Barotrauma
En Español (Spanish Version)

Definition
Barotrauma is the pain or discomfort that you feel when there is a difference in air pressure between the outside environment and the inside of your body. You may have this discomfort when you fly in an airplane or go scuba diving.

The air inside your body squeezes together or swells as the outside pressure increases or decreases. The outside pressure can increase or decrease from water or air pressure. The squeezing and the swelling can cause pain and damage. Barotrauma can affect the ear, face (sinuses), and lungs. It can affect any part of the body with air inside.
The Ear

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Ear Barotrauma
  • Barotrauma most commonly affects the middle ear. The middle ear has a pocket of air that is sensitive to changes in air pressure.
    • You have a thin layer of skin (or membrane) at the end of the ear canal. It vibrates and sends sound to your middle ear. This is called the eardrum.
    • The air pressure inside and outside your ear is normally same. The eustachian tube connects the middle ear and the throat. It works to balance the air pressure on both sides of your eardrum. It allows air to flow into or out of the middle ear.
    • Ear barotrauma happens when the eustachian tube gets blocked. Your body cannot balance the air pressure inside and outside the eardrum.
    • Ear barotrauma is usually not severe or dangerous. It is easily treatable. Sometimes there are complications such as loss of hearing , ear infection, dizziness, or a perforated (punctured) eardrum.
Sinus Barotrauma
  • Sinuses are air-filled pockets in the bone around the nose.
    • Sinus barotrauma occurs when there is a difference in pressure between the air in the sinuses and the pressure outside.
    • You may experience pain around your cheek bones or above your eyes.
    • You may also experience headaches.
    • It may lead to severe sinus infection if you also have a cold or nasal congestion.
Pulmonary (Lung) Barotrauma
Pulmonary barotrauma is the injury that is caused when outside pressure is different than the pressure of the air in your lungs.

  • Scuba divers swim with canisters of compressed air. It allows them to breathe under water. The lungs may overinflate if a diver has too much compressed air and returns to the surface of the water without properly exhaling. One complication is that the lung could collapse.
  • Another complication is decompression sickness. This is also referred to as "the bends."
    • Nitrogen is a chemical dissolved in blood by high pressure. It forms bubbles as pressure decreases (such as when you swim up to the surface when diving). These bubbles may leak out into your bloodstream as air bubbles called air embolisms.
    • Air embolisms can travel to any organ in the body. They are dangerous when they block blood vessels that feed an organ such as the heart, lungs, and the brain.
    • Decompression sickness is classified as Type 1 or Type 2. Type 1 is when the bubbles affect the tissues around joints. Knees, elbows, and shoulders are most often affected. Type 2 is more serious. It involves the central nervous system (brain and spinal cord) or the lung and heart.
Barotrauma can even be due to equipment such as a mask or dry suit used for scuba diving. The equipment can block and trap air against the skin. You may become injured if an air pocket happens when you dive. Dry suits can painfully pinch your skin. Masks can cause blood vessels in the eyes to burst.

Contact your doctor if you think you may have some type of barotrauma.

Causes
Barotrauma is caused when the air pressure inside and outside the body are different. This results in discomfort. Causes include:

  • Flying
  • Scuba diving
    • Ascending (going up to the surface) without exhaling freely
    • Swimming quickly to the surface when diving
    • Holding your breath when ascending
    • Underwater diving for an increased period of time
    • Repeated dives within 24 hours
    • Flying in an airplane after diving
    • Having air pockets in equipment (such as masks and dry suits)
Risk Factors
Risk factors that increase your chance of developing barotrauma include:

  • Congested nose from allergies or colds
  • Congenital (present before birth) blockage of the eustachian tubes
  • Smoker
  • Age: children and older adults
    • Eustachian tubes in children are smaller and more likely to become blocked.
  • Damaged eustachian tube, caused by scarring or a tumor
  • Obstructions in the ear
  • Cleft palate or lip—may affect balance of pressure in the middle ears
  • Holding your breath while diving
  • Deeper dives
  • Long amounts of time spent underwater diving
  • Repeated dives within 24 hours
  • Flying in an airplane after diving
  • Rapid return to the surface when diving
  • Fatigue
  • Dehydration
  • Cold water
  • Obesity
  • Poor fitting equipment used for scuba diving
  • Congenital (present before birth) blockage or narrowing of the sinus drainage system
Symptoms
You need to seek treatment immediately if you have symptoms of an air embolism due to pulmonary barotrauma. Symptoms of an air embolism to the brain are usually identified very quickly after you surface from the water.

Symptoms of decompression sickness usually occur within an hour of surfacing from the water. They can also occur up to six hours later. It is very important to seek treatment immediately if you have decompression sickness.

If you have any of these other symptoms do not assume it is due to barotrauma. These symptoms may be caused by other, less serious health conditions.

Symptoms include:

Ear Barotrauma
  • Discomfort or pain in one or both ears
  • Feeling as though your ears are clogged
  • Feeling of pressure in your ears
  • Dizziness
  • Hearing loss (temporary)
  • Bleeding from the ear (rare)
  • Tinnitus
Sinus Barotrauma
Pulmonary Barotrauma
Air Embolism Symptoms
Symptoms may include:

  • Reactions similar to a stroke :
    • Headache
    • Agitation
    • Confusion
  • Other symptoms:
    • Partial paralysis
    • Sudden loss of consciousness
    • Seizures
    • Coughing up blood
    • Frothy blood at the mouth
    • Chest pain
    • Shortness of breath
    • Raspy voice
    • Pneumothorax —a condition in which air escapes from the lungs into the chest cavity and compresses the lungs resulting in a collapsed lung
Decompression Symptoms
Decompression symptoms may include:

  • Swelling
  • Pain in muscles, joints, and tendons
  • Problems of the spinal cord—paralysis
  • Problems of the sensory system
  • Problems with lungs—chest pain, cough , shortness of breath (sometimes called the chokes)
  • Rashes or itchy skin
  • Bubbles under your skin
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. If you have been flying or have been diving recently it is important to tell your physician.

Get medical help right away if you think that you have pulmonary barotrauma or decompression sickness.

Ear Barotrauma
Your doctor will look into your ear with a special flashlight called an otoscope. The otoscope allows your doctor to see your eardrum. Your doctor may see a bulge of the eardrum if you have barotrauma. This bulge occurs from the difference in pressure between the inside and outside of your eardrum. There may even be blood behind the eardrum.

Sinus Barotrauma
There are no tests to diagnose sinus barotrauma. Diagnosis depends on your doctor getting an accurate history and then conducting a physical exam.

Pulmonary Barotrauma
Your doctor may order tests to check for air embolisms and possible lung collapse.

Your doctor may choose to treat you immediately if you have been diving recently and show symptoms of decompression sickness.

Treatment
Talk with your doctor about the best treatment plan for you. The following measures can also prevent barotrauma. Treatment options include the following:

Pressure Relief
To relieve the pressure in your eustachian tube, you can:

  • Suck candy
  • Chew gum
  • Yawn
  • Inhale and gently exhale through your nose while pinching your nostrils shut. This forces air through the blocked eustachian tube and possibly opens it.
Medications
It is important to relieve nasal congestion and open your eustachian tube. Your doctor may recommend that you take some medications, including:

  • Decongestant nasal sprays
  • Oral decongestants
  • Oral antihistamines
  • Pain medications
Antibiotics
Your doctor may prescribe antibiotics to prevent an ear infection if the barotrauma is severe.

Surgery
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 Treatment
Oxygen should be given immediately if you have pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube near your nose.

Recompression Therapy
If you have decompression sickness, you need to be in a high-pressure environment. This allows the air bubbles that have formed to shrink and break up in your blood. Some medical centers have hyperbaric chambers (also known as high-pressure or recompression chambers). These chambers provide a high-pressure environment.

The Divers Alert Network offers information on these chambers.

Prevention
Take the following steps to help reduce your chances of getting barotrauma:

Flying
  • Postpone your flight if you have a cold or are congested.
  • Do things that will help keep the eustachian tube open to relieve the pressure, especially during take-off and landing. You can do this if you:
    • Suck candy
    • Chew gum
    • Yawn
    • Breath with your mouth open
  • Avoid sleeping during descent because you may not be swallowing enough.
  • Get filtered earplugs. These special earplugs slowly equalize the air pressure against your eardrum.
  • Have babies suck on a bottle or pacifier; do not let them sleep during descent.
  • Take a decongestant pill or nasal spray before the start of the flight to shrink the membranes in the eustachian tube. This will help make your ears pop more easily.
  • Some people have frequent barotraumas. Your doctor may suggest having tubes surgically placed in your eardrums to help balance the pressure and prevent the condition.
Scuba Diving
  • Be properly trained.
  • Be in good health before diving.
  • Make sure all your equipment is working properly.
  • Go down and come up slowly in the water when scuba diving. The United States Navy Diving Manual has guidelines. They list how often you should stop during your ascent and how slowly you should make your ascent.
  • Take a decongestant pill or nasal spray a little before diving. It will unblock your eustachian tubes, nose, or sinuses.
  • To prevent pulmonary barotrauma, do not hold your breath during ascent (going up).
  • Don’t smoke.
  • Exhale freely while ascending to the surface when diving. You should do this even in a swimming pool.
  • Don’t dive as deep.
  • Don’t stay under the water at greater depths for so long.
  • Avoid flying or going to a higher altitude for the next 24 hours after diving.
  • Know the location of the nearest recompression chamber.
  • Check your dry suit and your facial mask. Make sure your equipment is properly vented and that it won't cause air to be trapped against the skin.
  • Never hold your breath while breathing compressed gas and ascending.
  • Never dive alone.



RESOURCES:
American Academy of Audiology

American Academy of Otolaryngology—Head and Neck Surgery


CANADIAN RESOURCES:
Canadian Society of Otolaryngology—Head and Neck Surgery


References:
Barotrauma. American Hearing Research Foundation website. Available at: http://american-hearing.org/disorders/barotrauma/. Updated October 2012. Accessed November 12, 2012.

Brandt MT. Oral and maxillofacial aspects of diving medicine. Military Medicine . 2004;169:137-141.

Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/earsAltitude.cfm. Updated February 2, 2012. Accessed November 12, 2012.

Ears and sinuses. Alert Diver . Jan 2001. Available at: http://www.diversalertnetwork.org/medical/articles/Ears_and_Sinuses.

Newton HB. Neurologic complications of scuba diving. Am Fam Physician . 2001;63:2211-2118, 2225-2226.

Last Reviewed December 2013



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