| name: | Barotrauma Ear |
| also known as: | Barotitis Media; Barotrauma; Eustachian Tube Dysfunction; ETD; Aerotitis Media; Ear Popping; Clogged Ear; Plugged Ear; Ears Clogged; Ears Plugged; Aerosinusisits; ICD 993.0 |
| also see: | Ear Injury; Ruptured Eardrum; Altitude Sickness; Decompression Sickness; Middle Ear Infection; ICD; ICD |
| description: | Barotrauma is inflammation of the middle ear space due to a pressure gradient between the middle ear and the "outside world" on the other side of the tympanic membrane (external ear canal). The middle ear is connected to the back of the throat by a long, narrow tube called the eustachian tube. Talking, swallowing, yawning opens up the tube which then equilibrates the air into the middle ear from the outside world. If the eustachian tube is blocked or otherwise, is not working correctly, the air pressure in the middle ear becomes either too high or too low, with either eardrum retraction or protrusion. Inflammation or damage to the middle ear (the part of the ear behind the eardrum) caused by these pressure changes occurs. Causes include airplane descent, scuba diving, sky diving, high impact sports, as well as medical conditions such as cold, flu, upper respiratory infection, sinus infection, hay fever, stuffy nose, nasal septal deviation, and cleft palate. Eustachian tube dysfunction is sometimes used to also describe a subset of barotrauma when the diagnosis is uncertain but the tube is nevertheless dysfunctioning. Risk increased with SCUBA diving, airplane flight, sky diving, mountain hiking, high impact sports, infants and young children. |
| signs & symptoms: | Ear pain or a sense of ear fullness or ear plugging, dizziness or vertigo, and ringing in the ear called tinnitus, as well as hearing loss. |
| diagnosis: | Based on signs and symptoms as well as an exam by the doctor and a hearing test with tympanogram. Differential diagnosis includes serous otitis media, outer ear infection, middle ear infection, bullous myringitis, nasopharyngeal tumor. |
| treatment: | Varies depending upon the severity and underlying cause. Can include medicine for pain as well as: 1. Decongestants such as pseudoephedrine (sudafed), pseudoephedrine/triprolidine (actifed) 2. Decongestant nasal sprays in order to equilibrate the pressure in the middle ear space, such as phenylephrine nasal spray (neo-synephrine, vicks, sinex), oxymetazoline nasal spray (afrin) 3. Antihistamines especially if there is an allergic component, such as diphenhydramine (benadryl), fexofenadine (allegra), loratadine (claritin), fexofenadine/pseudoephedrine (allegra-D), loratadine/pseudoephedrine (claritin-D), cetirizine (zyrtec) 4. Nasal steroid sprays such as beclomethasone nasal spray (beconase, vancenase). Techniques to open up the eustachian tube include classic valsalva - pinch nose and attempt to blow out through closed mouth, as well as other techniques to open the eustachian tube in order the allow pressure equilibration: breast feeding for infants, chewing gum if >4 years old, gently blowing up balloons if >8 years old. Rarely surgical intervention to drain infected fluid from the middle ear might be required, called a tympanotomy (tympanoplasty). For airplane flights, chewing gum, valsalva, antihistamines. If the person has reflux esophagitis that is irritating the eustachian tube orifice, might try omeprazole (prilosec) |
| prevention: | Avoid pressure changing situations if the person has a cold or respiratory infection. If the person is prone to barotrauma, such as when flying, chew gum on descents and consider taking an oral or nasal spray decongestant prior to the descent. |
| outcome: | Most cases of barotrauma recover uneventfully. The occasional case can go on to permanent hearing loss, ear infection or a ruptured eardrum. |
skynetMD suggests the following:
| if: | If the person has severe headache, vertigo, dizziness, fever, chills, complete hearing loss, or drainage from the ear |
| go to: | Go to the doctor |
| if: | If the person is prone to develop barotrauma, such as with flying, and is under the care of a doctor, they should also chew gum during the descent, and |
| go to: | Go to the pharmacy for both an oral over the counter nonprescription decongestants and decongestant nasal sprays (use spray for no more than 3 days). |
Last updated 11/16/2008