Many people suddenly experience severe pain in their ears and dizziness while an aircraft is approaching for landing, at the end of a mountain trip in a gondola or in the middle of a dive. These symptoms could indicate middle ear barotrauma. This is triggered by the changed pressure, which cannot be compensated.
What is a barotrauma?
The barotrauma is triggered by excessive pressure differences. Tissues of the body are damaged in the process, because the pressure in the environment rises or falls too much. Air-filled chambers in the body are particularly susceptible to this. Therefore, the ear is most commonly affected by barotrauma, but the sinuses and lungs are also susceptible to it.
However, the overpressure or underpressure can cause injuries in many other parts of the body. The exact extent of the barotrauma depends on the corresponding absolute magnitude of the pressure change and the speed at which the pressure rises or falls.
Barotrauma is triggered by rapid changes in ambient pressure and the body’s inability to equalize the pressure. During landing approaches in airplanes, dives, or cable car rides in the mountains, there are mainly situations in which the pressure conditions suddenly change. This means that the pressure of the environment is much higher or lower than in the specific organs.
- Barotrauma while diving
Diving most often results in pressures that are too different to make it difficult to equalize. The pressure is already twice as high at a water depth of ten meters. With previous illnesses such as a cold, sinus infection or allergy, it is even more difficult for the person affected to compensate for the pressure in the middle ear due to the swollen mucous membrane. The result is painful and uncomfortable barotrauma.
- Barotrauma while flying
When flying, the air pressure decreases with increasing altitude, which creates an overpressure in the middle ear. This is balanced out via the ear / nose-throat-area connection. During the landing approach, the pressure is increased to the corresponding pressure at sea level within around 15 minutes.
The pressure difference can be equalized if the nose is closed and the air is forced into this nose. If this pressure equalization does not succeed, barotrauma can occur.
- Ear plugs and swimming cap
Ear plugs are also a cause of barotrauma in the external ear canal. Because they often seal the ear canal so tightly, the ear is unable to equalize the pressure. Tight-fitting swimming caps often have the same effect.
- Barotrauma of the lungs
The reason for the dangerous barotrauma of the lungs is often that the air pressure becomes too low, for example if the breathing apparatus is not working properly or the ambient pressure drops, which cannot be compensated for by exhaling.
- Barotrauma on the tooth
Barotrauma can occur on the tooth, for example, due to a poor filling.
Symptoms, ailments & signs
Anyone who suffers from barotrauma usually complains of severe and stabbing pain in the ears, as the overpressure or underpressure in the body cavity of the corresponding organ, for example the middle ear, causes tissue damage. There is also a frequent feeling of dizziness and severe nausea.
The latter can lead to vomiting. In addition, barotrauma can cause acute otitis media. In more severe cases, bleeding in the middle ear or retraction of the eardrum is possible. If the eardrum is badly attacked, it can tear due to excessive stretching, which can sometimes develop into hearing loss as a long-term consequence of barotrauma. A tinnitus can be caused by barotrauma.
Diagnosis & course
In the case of a barotrauma in the area of the ears or paranasal sinuses, it is mainly the ENT doctor who carries out the examinations. In addition to the anamnesis (conversation), these include, for example, the observation of the nasopharynx, hearing tests, a mirroring of the ears up to ultrasound and computed tomography.
All of this can provide information about the severity of the disease. Which examinations are required depends on the findings. In some cases, however, it may also be necessary for the doctor to first look at the vital functions, for example in the case of a barotrauma of the lungs.
In most cases, barotrauma leads to uncomfortable feelings in the ears, eyes, or even teeth. Often the barotrauma occurs in a small form when flying in an airplane, when the pressure changes and can press on the eardrum. In this case, the symptom will go away on its own and there will be no further complications.
If there is no pressure equalization, the eardrum can tear in barotrauma. This leads to very severe pain and hearing loss in the patient. As a rule, the eardrum can no longer be treated because there is no specific treatment of the eardrum. However, hearing can be restored through the use of a hearing aid.
If there is discomfort in the nose, sprays can be used to prevent swelling. If the lungs are damaged in a barotrauma, treatment by the doctor must be carried out immediately. Depending on the cause of the symptom, irreversible damage can occur here, which in the worst case can lead to death.
Due to the barotrauma, diving underwater is no longer possible or life-threatening for most people. If the symptom is treated promptly, there will be no further complaints or complications.
When should you go to the doctor?
If a barotrauma is suspected, a specialist should be consulted as soon as possible. By examining the ear canal, the ENT doctor can determine whether there is a tear in the eardrum. Further examinations then provide information about the severity of the trauma and the therapy options. Whether it is a barotrauma can be seen from the typical symptoms. For example, severe and stabbing earache, dizziness and nausea indicate an injury to the middle ear.
In this case, a doctor’s visit is absolutely necessary. An ENT doctor must be consulted at the latest in the event of tinnitus or increasing hearing loss. Barotrauma usually occurs when diving or flying, but it can also be caused by ear plugs or a swimming cap.
Extreme athletes and people who use appropriate aids should speak to their family doctor directly if they have earache. If the symptoms are particularly intense or increase rapidly, a visit to the hospital is recommended. In any case, if a barotrauma is suspected, a knowledgeable doctor must be consulted immediately.
Treatment & Therapy
If a barotrauma is suspected, a specialist should be consulted as soon as possible. In the case of the ear, for example, the doctor can tell whether the eardrum has ruptured due to the lack of pressure equalization. Otherwise, pain relievers and decongestants are used for barotrauma.
If the eardrum has been damaged, the reduction in hearing that may have occurred can be compensated for by a hearing aid. If you have sinus barotrauma, a decongestant nasal spray can provide relief.
A barotrauma of the lungs requires immediate intensive treatment because this is life-threatening. First of all, the vital processes of the body must be ensured, if necessary, before the doctor takes care of further pressure damage. Some injuries resulting from barotrauma may even require surgery.
Outlook & forecast
With early diagnosis and medical treatment, barotrauma patients have a good prognosis. The later the treatment and the stronger the symptoms, the narrower the chances of recovery.
In severe cases, tinnitus or hearing loss occurs. No medical care is required for mild barotrauma. The patient can take it easy and should avoid the triggering situation. In the future, he should initiate changes in the conditions so that the pressure triggering of the height differences is reduced.
A moderate degree of severity of the barotrauma is treated with medication with good treatment success. Painkillers and ear drops are given that provide relief and then cure within a few days or weeks. Severe barotrauma can tear the eardrum. The bigger the crack, the weaker the hearing ability later on.
If the patient suffers from previous hearing disorders or if their hearing remains poor after the barotrauma has subsided, they need a hearing aid. The prognosis worsens once the lungs are involved. In order not to cause permanent damage to the lungs, intensive medical treatment must take place immediately. The good prognosis prospects are also reduced if there is already a tear in the eardrum. Therefore, the patient should avoid recurrence of the disease after experiencing barotrauma for the first time.
Barotrauma can be prevented when diving by excluding an inflammatory infection before all dives. Even a harmless cold can have serious consequences underwater. Divers should not take decongestants if they have a cold or runny nose, for example to make the dive possible.
During the dive, the drugs can lose their effectiveness and cause problems. If you notice earache, you should never dive deeper. If there are repeated attempts to equalize the pressure, it is important to stop the dive.
Before and during conquering great heights with corresponding pressure differences, it is helpful to drink a lot. The nasal mucous membranes should be kept moist with a nasal spray to avoid barotrauma.
You can do that yourself
Barotrauma should always be diagnosed and treated by a doctor first. The symptoms can be alleviated with a few home remedies and measures.
As a first aid measure, rest and cooling are recommended. Ice packs or frozen vegetables relieve pain and reduce swelling in the inner ear. On the other hand, further pressure equalization should be avoided, as this can potentially worsen the injury. It makes more sense to rest in bed and avoid loud noises. Medicinal herbs such as arnica or the anti-inflammatory comfrey can also be used.
Natural products can be used after consultation with the doctor either as a medicinal preparation or in the form of teas, tinctures and ointments made in-house. However, the mentioned agents should never be applied directly to the auricle or the ear canal, as this can cause inflammation.
If the symptoms persist despite all measures, you should speak to your doctor. Often the barotrauma is based on a tear that must be treated surgically. After the surgery, diving should be avoided temporarily. The doctor responsible can provide further tips and measures for a speedy recovery.