Barotrauma is the pain or discomfort that is felt with a difference in air or water pressure between the outside environment and the inside of the body.
Any part of the body that contains air can be sensitive to these pressures: Ear (most common)—affecting structures in the middle earSinus—air-filled facial sinuses surround the bones in the skullPulmonary (most critical)—lungs
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Normally air moves easily between outside and inside of the ear, sinuses, and lungs, helping to maintain a balance of pressure. Imbalances may be created with: Sudden or severe changes in surrounding pressureBlockages in the body's air cavities
The imbalance of pressure causes the air inside your body to shrink or swell. This is what can cause pain and damage.
Activities that can expose someone to significant pressure changes include: Airplane travel
Ascending (going up to the surface) without exhaling freelySwimming quickly to the surface when divingHolding your breath when ascendingUnderwater diving for an increased period of timeRepeated dives within 24 hoursFlying in an airplane after divingHaving air pockets in equipment (such as masks and dry suits)Mechanical ventilation
—use of a machine to move air into and out of the lungs (associated with pulmonary trauma)
Exposure to shock waves from an explosion
The inner ear is connected to outside air through tubes to keep inner and outer pressure balanced. Blockages and congestion in these tubes increase the risk of ear barotrauma because the inside pressure is not allowed to change to match the outside pressure. These tubes may be blocked or limited by:
coldsMiddle ear infections—more common in younger childrenDefects of eustachian tube (small tube that runs from the middle ear to the back of the nose and upper throat and helps stabilize internal and external pressures)Damaged or blockage of eustachian tube—resulting from scarring or a tumorCleft palate
Similarly, blockages in the sinuses will block the flow of air from outside to inside the body. Sinuses may be impaired by:
Nasal congestion from a
, cold, or allergies
Structural defects of the sinuses or their drainage system
Pulmonary barotrauma may be more likely in those with damage from previous or current lung conditions.
Other factors that may affect the ability for air spaces in the body to work properly include: SmokingDehydrationObesity
Symptoms will depend on what areas are affected.
Ear barotrauma may cause: Discomfort or pain in one or both earsFeeling as though your ears are cloggedFeeling of pressure in your earsLightheadedness
Ringing in the ear—
hearing lossRarely, bleeding from the ear
Complications include long-term or permanent hearing loss,
, or a
Sinus barotrauma may cause: Sinus pressure and/or painFeeling of fullness in the headNasal bleedingHeadachesTooth pain
Pulmonary barotrauma may cause: Shortness of breathChest painFeeling of fullness in the chestPain that radiates to the neck and/or shouldersLightheadednessConfusionSeizureDegrees of consciousnessComa
Potential complications can include
Your doctor will ask about your symptoms and medical history. A physical exam will be done to look for irritation or tissue damage. Barotrauma may be suspected based on your recent activities, such as air travel or scuba diving.
Ear structures will be visually examined
Suspected pulmonary barotrauma may be evaluated with: Chest x-rayCT scanMRI scanLung perfusion scanPulmonary function tests
to measure lung function
Pulse oximetry—to measure the amount of oxygen in the blood
Pulmonary barotrauma is serious and needs immediate medical attention. Treatment will depend on the specific lung problem that is present, such as a collapsed lung.
The following measures can also prevent barotrauma. Treatment options include the following:
Pressure can be relieved with self-care and medications.
To relieve the pressure in the eustachian tube, you can: Suck candyChew gumYawnInhale and gently exhale through your nose while pinching your nostrils shut. This forces air through the blocked eustachian tube and possibly opens it.
It is important to relieve nasal congestion and open your eustachian tube. Medications to relieve ear and sinus pressure include: Decongestant nasal spraysOral decongestantsOral antihistamines
Pain relievers can be used if ear or sinus pressure is causing pain. Antibiotics may be used if a bacterial infection is present or possible.
Emergency medical care may include:
Surgery may be necessary to relieve the pressure if your eustachian tube does not open with other treatments. Your doctor will make a small cut in your eardrum to equalize the air pressure. Any fluid blocking the tube may also be removed.
Oxygen should be given immediately for pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube under the nose.
To help reduce your chance of barotrauma during:
If you can, postpone your flight if you have a cold or are congested. Use a decongestant if travel can not be delayed.
To relieve the pressure during take-off and landing, try:
Sucking candyChewing gumYawningBreathing with your mouth openUse filtered earplugs to slowly equalize the air pressure against your eardrum.Avoid sleeping during descent because you may not be swallowing enough.
To help your baby through pressure changes, give your baby a pacifier or bottle during landing and take off.
Get proper training and certification.Make sure all your equipment is working and vented properly.Keep diving depth to level of experience.Follow all breathing guidelines, especially when coming up from a dive.Don’t stay under the water at greater depths long periods of time.Avoid flying or going to a higher altitude for the next 24 hours after diving.Take a decongestant pill or nasal spray a little before diving.
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http://american-hearing.org/disorders/barotrauma. Updated October 2012. Accessed November 4, 2014.
Barotrauma. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/injuries_poisoning/injury_during_diving_or_work_in_compressed_air/barotrauma.html. Updated May 2013. Accessed November 3, 2014.
Brandt MT. Oral and maxillofacial aspects of diving medicine.
Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/content/ears-and-altitudeearsAltitude.cfm. Updated February 2, 2012. Accessed November 4, 2014.
Newton HB. Neurologic complications of scuba diving.
Am Fam Physician. 2001;63(11):2211-2218.
Last reviewed December 2014 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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