Many people experience sudden severe pain in the ears and dizziness during an airplane landing approach, at the end of a mountain ride by gondola, or in the middle of a dive. These symptoms could indicate barotrauma of the middle ear. This is triggered by the altered pressure, which cannot be compensated.
What is barotrauma?
Barotrauma is caused by excessive pressure differences. Tissues of the body are damaged because the pressure of 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. However, the positive or negative pressure can cause injury in many other parts of the body. The exact extent of barotrauma depends on the corresponding absolute amount of pressure change and the rate of pressure increase or decrease.
Causes
Barotrauma is caused by rapid changes in ambient pressure and the body’s inability to equalize pressure. During landing approaches in airplanes, diving, or cable car rides in the mountains, such situations predominantly occur in which the pressure conditions change suddenly. This means that the pressure of the environment is much higher or lower than in the specific organs.
- Barotrauma during diving
Diving most often leads to pressures that are too different, making it difficult to equalize the pressure. The pressure is already double at a water depth of ten meters. With pre-existing conditions such as a cold, sinusitis or allergy, it is even more difficult for the affected person to balance the pressure in the middle ear due to the swollen mucosa. The result is then the painful and unpleasant barotrauma.
- Barotrauma when flying
Air pressure decreases with increasing altitude when flying, resulting in overpressure in the middle ear. This is balanced via the connection ear / nose / throat. The pressure is raised during the landing approach within about 15 minutes to the corresponding pressure at sea level. The pressure difference can be equalized by holding the nose closed and forcing air into this nose. If this pressure equalization does not succeed, barotrauma may result.
- Earplugs and bathing cap
Earplugs are also a cause of barotrauma in the external ear canal. Because they often seal the ear canal so much, the ear is not able to compensate for the pressure. Tight-fitting bathing 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, when the breathing apparatus does not work properly or the ambient pressure drops, which can not be compensated by an exhalation.
- Barotrauma on the tooth
Barotrauma can occur on the tooth, for example, due to a bad filling.
Symptoms, complaints and signs
Those who suffer from barotrauma usually complain of severe and stabbing pain in the ears, because of the overpressure or underpressure in the body cavity of the corresponding organ, for example, at the middle ear, injuries to the tissue occur. Likewise, a strong feeling of dizziness and violent nausea often occur. The latter can lead to vomiting. In addition, barotrauma can cause an acute middle ear infection. In more severe cases, even hemorrhages in the middle ear or tympanic membrane entrapment are possible. If the eardrum is severely affected, it may rupture due to severe stretching, which sometimes develops into hearing loss as a long-term consequence of barotrauma. Tinnitus can also result from barotrauma.
Diagnosis and course
In the case of barotrauma in the area of the ears or paranasal sinuses, it is predominantly the ENT physician who performs the examinations. These include, in addition to the anamnesis (conversation), for example, the observation of the nasopharynx, hearing tests, a reflection of the ears to ultrasound and computer tomography. All of this can provide information about the severity of the disease. Which examinations are necessary depends on the findings. In some cases, however, it may be necessary for the doctor to first look at vital functions, for example, in the case of barotrauma of the lungs.
Complications
In most cases, barotrauma results in uncomfortable sensations in the ears, eyes, or even teeth. Often, barotrauma occurs in a small manifestation when flying in an airplane, when the pressure changes and can press on the eardrum. In this case, the symptom disappears again on its own and no further complications occur. Due to a lack of pressure equalization, the eardrum can rupture in barotrauma. This results in very severe pain and hearing loss in the patient. Usually, the eardrum can no longer be treated because there is no specific treatment for the eardrum. However, hearing can be restored by using a hearing aid. If there is discomfort in the nose, sprays can be used to prevent swelling. If the lungs are damaged in barotrauma, treatment by a doctor must be immediate. Depending on the cause of the symptom, irreversible damage can occur here, leading to death in the worst case. Barotrauma makes diving underwater impossible or life-threatening for most people. If the symptom is treated promptly, there will be no further discomfort or complications.
When should you see a doctor?
If barotrauma is suspected, a specialist should be consulted as soon as possible. By examining the ear canal, the otolaryngologist can determine whether a ruptured eardrum is present. Further examinations subsequently provide information about the severity of the trauma and the treatment options. Whether a barotrauma is involved can be recognized by the typical symptoms. For example, severe and stabbing ear pain, dizziness and nausea indicate an injury to the middle ear. A visit to the doctor is absolutely necessary in this case. An ENT specialist must be consulted at the latest in the event of tinnitus or increasing hearing loss. Barotrauma mostly occurs during diving or flying, but can also be caused by earplugs or a swimming cap. Extreme athletes and people who use such aids should therefore talk directly to their family doctor if they experience ear pain. If the complaints are particularly intense or increase rapidly, a visit to the hospital is recommended. In any case, a knowledgeable physician must be consulted immediately if barotrauma is suspected.
Treatment and therapy
If barotrauma is suspected, a specialist should be consulted as soon as possible. In the case of the ear, for example, the physician can recognize whether a rupture of the eardrum has been caused due to the lack of pressure equalization. Otherwise, painkillers and decongestants are used for barotrauma. If the eardrum has been damaged, the reduction in hearing that may have occurred as a result can be well compensated for by a hearing aid. If there is barotrauma to the sinuses, a decongestant nasal spray may provide relief. Barotrauma to the lungs requires immediate intensive care because it is life-threatening. First, if necessary, the body’s vital processes must be ensured before the physician can address further pressure damage. Some injuries resulting from barotrauma may even require surgical intervention.
Outlook and prognosis
With early diagnosis and medical treatment, the patient with barotrauma has a good prognosis. The prospects for recovery diminish the later treatment is given and the more severe the symptoms are. In severe cases, tinnitus or hearing loss occurs. Mild barotrauma does not require medical care. The patient can take sufficient care of himself and should avoid the triggering situation. In the future, he should initiate changes in the circumstances so that the pressure triggering the height differences is reduced. A moderate severity of barotrauma is treated with medication with good treatment success. Pain medication and ear drops are administered, resulting in relief and then healing within a few days or weeks. If the barotrauma is severe, the eardrum may rupture. The larger the tear, the weaker the hearing later. If the patient suffers from pre-existing hearing conditions or if hearing remains poor after the barotrauma has subsided, he or she will need a hearing aid. The prognosis worsens as soon as the lung is involved.In order not to trigger permanent damage to lung activity, intensive medical treatment must be given immediately. The good prognostic prospects are also reduced if a rupture of the tympanic membrane is already present. Therefore, after experiencing barotrauma for the first time, the patient should avoid recurrence.
Prevention
When diving, barotrauma can be prevented by ruling out inflammatory infection before all dives. Even a harmless cold can have serious consequences underwater. Divers should not take decongestants if they have an existing cold or rhinitis, for example, to make the dive possible. During the dive, the medication can lose its effect and lead to problems. If ear pain becomes noticeable, do not dive deeper under any circumstances. In case of repeated attempts to equalize pressure, it is important to stop the dive. It is helpful to drink plenty of fluids before and during the ascent to great heights with corresponding pressure differences. Nasal mucous membranes should be kept moist with a nasal spray to avoid barotrauma.
What you can do yourself
Barotrauma should always be diagnosed and treated by a doctor first. The discomfort can be relieved by some home remedies and measures. As a first aid measure, rest and cooling are recommended. Ice packs or frozen vegetables relieve the pain and reduce swelling in the inner ear. Further pressure relief, on the other hand, should be avoided, as this may make the injury worse. More sensible is bed rest and avoiding loud noises. Medicinal herbs such as arnica or the anti-inflammatory comfrey can be used to accompany the treatment. Natural remedies can be used after consultation with the doctor either as a medicinal preparation or in the form of home-made teas, tinctures and ointments. However, the mentioned remedies should never be applied directly to the auricle or ear canal, as this may cause inflammation. If the symptoms persist despite all measures, the doctor should be consulted. Often, the barotrauma is due to a tear, which must be treated surgically. After the surgical procedure, diving should be temporarily avoided. The doctor in charge can give further tips and measures for a quick recovery.
