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The middle ear is a cavity covered on one side by the eardrum, with the other sides being bony.
During ascent, as the ambient pressure falls, the trapped air inside the middle ear expands, as per the Boyle’s law. However, if the pressure is not equalized, the eardrum is increasingly pushed inward giving rise to increasing intensity of pain. It is important to know that during a bout of common cold or related conditions, the tube remains temporarily blocked.
Early recognition of symptoms and then correct actions during flight can reduce the severity of pain. Besides avoiding flying during an attack of common cold or sore throat, voluntary equalisation of pressure in the middle ear helps prevent Otitic Barotrauma. Delayed Otitic Barotrauma can be prevented, if the aircrew, who had been on 100% Oxygen during their night flying, must consciously do Valsalva manoeuvre several times before going to bed.
The bones of the skull impinging the auditory nerve can create tinnitus, especially the sphenoid and temporal bones. There may be complaints of mild to severe pain in the ear, deafness, vertigo and ringing noise.
Though voluntary efforts, like Valsalva, can open the tube to equalize the pressure, it has limitations. Once the pain has started, it is advisable that the affected pilot stops the descent of the aircraft and levels off.

This is advisable since assessment of the degree of damage to the eardrum and an early start of treatment shall help prevent complications. Correctly done Valsalva manoeuvre helps pilots and passengers to keep open the Eustachian tube.
This is not a condition whose ultimate therapy combination has yet been found.  However, there may be help for you in our office. Divers during under-water operations, and patients in hyperbaric chamber may also suffer from barotrauma. This tube, akin to a flutter valve, is partly rigid and party collapsible; and normally remains closed. The expanding air inside the middle ear forces the tube open almost at every500 ft of ascent in an aircraft. If the pressure difference is allowed to rise beyond 85-90 mm Hg, any voluntary effort becomes ineffective, giving rise to severe pain in the affected ear. Even under normal conditions inability to ventilate due to pre-occupation or ignorance may sometimes lead to this condition. Flying during recovery is best avoided to prevent another attack and further complications. Valsalva manoeuvre is done by taking a deep breath in, pinching one’s nostrils and pressing the lips, to tightly close the mouth and nose and then trying to blow the air out with force, without letting it out from the mouth or the nostrils.
While breathing 100% Oxygen, particularly during night flying, the air in the middle ear is replaced with Oxygen.

The primary reason of Otitic Barotruama is pressure differential, either negative or positive, between the air in the middle ear cavity and the atmosphere, especially in presence of sore throat or cold. This allows the equalization of pressure with the ambient and the eardrum returns to its normal position.
If not relieved, it is advisable that one gains altitude at a slow rate of ascent while performing Valsalva manoeuvre repeatedly. It can be opened voluntarily by building up pressure inside the mouth and throat as in Valsalva manoeuvre.
During descent, on the other hand, the outside pressure progressively increases compared to the pressure inside the middle ear.
This may usually relieve the pain, and subsequent descent should be gradual while frequently performing Valsalva manoeuvre to ensure that the Eustacian tube is adequately ventilated. This invariably wakes the aircrew from sleep, later in the night, with severe pain in one or both ears. The Eustachian tube, as a flutter valve, remains closed unless opened by some active action like swallowing, chewing, yawning or Valsalva manoeuvre.

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