Ear Barotrauma: Causes, Symptoms, Treatment and Prevention

01Causes

Causes

• Flying: especially during descent.
• Scuba diving and free diving: pressure increases quickly underwater.
• Driving or travelling through mountains.
• Hyperbaric oxygen therapy.
• Explosions or blasts (rarely).
• Colds, allergies, sinusitis and enlarged adenoids increase the risk.

02Symptoms

Symptoms

• Ear pain or pressure.
• Feeling of fullness or blockage.
• Muffled hearing.
• Ringing or buzzing (tinnitus).
• Mild dizziness.
• In more severe cases: bleeding, fluid from the ear, severe pain followed by sudden relief (eardrum perforation), significant hearing loss or vertigo.

03Flying

Preventing barotrauma when flying

• Swallow, yawn or chew gum during take-off and especially descent.
• Use the Valsalva manoeuvre: pinch the nose, close the mouth and gently blow.
• Stay awake during descent so you can equalise.
• Consider pressure-regulating earplugs.
• If you have a cold, a pharmacist may suggest a decongestant spray before descent.
• Give babies a feed, bottle or dummy during take-off and landing.
• Avoid flying with a severe cold or ear infection if possible.

04Evidence

What the evidence shows

A review of otic barotrauma from air travel in the Journal of Laryngology and Otology described it as one of the most common medical problems for air travellers, especially children and people with upper respiratory tract infections. It recommended preventive measures such as swallowing, yawning, autoinflation, decongestants and pressure-regulating earplugs, and advised that people with colds consider postponing flights. Pressure changes from flying are also a common cause of earache in children.

05Diving

Preventing barotrauma when diving

• Do not dive with a cold, congestion or ear infection.
• Equalise early and often during descent, before you feel pain.
• Descend slowly, feet first if helpful.
• Stop descending if you cannot equalise; ascend slightly and try again.
• Never force equalisation with a very hard Valsalva.
• Take diving courses that teach equalisation techniques.

06Treatment

Treatment

• Keep trying to equalise: swallowing, yawning and gentle Valsalva.
• Take simple painkillers such as paracetamol or ibuprofen.
• Use a warm compress over the ear.
• Use decongestants or nasal steroid sprays if a pharmacist or doctor advises.
• Avoid flying or diving again until symptoms have fully resolved.
• Ear pressure tips are in ear pressure relief and ear won’t pop.

07Recovery

Recovery time

Mild barotrauma usually resolves within a few hours to a few days. If fluid collects behind the eardrum, muffled hearing may last a week or two. A perforated eardrum usually heals on its own within a few weeks, and the NHS advises keeping the ear dry and avoiding swimming while it heals. Inner ear barotrauma, which causes vertigo and hearing loss, may need specialist treatment and sometimes surgery. More about perforations is in perforated eardrum.

08Children

Ear barotrauma in children

Children have narrower, more horizontal Eustachian tubes, so they are more prone to ear pain when flying. Babies can be fed or given a dummy during descent; older children can drink, chew or suck sweets. If a child has a cold or ear infection, talk to a doctor before flying. Crying during descent can actually help equalise pressure.

09Muffled

When muffled hearing persists

If hearing remains muffled for more than a few days after flying or diving, see a doctor. Fluid behind the eardrum, a perforation or inner ear injury may need assessment. Sudden hearing loss without an obvious cause is an emergency. See our guide to muffled hearing.

10Cases

Three common situations

• Ear pain and blocked hearing after landing: swallow, yawn, gently Valsalva and take pain relief; it usually settles within a day.
• Diver with ear pain who could not equalise: stop diving until symptoms resolve and see a doctor if pain persists.
• Sudden vertigo and hearing loss after a dive: seek emergency care.

11Valsalva

How to do the Valsalva manoeuvre safely

• Close your mouth and pinch your nostrils shut.
• Gently blow as if blowing your nose, until you feel a pop.
• Do not blow hard, as this can damage the ear.
• Repeat every few minutes during descent.
• Alternatives include swallowing while pinching the nose (Toynbee manoeuvre) or yawning.
• Stop if it causes pain, and do not use it if you have a known perforation.

12Who

Who is at higher risk?

• Children and babies.
• People with colds, allergies or sinusitis.
• People with a history of Eustachian tube dysfunction or ear surgery.
• Divers learning to equalise.
• People who sleep through descent on flights.

13Summary

Key points to remember

• Ear barotrauma is caused by pressure changes.
• Equalise early during descent when flying or diving.
• Avoid flying or diving with a cold if possible.
• Severe pain, bleeding, vertigo or hearing loss need urgent care.