Otic barotrauma is ear pain or damage to the tympanic membrane caused by rapid changes in environmental pressure.
To maintain equal pressure on both sides of the tympanic membrane, gas must move freely between the nasopharynx and middle ear. When an upper respiratory infection, allergy, or other mechanism interferes with eustachian tube function during changes in environmental pressure, the pressure in the middle ear either falls below ambient pressure, causing retraction of the tympanic membrane, or rises above it, causing bulging. With negative middle ear pressure, a transudate of fluid may form in the middle ear. As the pressure differential increases, ecchymosis and subepithelial hematoma may develop in the mucous membrane of the middle ear and the tympanic membrane. A very large pressure differential may cause bleeding into the middle ear, tympanic membrane rupture, and the development of a perilymph fistula through the oval or round window of the inner ear.
Symptoms of otic barotrauma are severe pain, conductive hearing loss, and, if there is a perilymph fistula, sensorineural hearing loss and/or vertigo. Symptoms usually worsen during a rapid increase in external environmental pressure, such as a rapid ascent (eg, during scuba diving) or descent (eg, during air travel or sky diving). Sensorineural hearing loss or vertigo during descent suggests the development of a perilymph fistula; the same symptoms during ascent from a deep-sea dive can suggest an air bubble formation in the inner ear.
If patients have eustachian tube dysfunction are treated with hyperbaric oxygen and experience similar symptoms during their first hyperbaric treatment, they require placement of tympanostomy tubes. Tube placement is also reasonable for patients with ear pressure after their first hyperbaric dive; such patients may have occult eustachian tube dysfunction or dysfunction only in certain situations (eg, only during hyperbaric treatment but not during an airplane flight). Tubes should be placed prophylactically for patients who have known eustachian tube dysfunction.
Treatment of Otic Barotrauma
Methods to equalize pressure (eg, yawning, swallowing, chewing gum)
Routine self-treatment of pain caused by changing pressure in an aircraft includes chewing gum, attempting to yawn and swallow, blowing against closed nostrils, and using decongestant nasal sprays. If pain is severe and hearing loss is conductive, myringotomy may help.
If hearing loss is sensorineural and vertigo is present, a perilymphatic fistula is suspected and middle ear exploration to close a fistula should be considered.
Prevention of Otic Barotrauma
A person with nasal congestion due to an upper respiratory infection or allergies should avoid flying and diving. When these activities are unavoidable, a topical nasal vasoconstrictor (eg, phenylephrine, oxymetazoline) is applied 30 to 60 minutes before descent and ascent.
