Ear Barotrauma: Symptoms, Causes, And Tinnitus Connection

Scuba diver

If you’ve ever felt pressure in your ears after driving over a big hill or flying in an airplane, you’ve probably experienced ear barotrauma. That unmistakable feeling like your ears need to “pop” is due to rapid pressure fluctuations while your body attempts to adjust. Ear barotrauma is usually fleeting, but in some cases, that feeling intensifies and can even lead to tinnitus or hearing changes. Prepare yourself for pressure changes during air travel and know your risk factors so your ears stay comfortable and quiet – even under pressure.

What Is Barotrauma?

The “baro” prefix in the word barotrauma refers to barometric pressure, or the amount of atmospheric pressure exerted on your body. When your body can’t keep up with sudden changes in water or air pressure, sensitive structures like ears, lungs, or blood vessels can become damaged. Although the brief sensation of ear barotrauma is familiar to many of us, it is a type of injury and it’s a good idea to take it seriously before it becomes bothersome.

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Barotrauma is a common medical problem most often experienced by air travelers and people who experience rapid changes in altitude, like driving over a mountain or steep hill. Even a long elevator ride in a high-rise building can impact your ear. Skydivers and scuba divers frequently experience barotrauma, because water or air pressure changes occur very rapidly.

Ear barotrauma is, of course, limited to the ear and related structures, whereas generalized barotrauma affects the whole body. This is also called decompression sickness and it can be very serious. Scuba divers who ascend too quickly without giving their body time to adjust are at risk of decompression sickness – also known as the bends, which can cause extreme pain and may even be life threatening. Barotrauma that affects the lungs can become a complex medical condition that may also have serious consequences. Ear barotrauma, on the other hand, is not deadly, but it’s still an injury. In most cases, ear barotrauma is a mild annoyance, but in extreme conditions, symptoms can be severe. The long-term effects can lead to pain, tinnitus, or permanent hearing loss.

Common Symptoms Of Ear Barotrauma

Man covering his eyes

The most common symptoms of ear barotrauma include ear pain, ear fullness, and that tell-tale sensation that your ears need to pop. That feeling of fullness may extend to your sinuses, and you might have a runny nose. You may notice that sound seems muffled and you may hear a ringing in one or both ears. The majority of ear barotrauma cases are mild and resolve quickly, with or without treatment.

If you notice a spinning sensation, your vestibular system or eighth cranial nerve may be impacted. The fluid in your inner ear controls your sense of balance and spatial orientation, so some people with ear barotrauma experience vertigo.

Severe symptoms can be much more distressing and can cause more significant injury. Watch out for severe pain, dizziness or vertigo, bleeding, fluid draining from the middle ear into the outer ear, hearing loss, motion sickness, nausea, headaches, and intense tinnitus. In some cases, ear barotrauma can impact your inner ear’s balance system, spark an ear infection, or even rupture your eardrum.

See your doctor right away if you notice these more severe symptoms due to a sudden pressure difference. Your healthcare provider will likely perform exams including otoscopy, imaging, tympanometry, and a hearing test to reach a diagnosis and make a treatment plan.

How And Why Does Pressure Impact The Ear?

The rapid change in air or water pressure affects the eustachian tubes, which connect the middle ear and the back of the nose and throat. The eustachian tubes manage the amount of air pressure in the middle ear space and on the eardrum. Its job is to ensure equal air pressure on both sides of the eardrum and allow your ear to function properly. Too much pressure too quickly can overwhelm the eustachian tube, disrupting the balance of pressure on the middle ear.

Middle Ear Barotrauma

Middle ear barotrauma is the most commonly experienced type, and most people say it feels like a fullness in the ear. It’s very common among children because their eustachian tubes are still developing, and are narrower than those of adults. This makes ear canal blockages more likely. This is the same reason children are more prone to ear infections (otitis media) – the eustachian tube is narrow and inefficient at draining fluid from the middle ear space.

In severe cases of middle ear pressure, the eardrum (also known as the tympanic membrane) can be ruptured. This may cause bleeding or fluid drainage from the middle ear space into the ear canal and outer ear. Although this level of ear barotrauma is rare, always seek medical attention for a ruptured tympanic membrane, as it can result in permanent hearing loss and tinnitus.

Inner Ear Barotrauma

Less often, pressure may affect the inner ear. It may even create a tear in the membranes that separate the middle and inner ear, causing perilymphatic fluid from the middle ear space. This is known as a perilymphatic fistula and requires medical attention.

In rare cases, it is possible for sharp pressure changes to cause inner ear decompression sickness (IEDCS) among divers. It can be hard to distinguish IEDCS from barotrauma as both conditions present with similar cochlear and vestibular symptoms. IEDCS results from gas bubbles that occur in the endolymphatic and perilymphatic spaces of the inner ear during a quick ascent, and this condition can cause tinnitus and acute sensorineural hearing loss. Thankfully, IEDCS is extremely rare, and occurs in only 0.2-0.3% of recreational dives.

Research On Ear Barotrauma

Middle ear barotrauma as a complication of hyperbaric oxygen therapy is possible. A study of patients undergoing hyperbaric oxygen therapy found that 43.2% of patients experienced middle ear barotrauma as a complication.

Scuba diver

A recent study explored data to evaluate and understand inner ear symptoms among divers. The study found that as a diver descends, increased pressure causes the eardrum to be pressed into the middle ear space, which puts pressure on the stapes (one of the three tiny bones in the middle ear). The stapes then pushes more pressure on the oval window, the opening between the end of the middle ear and beginning of the inner ear and cochlea. In attempt to equalize this pressure, the diver typically performs a forceful valsalva maneuver (pinching the nose and forcefully blowing with mouth closed), which intracranial pressure and increased pressure of the cochlea, leading to a rupture of the round window in the middle ear.

That study found that 73% of those patients diagnosed with inner ear barotrauma experienced tinnitus. Other inner ear injuries in this group include perilymphatic fistula, inner ear hemorrhage, intracochlear membrane tear – and there was no significant difference in tinnitus symptoms between the different locations of injury.

How Is Ear Barotrauma Related To Tinnitus?

If you already experience chronic tinnitus, barotrauma can be particularly distressing. The sudden pressure shift can worsen tinnitus, or even trigger the onset of new tinnitus symptoms. The inner ear and middle ear are physically close to the auditory nerve, and any disruptions to these delicate structures can impact your hearing. As a result, barotrauma-related tinnitus can become a ringing or buzzing sound, which can persist long after the air pressure changes have settled. 

Preventing Ear Barotrauma

Ear barotrauma is much more likely to occur if you’re flying while you have an active cold, ear infection, or allergies. Take decongestants prior to flying to ease sinus pressure, since people with allergies have an increased risk of experiencing symptoms and discomfort. Your eustachian tubes are already working to equalize the pressure, so the additional air pressure during air travel can worsen these symptoms. Avoid air travel when sick to reduce your risk of barotrauma – and to prevent spreading germs to other passengers. 

You may also wish to chew gum, suck on hard candy, or sip water to prevent “airplane ear.” Yawning or swallowing can help ease that popping feeling as well. If you travel a lot or are concerned about your risk factors of severe ear barotrauma, there are also special earplugs you can use during a flight. However, if barotrauma is a chronic issue, ear ventilation tubes may be an option to help equalize air pressure. 

If you’re a diver, always follow all scuba diving instructions to ensure equal pressure on ascending and descending. Following proper scuba diving protocol will protect not only your ears but your whole health.

Ear Barotrauma Treatment 

In most cases of mild ear barotrauma due to air pressure differences, no special treatment is necessary. Your eustachian tube will equalize the pressure in your middle ear in time. Hearing loss and ear pain typically resolves after the air pressure stabilizes.

If you experience a more severe case of ear barotrauma, see a doctor, and in the event that your eardrum has ruptured, keep your ear dry and away from water until you are able to see a physician. In some cases, your eardrum may require surgical repair if it does not heal on its own. Placing a patch over the eardrum is called a tympanoplasty, and may preserve your hearing. Treatment for inner ear barotrauma may include bed rest or surgery.

If ear barotrauma has caused or worsened your tinnitus, you have treatment options. An audiologist can guide you through tinnitus management techniques like sound therapy, tinnitus retraining therapy (TRT), and relaxation exercises to ease discomfort and reduce stress.

Easing Middle Ear Pressure and Tinnitus

Quiet the ringing in the ears and prevent ear barotrauma during your airplane flight by preparing well. The sudden highs and lows in air pressure put stress on your eustachian tubes, which may struggle to adjust. Reduce pain by avoiding travel when you have sinus pressure or an infection.

Remember, the takeoff and landing during a flight cause the sharpest air pressure changes, so moving your jaw by chewing gum or yawning can be very helpful for reducing discomfort and pain. This helps your eustachian tubes adjust to the air pressure changes more quickly.

If you enjoy skydiving or scuba diving, always follow safety guidelines and allow your body to adjust to the pressure change. Although most ear barotrauma results in only mild symptoms, the possible complications can be dangerous. If you’re at increased risk of barotrauma, consider diving medicine to help your body adjust to the pressure differences while scuba diving. 

If you have ear pain, hearing loss, or other symptoms or concerns, talk to your doctor about your experience with middle ear equalization and techniques to prevent symptoms in the future. Taking steps to reduce injury before, during, and after pressure changes are key to protecting your hearing.

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