How pressure works in the ear

The middle ear is an air-filled hole. It sits between the inner and outer parts of the ear. It has 3 small bones that help send sound. It also has the opening of the Eustachian tube. This is a small tube that leads from the middle ear to an area behind the nose. This tube stays closed most of the time.

For your hearing to work, the pressure in the middle ear has to match the pressure in the air around you. If the pressure does not match, the Eustachian tube will open. This makes the pressure in the middle ear and the air around you the same.

What causes ear barotrauma?

It’s caused by a pressure difference that can happen during:

• Scuba diving. Scuba diving can also cause another condition that is like barotrauma and needs treatment right away.

• Air travel

• High pressure oxygen therapy for wound healing

• Exposure to an explosive blast

Most people in these situations don’t get ear barotrauma. It happens only when the Eustachian tube does not open. Swelling or fluid buildup in the area around the tube can make it not open. This may be caused by:

• Allergies

• Sinus stuffiness

• Having a cold or other infection

• Anatomical problems

• Contact with irritants such as tobacco smoke

• Certain hormonal changes such as during pregnancy

What are the symptoms of ear barotrauma?

Symptoms can be mild to severe. The most common symptoms of ear barotrauma may include:

• Feeling of pressure in the ear

• Ear pain

• Dizziness

• Feeling like you have a blocked ear

• Bleeding from the ears or into the middle ear

• Ringing in your ears

• Hearing loss

Some events that cause ear barotrauma may also harm the lungs and sinuses. This can cause symptoms such as facial pain or shortness of breath.

How is barotrauma diagnosed?

Your healthcare provider will ask about your health history and your symptoms. You’ll be asked about recent events that may have caused ear barotrauma, such as air travel. Your healthcare provider will give you a physical exam. This may include an exam of the ear, and hearing and balance tests.

How is barotrauma treated?

Treatment for barotrauma depends on the part of the ear that is affected. For middle ear barotrauma, your healthcare provider may tell you to: 

• Keep the ear clean and dry

• Use steroid or decongestant medicine in the nose as directed

• Take antibiotic medicine as prescribed, if an infection develops

When to call your healthcare provider

Call your healthcare provider right away if you have the symptoms of barotrauma, especially if they are lasting or severe.