Ear Barotrauma

• Barotrauma most commonly affects the middle ear because that is where there is a pocket of air that is sensitive to changes in air pressure.
  • In the ear, you have a thin layer of skin (or membrane) at the end of the ear canal that vibrates and transmits sound to your middle ear. This is called the eardrum.
  • Normally, the air pressure inside and outside your ear is the same. The eustachian tube, the tube that connects the middle ear and the throat, works to balance the air pressure on both sides of your eardrum by allowing air to flow into or out of the middle ear.
  • Ear barotrauma is caused when the eustachian tube gets blocked and your body is not able to equalize the air pressure inside and outside the eardrum.
  • Ear barotrauma is usually not severe or dangerous and is easily treatable, but occasionally there are complications such as loss of hearing]]> , ear infection, dizziness, or a perforated (punctured) eardrum.

Sinus Barotrauma

• Sinuses are air-filled pockets in the bone around the nose.
  • Sinus barotrauma occurs when there is a difference in pressure between the air in the sinuses and the pressure outside.
  • You may experience pain around your cheek bones or above your eyes.
  • You may also experience headaches.
  • In the presence of a cold or nasal congestion, this may lead to severe ]]>sinus infection]]> .

Pulmonary (Lung) Barotrauma

• Pulmonary barotrauma is the injury that is caused when outside pressure is different than the pressure of the air in your lungs.
  • Scuba divers swim with canisters of compressed air for breathing under water. If a diver has too much compressed air and ascends without properly exhaling, the lungs may overinflate. One complication is that the lung could collapse.
  • Another complication is “decompression sickness” (often referred to as “the bends”).
    • Decompression sickness occurs when nitrogen, a chemical dissolved in blood by high pressure, forms bubbles as pressure decreases (such as when you swim up to the surface when diving). These bubbles may leak out into your bloodstream as air bubbles, called air embolisms.
    • Air embolisms can travel to any organ in the body and are dangerous when they block blood vessels that feed an organ, especially the heart, lungs, and the brain.
    • Decompression sickness is classified as Type 1 or Type 2. Type 1 is when the bubbles affect the tissues around joints. Knees, elbows, and shoulders are most often affected. Type 2 is more serious and involves the central nervous system (brain and spinal cord) or the lung and heart.

Ear Barotrauma

• Discomfort or pain in one or both ears
• Feeling as though your ears are clogged
• Feeling of pressure in your ears
• Dizziness
• Hearing loss]]> (temporary)
• Bleeding from the ear (rare)
• ]]>Tinnitus]]>

Sinus Barotrauma

• Sinus pressure and/or pain
• ]]>Nasal bleeding]]>
• Headaches
• Tooth pain

Pulmonary Barotrauma

Ear Barotrauma

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.

Sinus Barotrauma

There are no tests to diagnose sinus barotrauma. Diagnosis depends on your doctor getting an accurate history and then conducting an appropriate examination.

Pulmonary Barotrauma

To check for air embolisms and possible lung collapse, your doctor may order tests such as:

• Chest x-ray]]> —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—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)]]> —imagining scan that provides a three-dimensional image of your body, allowing your doctor to look for brain or spinal cord abnormalities
• Pulse oximetry—to measure the level of oxygen in your blood. This is a simple device that clips on the finger to measure the oxygen level.

Pressure Relief

To relieve the pressure in your eustachian tube, you can:

• Suck candy
• Chew gum
• Yawn
• Inhale and gently exhale through your nose while pinching your nostrils shut, forcing air through the blocked eustachian tube and possibly opening it.

Medications

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

Antibiotics

Your doctor may prescribe antibiotics to prevent an ear infection if the barotrauma is severe.

Surgery

Surgery is usually a 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 remove any fluid that might be blocking the tube.

Oxygen Treatment

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.

Recompression Therapy

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 Divers Alert Network offers information on these chambers.

Flying

• 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
  • Yawn
  • 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 before the start of the flight to shrink the membranes in the eustachian tube. This will 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.

Scuba Diving

• 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, nose, or 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.
• 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.
• Never dive alone.