tooth pain

Your doctor will look into your ear with a special flashlight called an otoscope. The otoscope allows your doctor to see your eardrum. Your doctor may see a bulge of the eardrum if you have barotrauma. This bulge occurs from the difference in pressure between the inside and outside of your eardrum. There may even be blood behind the eardrum.

There are no tests to diagnose sinus barotrauma. Diagnosis depends on your doctor getting an accurate history and then conducting a physical exam.

Your doctor may order tests to check for air embolisms and possible lung collapse.

• Your doctor may need pictures of your lungs. This can be done with:
  • Chest x-ray
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Lung perfusion scan
• Your doctor may need information about how your lungs function. This can be done with a pulmonary function test.
• Your doctor may need to measure the level of oxygen in your blood. This can be done with pulse oximetry.

To relieve the pressure in your 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.

It is important to relieve nasal congestion and open your eustachian tube. Your doctor may recommend that you take some medications, including:

• Decongestant nasal sprays
• Oral decongestants
• Oral antihistamines
• Pain medications

Your doctor may prescribe antibiotics to prevent an ear infection if the barotrauma is severe.

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 should be given immediately if you have pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube near your nose.

If you have decompression sickness, you need to be in a high-pressure environment. This allows the air bubbles that have formed to shrink and break up in your blood. Some medical centers have hyperbaric chambers (also known as high-pressure or recompression chambers). These chambers provide a high-pressure environment.

The Divers Alert Network offers information on these chambers.

• Postpone your flight if you have a cold or are congested.
• Do things that will help keep the eustachian tube open to relieve the pressure, especially during take-off and landing. You can do this if you:
  • Suck candy
  • Chew gum
  • Yawn
  • Breath with your mouth open
• Avoid sleeping during descent because you may not be swallowing enough.
• Get filtered earplugs. These special earplugs slowly equalize the air pressure against your eardrum.
• Have babies suck on a bottle or pacifier; do not let them sleep during descent.
• Take a decongestant pill or nasal spray before the start of the flight to shrink the membranes in the eustachian tube. This will help make your ears pop more easily.
• Some people have frequent barotraumas. Your doctor may suggest having tubes surgically placed in your eardrums to help balance the pressure and prevent the condition.

• Be properly trained.
• Be in good health before diving.
• Make sure all your equipment is working properly.
• Go down and come up slowly in the water when scuba diving. The The United States Navy Diving Manual has guidelines. They list how often you should stop during your ascent and how slowly you should make your ascent.
• Take a decongestant pill or nasal spray a little before diving. It will unblock your eustachian tubes, nose, or sinuses.
• To prevent pulmonary barotrauma, do not hold your breath during ascent (going up).
• Don’t smoke.
• Exhale freely while ascending to the surface when diving. You should do this even in a swimming pool.
• Don’t dive as deep.
• Don’t stay under the water at greater depths for so long.
• Avoid flying or going to a higher altitude for the next 24 hours after diving.
• Know the location of the nearest recompression chamber.
• Check your dry suit and your facial mask. Make sure your equipment is properly vented and that it won't cause air to be trapped against the skin.
• Never hold your breath while breathing compressed gas and ascending.
• Never dive alone.