Barotrauma of the Ear

What is barotrauma of the ear?

It is where you have ear pain and dulled hearing because of unequal pressure that develops between the air in the middle ear and the air outside the ear. Barotrauma means damage to tissues caused by a difference in pressure between an air space inside the body. Barotrauma of the ear is the most common type of barotrauma.

What causes barotrauma of the ear?

The small space in the middle ear behind the eardrum should normally be filled with air. This air space is connected to the back of the nose by a tiny channel called the Eustachian tube. The air on either side of the eardrum should be at the same pressure for the eardrum to vibrate and function normally.

If the air pressure outside the ear quickly increases then this pushes the eardrum inwards which can be painful. The tensed eardrum also cannot vibrate as well as it should and so you may also have dulled hearing. To relieve the tensed eardrum, the pressure inside the middle ear has to rise quickly too. Air needs to travel up the Eustachian tube into the middle ear to equalise the pressure.

The most common example of barotrauma occurs to some air travellers. As a plane descends to land, the air pressure becomes higher nearer the ground. This pushes the eardrum inwards. If the pressure inside the middle ear is not equalised quickly, then you can get ear pain. Other situations where air pressure may quickly rise outside the ear is during scuba diving, diving to the bottom of a swimming pool, or rapidly descending in a lift (elevator).

Why are some people affected more than others?

The Eustachian tube is normally closed but opens from time to time when we swallow, yawn or chew. So, in most people, just normal swallowing and chewing allows air to flow up or down the Eustachian tube to quickly equalise the air pressure either side of the eardrum.

However, the Eustachian tube in some people does not open as easily and so the pressure may not be equalised so quickly. For example, some people may have a more narrow Eustachian tube than normal. Also, if you have any condition that causes a blockage to the Eustachian tube, then the air cannot travel up or down. The common cause of a blocked Eustachian tube is from mucus and inflammation that occur with colds, throat infections, hay fever, etc. In fact, any condition causing extra mucus in the back of the nose can cause this problem.

How can I prevent ear pain when I fly?

Ideally, anyone with a cold, respiratory infection, ear infection, etc, should not fly. However, not many people will cancel their holiday trips for this reason. The following may help people who develop ear pain when flying.

  • Suck sweets when the plane begins to descend. Air is more likely to flow up the Eustachian tube if you swallow, yawn or chew. For babies, it is a good idea to feed them or give them a drink at the time of descent to encourage them to swallow.
  • Try doing the following. Take a breath in. Then, try to breathe out gently with your mouth closed and pinching your nose (the Valsalva manoeuvre). In this way, no air is blown out but you are gently pushing air into the Eustachian tube. If you do this you may feel your ears go 'pop' as air is pushed into the middle ear. This often cures the problem. Repeat this every few minutes until landing - whenever you feel any discomfort in the ear.
  • Do not sleep when the plane is descending to land. (Ask the air steward to wake you when the plane starts to descend.) If you are awake you can make sure that you suck and swallow to encourage air to get into the middle ear.

The above usually works for most people. However, if you are particularly prone to develop aeroplane ear, you may wish to also consider the following in addition to the tips above.

  • Antihistamine tablets (available at pharmacies). Take the recommended dose the day before and the day of travel. This may help to limit the amount of mucus that you make.
  • A decongestant nasal spray can 'dry up' the mucus in the nose. For example, one containing Xylometazolene - available at pharmacies. Spray the nose about one hour before the expected time of descent. Spray again five minutes later. Then spray every 20 minutes until landing.

What about divers?

Normal practice of divers is to descend and ascend slowly which should give time for the air pressures to equalise either side of the eardrum. Divers can do the Valsalva manoeuvre (described above) too. You should not dive if you have a condition that may cause a blocked Eustachian tube as this may cause severe barotrauma and severe ear pain.

Are there any complications?

Ear pain can be severe, but in most cases no serious damage is done to the ear. Occasionally, the eardrum will perforate (tear). However, if this occurs, the eardrum is likely to heal by itself without any treatment within several weeks. See separate leaflet called 'Perforated Eardrum'.

© EMIS and PIP 2006   Updated: December