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What is Barotrauma?
References
What is Barotrauma?
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.
Figure 1
Middle Ear
The most common problem that occurs in diving and flying is the failure to equalize pressure
between the middle ear and the ambient environment (see Figure 2). Equalization of pressure
occurs through the eustachian tube, which is the soft tissue tube that extends from the back of the
nose to the middle ear space. The extent of injury depends upon the degree and speed of the
ambient pressure changes. The greatest relative pressure changes in diving occur near the
surface. Therefore, the largest proportional volume changes, and thus the most injuries, occur at
shallow depths.
As a diver descends to only 2.6 feet with difficulty equalizing the pressure of his middle ear
space, the tympanic membrane and ossicles are retracted, and the diver experiences pressure and
pain (see Figure 3). At higher pressures the eustachian tube may become locked closed by the
negative pressure in the middle ear. This can occur at about 3.9 feet of water. Further increases in
pressure, at depths of only 4.3 to 17.4 feet of water, can cause the tympanic membrane to
rupture.
Acknowledgments
Figures are courtesy of Northwestern University.
This article was revised for this web site by Timothy C. Hain, MD
References
Bennett MH, Lehm JP, Mitchell SJ, Wasiak J. 2012. Recompression and adjunctive
therapy for decompression illness. Cochrane Database Syst Rev 5: CD005277
Mirza S, Richardson H. 2005. Otic barotrauma from air travel. The Journal of
laryngology and otology 119: 366-70
Park GY, Byun H, Moon IJ, Hong SH, Cho YS, Chung WH. 2012. Effects of early
surgical exploration in suspected barotraumatic perilymph fistulas. Clinical and
experimental otorhinolaryngology 5: 74-80
Vahidova D, Sen P, Papesch M, Zein-Sanchez MP, Mueller PH. 2006. Does the slow
compression technique of hyperbaric oxygen therapy decrease the incidence of middleear barotrauma? The Journal of laryngology and otology 120: 446-9