The air pressure in the middle ear is usually the same as the air pressure outside of the body. The eustachian tube is a connection between the middle ear and the back of the nose and upper throat.
Swallowing or yawning opens the eustachian tube and allows air to flow into or out of the middle ear, keeping the air pressure on both sides of the eardrum equal. If the eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum. This causes barotrauma.
Many people experience barotrauma at some time. Barotrauma commonly occurs with altitude changes, such as flying, scuba diving, or driving in the mountains. If you have a congested nose from allergies, colds, or an upper respiratory infection, you are more likely to develop barotrauma.
Blockage of the eustachian tube could also be present before birth (congenital), or it may occur because of swelling in the throat.
Feeling of pressure in the ears (as if underwater)
Moderate to severe hearing loss
Signs and tests
During an inspection of the ear, the doctor may see a slight outward bulge or inward pull of the eardrum. If the condition is severe, there may be blood behind the eardrum.
Severe barotrauma may be difficult to tell apart from an ear infection.
To relieve ear pain or discomfort, first try to open the eustachian tube and relieve the pressure.
Inhale, and then gently exhale while holding the nostrils closed and the mouth shut
Suck on candy
When flying, do not sleep during the descent. Use these measures frequently to open the eustachian tube. Allow infants and children to nurse or sip a drink during descent.
Divers should descend and ascend slowly. Diving while you have allergies or a respiratory infection is dangerous, because barotrauma may be severe.
If self-care attempts do not relieve your discomfort within a few hours, or if the barotrauma is severe, you may need medical intervention.
Medications recommended may include:
Decongestants taken by mouth or by a nose spray
These medications may relieve nasal congestion and allow the eustachian tube to open. Antibiotics may prevent ear infection if barotrauma is severe.
If the tube will not open with other treatments, surgery may be necessary. A surgical cut is made in the eardrum to allow pressure to become equal and fluid to drain (myringotomy). However, surgery is rarely necessary.
If you must make frequent altitude changes or you are susceptible to barotrauma, you may have tubes surgically placed in the eardrum.
Barotrauma is usually noncancerous (benign) and responds to self-care. Hearing loss is almost always temporary.
You can use nasal decongestants or antihistamines before altitude changes. Try to avoid altitude changes while you have an upper respiratory infection or allergy attack.
Talk to your doctor about using decongestants if you plan to scuba dive.
O’Reilly RC, Sando I. Anatomy and physiology of the eustachian tube. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 131.
Arts HA. Sensorineural hearing loss in adults. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 149.
A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington (8/3/2010).