What Is Barotrauma In The Middle Ear And How Can It Be Treated?

Barotrauma in the middle ear refers to a lesion in the middle ear caused by pressure changes (usually in aircraft cabins). In most cases, it is not very serious and disappears on its own shortly after you get off the plane.
What is barotrauma in the middle ear and how can it be treated?

The increasing number of international flights means that more and more people have to cope with the changing air pressure in the cabin. The air pressure in aircraft is lower than what we experience at sea level. As a result, it can trigger a condition known as barotrauma in the middle ear .

According to the report from IATA, International Air Transport Association , in 2019, there were a total of 4.3 million air passengers worldwide in 2018. A large number of them experience a discomfort in the middle ear that develops when the aircraft flies rapidly upwards to reach its flight level , or during the descent.

In most cases, the discomfort is temporary, but some people are unable to balance the pressure in the middle ear. This is known as barotrauma in the middle ear .

Read on to learn what it’s about and how to treat it.

What exactly is barotrauma in the middle ear?

This condition is also known as air pressure damage in the ear. As we mentioned earlier , it consists of an imbalance in the pressure in the middle ear that causes pain and even damage to the ear. This occurs more often in children.

To better understand this situation, we need to talk about some general concepts about the ear that will help us understand how we prevent or treat this condition.

Man with pain in the ear
Barotrauma affects the middle ear and causes pain and vertigo.

How does the middle ear work?

The middle ear is an air-filled space separated from the outside by two structures. On one side we have the eardrum and on the other side we have the eardrum. The latter separates the middle ear from the pharynx.

The pressure inside the space must be the same as the environment for the eardrum to vibrate and complete its function when it comes to hearing. Instantly, when we yawn or swallow, the eardrum opens briefly, allowing airflow through. This balances the pressure.

When the eardrum does not work properly, pressure differences will develop between the middle ear and the environment around us. This can lead to barotrauma.

The most common cause of this condition is flying. However, there are also some other causes, such as diving, climbing or using a hyperbaric chamber.

What happens on the plane?

On commercial aircraft, the cabin has a pressure similar to that found between altitudes of 7,000 and 10,000 feet. This is lower than the pressure at sea level. As the plane rises and falls, the atmospheric pressure will also change, which means that the pressure in the middle ear must change.

This change should be gradual and balanced if we swallow as normal. The air will therefore move spontaneously into or out of the middle ear through the eardrum. When this does not happen, however, the pressure can cause pressure and stretching of the eardrum, causing pain and hearing loss.

Bruising or bleeding may develop in the eardrum. Fluid can also occur in the middle ear. In the worst cases, the eardrum may rupture. There is a feeling of tension in the ear and the person may experience tinnitus.

What should you do if you experience barotrauma in the middle ear?

Most mild ear injuries will improve on their own over time, including rupture of the eardrum. However, this depends on the eardrum returning to normal. Hearing is usually good again.

In some cases, your doctor may prescribe oral mucosal decongestants, antihistamines and even antibiotics. All of these will help keep the eardrum clean. The use of painkillers will also help reduce the pain.

In a few situations, a fistula may occur. This is an abnormal communication between the middle ear and the inner ear and causes dizziness. In an emergency such as this, a specialist in otorhinolaryngology must intervene to evaluate the need for surgical repair.

Myringotomy (a small surgical incision made in the eardrum) and tympanostomy (placement of a tube in the eardrum) help prevent barotrauma in the middle ear and balance the pressure. It is also used as a treatment as it helps to drain the ear of fluids.

Woman at airport
Flights are the most common cause of barotrauma in the middle ear as the pressure changes affect the middle ear.

What precautions can we take when traveling by air?

If we travel by plane , we can help balance the pressure during ascent and descent to limit the discomfort or injuries. This is possible using the following methods:

  • Yawning or performing a gentle Valsalva maneuver, an exhalation effort while keeping the airways closed.
  • Chewing gum and swallowing often.
  • Eating sour candy.
  • Babies can suck on a bottle or a pacifier.
  • Sometimes mucosal decongestants, antihistamines and nasal sprays can be used before the flight, as long as they are prescribed by a doctor.
  • Experts have designed earplugs to reduce pressure changes. However, their actual benefits have not yet been proven.

If you have to fly, it is advisable to talk to your pediatrician or ENT specialist for advice. Preventing barotrauma in the middle ear, especially in the case of people with allergies or who are undergoing some form of infection, is crucial to improving your well-being on board aircraft.

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