Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment. The most common examples of barotrauma occur in air travel and scuba diving. Although the degree of pressure changes are much more dramatic during scuba diving, barotraumatic injury is possible during air travel.

Barotrauma can affect several different areas of the body, including the ear, face and lungs. Here we will focus on barotrauma as it relates to the ear.

What are the Symptoms of Barotrauma?

Symptoms of barotrauma include “clogging” of the ear, ear pain, hearing loss, dizziness, ringing of the ear (tinnitus), and hemorrhage from the ear.

Dizziness (or vertigo) may also occur during diving from a phenomenon known as alternobaric vertigo. It is caused by a difference in pressure between the two middle ear spaces, which stimulates the vestibular (balance) end organs asymmetrically, thus resulting in vertigo. The alternobaric response can also be elicited by forcefully equalizing the middle ear pressure with the Politzer maneuver, which can cause an unequal inflation of the middle ear space.

Inner Ear Decompression Sickness

Inner ear decompression sickness (IEDCS) is an injury that closely resembles inner ear barotrauma; however, the treatment is different. This injury is more common among commercial and military divers who breathe a compressed mixture of helium and oxygen. Symptoms include hearing loss, ringing of the ears, and/or dizziness during ascent or shortly thereafter.

IEDCS most often occurs during decompression (ascent), or shortly after surfacing from a dive. In contrast, barotrauma most often occurs during compression (descent) or after a short, shallow dive. Patients with IEDCS should be rapidly transported to a hyperbaric chamber for recompression. A significant correlation exists between early recompression and recovery.

What Causes Barotrauma?
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