(Ear Barotrauma–Eustachian Tube Dysfunction, Barotitis Media, Ear popping, Ear pressure, Airplane ear; Sinus Barotrauma–Sinus Squeeze, Aerosinusitis, Barosinusitis; Pulmonary Barotrauma–Lung Barotrauma, Pulmonary Overpressurization Syndrome, Decompression Sickness, DCS, Decompression Illness, Caisson Disease, the Bends)
Barotrauma is the pain or discomfort that you feel when there is a difference in air pressure between the outside environment and the inside of your body. You may experience this discomfort when you fly in an airplane or go scuba diving.
The air inside your body squeezes together or expands (swells) as the outside pressure (from water or air pressure) increases or decreases. The squeezing and the swelling can cause pain and damage. Barotrauma can affect the ear, face (sinuses), and lungs—any part of the body with air inside.
Barotrauma can even be due to equipment. The equipment, such as a mask or dry suit that you use for scuba diving, can block and trap air against the skin. If such an air pocket exists when you dive, you may become injured. Dry suits can painfully pinch your skin. Masks can cause blood vessels in the eyes to burst.
Contact your doctor if you think you may have some type of barotrauma.
Barotrauma is caused when the air pressure inside and outside the body are different, causing discomfort. Causes include:
- Scuba diving
- Ascending (going up to the surface) without exhaling freely
- Swimming quickly to the surface when diving
- Holding your breath when ascending
- Length of time spent underwater diving
- Repeated dives within 24 hours
- Flying in an airplane after diving
- Air pockets in equipment (e.g., scuba diving equipments such as masks and dry suits)
A risk factor is something that increases your chances of getting a disease or condition.
The following factors increase your chances of developing barotrauma:
- Congested nose from allergies or colds
- Congenital (present before birth) blockage of the eustachian tubes
- Young age–eustachian tubes in children are smaller and more likely to become blocked
- Damaged eustachian tube, caused by scarring or a tumor
- Obstructions in the ear
- Cleft palate or lip–may affect balance of pressure in the middle ears
- Holding your breath while diving
- Deeper dives
- Long amounts of time spent underwater diving
- Repeated dives within 24 hours
- Flying in an airplane after diving
- Rapid climb to the surface when diving
- Cold water
- Older age
- Ill-fitting equipment used for scuba diving
If you have symptoms of an air embolism (an air bubble in your blood stream) due to pulmonary barotrauma, you need to seek treatment immediately. Symptoms of an air embolism to the brain are usually identified very quickly after you surface from the water.
Symptoms of decompression sickness usually occur within an hour of surfacing from the water but can occur up to six hours later. If you have decompression sickness, it is very important to seek treatment immediately.
If you experience any of these other symptoms do not assume it is due to barotrauma. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
- Discomfort or pain in one or both ears
- Feeling as though your ears are clogged
- Feeling of pressure in your ears
- Hearing loss (temporary)
- Bleeding from the ear (rare)
- Sinus pressure and/or pain
- Nasal bleeding
- Tooth pain
Symptoms from an air embolism to the brain include reactions similar to a stroke:
- Partial paralysis
- Sudden loss of consciousness
- Coughing up blood
- Frothy blood at the mouth
- Chest pain
- Shortness of breath
- Pneumothorax: a condition in which air escapes from the lungs into the chest cavity and compresses the lungs resulting in a collapsed lung
- Decompression sickness, symptoms include:
- Pain in muscles, joints, tendons
- Problems of the spinal cord–paralysis
- Problems of the sensory system
- Problems with lungs–chest pain, cough, shortness of breath (sometimes called the chokes)
- Rashes or itchy skin
- Bubbles under your skin
Your doctor will ask about your symptoms and medical history, and perform a physical exam. If you have been flying or have been diving recently it is important to tell your physician.
If you think that you have pulmonary barotrauma or decompression sickness, seek medical attention immediately through your doctor or a local hospital.
When you go to your doctor, he or she will look into your ear with a special flashlight called an otoscope. The otoscope allows your doctor to see your eardrum. If you have barotrauma, your doctor may see a bulge of the eardrum due to the difference in pressure between the inside and outside of your eardrum. If your condition is serious, 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 an appropriate examination.
To check for air embolisms and possible lung collapse, tests your doctor may order include:
- Chest x-ray–This is an x-ray that looks for changes in blood vessel patterns.
- Computed tomography (CT)–An imaging scan that can find small strokes in the brain that may be caused by air embolisms.
- Pulmonary Function test–A test that measures how much air is in the lungs and how forcefully this air can be exhaled.
- Lung perfusion scan–This scan tests for pulmonary embolisms. A tiny amount of radioactive substance is injected into a vein and travels to the lungs. The scan allows your doctor to examine the blood supply to the lungs.
- Magnetic Resonance Imaging (MRI)–This is an imagining scan that provides a three-dimensional image of your body and your doctor can look for brain or spinal cord abnormalities.
- Pulse oximetry–Your doctor will use this instrument to measure the level of oxygen in your blood. This is a simple device that clips on the finger to measure the oxygen level.
If you have been diving recently and show symptoms of decompression sickness, your doctor may choose to treat you immediately without doing any other tests or at least without waiting for test results to return.
Talk with your doctor about the best treatment plan for you. The following measures can also prevent the occurrence of barotrauma. Treatment options include the following:
To relieve the pressure in your eustachian tube, you can:
- Suck candy
- Chew gum
- Inhale and gently exhale through your nose while pinching your nostrils shut – this will force air through the blocked eustachian tube and may open it
To relieve nasal congestion and open your Eustachian tube, especially if you are suffering from allergies or have a cold, your doctor may recommend that you take some medications, including:
- Decongestant nasal sprays
- Oral decongestants
- Oral antihistamines
- Pain medications–to relieve the pain
Your doctor may prescribe antibiotics to prevent an ear infection if the barotraumas is severe.
Surgery is usually a very last resort. If your eustachian tube does not open with other treatments, surgery may be necessary to relieve the pressure. Your doctor will make a small cut in your eardrum to equalize the air pressure and also to remove any fluid that might be blocking the tube.
Oxygen should be administered immediately if you have pulmonary barotrauma. The oxygen is either administered 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 so that the air bubbles that have formed shrink and break up in your blood. Some medical centers have hyperbaric chambers (also known as high-pressure or recompression chambers) to provide a high-pressure environment.
The National Diving Alert Network of Duke University provides a 24-hour hotline to get a list of these facilities. The Network can be reached at 919-684-8111.
To help reduce your chances of getting barotrauma, take the following steps:
- Postpone your flight if you have a cold or are congested.
- When flying in an airplane, especially during take-off and landing, do things that will help keep the eustachian tube open to relieve the pressure. Things you can do include:
- Suck candy
- Chew gum
- Breath with mouth open
- When flying, 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.
- For babies on airplanes, have them suck on a bottle or pacifier; do not let the baby sleep during descent.
- Take a decongestant pill or nasal spray a little before the start of the flight to shrink the membranes in the eustachian tube–to help make your ears pop more easily.
- If you are particularly prone to 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 United States Navy Diving Manual provides guidelines for how often you should stop during your ascent (called decompression stops) and how slowly you should make your ascent.
- Take a decongestant pill or nasal spray a little before diving to unblock you eustachian tubes, your nose or your sinuses.
- To prevent pulmonary barotrauma, do not hold your breath during ascent (going up).
- Don’t smoke.
- Exhale freely when diving, even in shallow waters of a swimming pool, while ascending to the surface.
- 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. The National Diving Alert Network of Duke University provides a 24-hour hotline to get a list of these facilities; the Network can be reached at 919-684-8111.
- Check your dry suit and your facial mask to make sure your equipment is properly vented and your equipment isn’t causing any air to be trapped against the skin.
- Never hold your breath while breathing compressed gas and ascending.