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Once the sound waves travel into the ear canal, they vibrate the tympanic membrane, commonly called the eardrum. Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment. Barotrauma can affect several different areas of the body, including the ear, face and lungs.
Dizziness (or vertigo) may also occur during diving from a phenomenon known as alternobaric vertigo. Inner ear decompression sickness (IEDCS) is an injury that closely resembles inner ear barotrauma; however, the treatment is different. IEDCS most often occurs during decompression (ascent), or shortly after surfacing from a dive.
Barotrauma is caused by a difference in pressure between the external environment and the internal parts of the ear. The outer ear is an air-containing space that can be affected by changes in ambient pressure (see Figure 1). The most common problem that occurs in diving and flying is the failure to equalize pressure between the middle ear and the ambient environment (see Figure 2). As a diver descends to only 2.6 feet with difficulty equalizing the pressure of his middle ear space, the tympanic membrane and ossicles are retracted, and the diver experiences pressure and pain (see Figure 3). Inner ear injury during descent is directly related to impaired ability to equalize the middle ear pressure on the affected side.
The implosive mechanism theory (see Figure 4) involves clearing of the middle ear during descent. The explosive theory (see Figure 5) suggests that when a diver attempts to clear a blocked middle ear space by performing a Politzer maneuver and the eustachian tube is blocked and locked, a dramatic increase in the intracranial pressure occurs. For outer ear barotrauma, the treatment consists of clearing the ear canal of the obstruction, and restricting diving or flying until the blockage is corrected and the ear canal and drum return to normal. For middle ear barotrauma, treatment consists of keeping the ear dry and free of contamination that could cause infection. Prevention of air barotraumas to the middle ear has been attempted with dasal decongestants or vasoconstrictors with mixed results. For inner ear barotrauma, treatment consists of hospitalization and bed rest with the head elevated 30 to 40 degrees.
If barotrauma results from diving, you should not to return to diving until your ear examination is normal, including a hearing test and the demonstration that the middle ear can be autoinflated.
The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear and is also committed to educating the public about these health issues. Sudden changes in pressure, as from an explosion, blow to the head, flying, scuba diving, falling while water skiing, or being slapped on the head or ear. If the object is sticking out and easy to remove, gently remove it by hand or with tweezers. If you think a small object may be lodged within the ear, but you cannot see it, DO NOT reach inside the ear canal with tweezers.
Turn the person's head so that the affected side is up, and wait to see if the insect flies or crawls out. Cover the injury with a sterile dressing shaped to the contour of the ear, and tape it loosely in place.
Cover the outside of the ear with a sterile dressing shaped to the contour of the ear, and tape it loosely in place.
If you tend to feel pain and pressure when flying, drink a lot of fluid before and during the flight. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
Research indicates that when young children get colds, they end up with an ear infection more than 50% of the time. It is intended for general information purposes only and does not address individual circumstances.
It is caused by a difference in pressure between the two middle ear spaces, which stimulates the vestibular (balance) end organs asymmetrically, thus resulting in vertigo.
This injury is more common among commercial and military divers who breathe a compressed mixture of helium and oxygen. In contrast, barotrauma most often occurs during compression (descent) or after a short, shallow dive.


Since fluids do not compress under pressures experienced during diving or flying, the fluid-containing spaces of the ear do not alter their volume under these pressure changes. Equalization of pressure occurs through the eustachian tube, which is the soft tissue tube that extends from the back of the nose to the middle ear space. Sudden, large pressure changes in the middle ear can be transmitted to the inner ear, resulting in damage to the delicate mechanisms of the inner ear. The pressure is transmitted from an inward bulging eardrum, causing the ossicles to be moved toward the inner ear at the oval window.
Since the fluids surrounding the brain communicate freely with the inner ear fluids, this pressure may be transmitted to the inner ear. If the history indicates ear pain or dizziness that occurs after diving or an airplane flight, barotrauma should be suspected. Topical nasal steroids and decongestants may be started in an attempt to decongest the eustachian tube opening. Controversy exists whether this type of injury needs immediate surgery, though success has been reported with careful patient selection (Park et al 2012). At the American Hearing Research Foundation (AHRF), we have funded basic research on barotrauma in the past, and are interested in funding sound research on barotrauma in the future. These objects can be difficult to remove because the ear canal is a tube of solid bone that is lined with thin, sensitive skin.
As you pour the oil, pull the ear lobe gently backward and upward for an adult, or backward and downward for a child.
Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington.
A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.
Although the degree of pressure changes are much more dramatic during scuba diving, barotraumatic injury is possible during air travel.
The alternobaric response can also be elicited by forcefully equalizing the middle ear pressure with the Politzer maneuver, which can cause an unequal inflation of the middle ear space.
Patients with IEDCS should be rapidly transported to a hyperbaric chamber for recompression. However, the air-containing spaces of the ear do compress, resulting in damage to the ear if the alterations in ambient pressure cannot be equalized. An obstruction such as wax, a bony growth, or earplugs can create an air-containing space that can change in volume in response to changes in ambient pressure. This pressure wave is transmitted through the inner ear and causes an outward bulging of the other window, the round window membrane.
A sudden rise in the inner ear pressure could then cause the round or oval window membrane to explode. The diagnosis may be confirmed through ear examination, as well as hearing and vestibular testing.
A trial evaluating the effect of these earplugs found them to have no effect on eustachain tube function (Jumah et al 2010). Once healed, a diver should not return to diving until hearing and balance function tests are normal. Get more information about contributing to the AHRF’s efforts to detect and treat acoustic neuroma.. Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude.
Does the slow compression technique of hyperbaric oxygen therapy decrease the incidence of middle-ear barotrauma? Diagnosing an ear infectionDoctors usually diagnose an ear infection by examining the ear and the eardrum with a device called an otoscope. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. During descent, the volume of this space decreases causing the tympanic membrane to bulge outward (toward the outer ear canal). If a diver performs a forceful Politzer maneuver and the eustachian tube suddenly opens, a rapid increase in middle ear pressure occurs. In many cases, a doctor will need to use special instruments to examine the ear and safely remove the object.
AVOID using oil to remove any object other than an insect, since oil can cause other kinds of objects to swell.


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Slow compression hyperbaric oxygen therapy is associated with a lower risk of otic barotraumas than traditional hyperbaric oxygen therapy (Vahidova et al 2006). Therefore, the largest proportional volume changes, and thus the most injuries, occur at shallow depths. This causes the ossicles to suddenly return to their normal positions, causing the round window to implode. If the eustachian tube demonstrates chronic problems with middle ear equalization, the likelihood of recovery is drastically reduced. Any duplication or distribution of the information contained herein is strictly prohibited. Anatomy of an inner ear infectionThe Eustachian tube is a canal that connects the middle ear to the throat. It is lined with mucus, just like the nose and throat; it helps clear fluid out of the middle ear and maintain pressure levels in the ear. Colds, flu and allergies can irritate the Eustachian tube and cause the lining of this passageway to become swollen.
Fluid in the earIf the Eustachian tube becomes blocked or narrowed, fluid can build up in the middle ear. Perforated eardrumWhen too much fluid or pressure builds up in the middle ear, it can put pressure on the eardrum that may then perforate (shown here). Although a perforated eardrum sounds frightening, it usually heals itself in a couple of weeks.
Signs to watch for are tugging or pulling on an ear, irritability, trouble sleeping and loss of appetite.
Babies may push bottles away or resist breastfeeding because pressure in the middle ear makes it painful to swallow. Home care for ear infectionsAlthough the immune system puts up its fight, you can take steps to ease the pain of an ear infection. Over-the-counter painkillers such as age-appropriate ibuprofen or paracetamol, are also an option.
Antibiotics for ear infectionsAntibiotics can help a bacterial ear infection, but in most cases the infection is caused by a virus and the child’s immune system can fight off the infection without help. Complications of ear infectionsChronic or recurrent middle ear infections can have long-term complications. These include scarring of the eardrum with hearing loss, and speech and language developmental problems. A hearing test may be needed if your child suffers from chronic or frequent ear infections. Ear tubesIf your child has recurrent ear infections or fluid that just won't go away, hearing loss and a delay in speech may be a real concern. The tubes are usually left in for eight to 18 months and usually they fall out on their own. They can become enlarged and can affect the Eustachian tubes that connect the middle ears and the back of the throat. An adenoidectomy (removal of the adenoids) may be carried out when chronic or recurring ear infections continue despite appropriate treatment - or when enlarged glands cause a blockage of the Eustachian tubes. Preventing ear infectionsThe biggest cause of ear infections is the common cold, so try to keep cold viruses at bay. Other lines of defence against ear infections include avoiding secondhand smoke, vaccinating your children and breastfeeding your baby for at least six months. Allergies and ear infectionsLike colds, allergies can irritate the Eustachian tubes and contribute to middle ear infections. Swimmer's earOtitis externa, sometimes called “swimmer's ear”, is an infection of the ear canal.
Breaks in the skin of the ear canal, such as from scratching or using cotton buds, can also increase risk of infection.



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