The air pressure in the middle ear is most often the same as the air pressure outside of the body. The Eustachian tube is a connection between the middle ear and the back of the nose and upper throat.
Swallowing or yawning opens the Eustachian tube and allows air to flow into or out of the middle ear. This helps equalize pressure on either side of the ear drum. If the Eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum. This can cause barotrauma.
Many people have barotrauma at some time. The problem often occurs with altitude changes, such as flying, scuba diving, or driving in the mountains. If you have a congested nose from allergies, colds, or an upper respiratory infection, you are more likely to develop barotrauma.
Blockage of the Eustachian tube could also be present before birth (congenital). It may also be caused by swelling in the throat.
To relieve ear pain or discomfort, you can take steps to open the Eustachian tube and relieve the pressure, such as:
Inhale, and then gently exhale while holding the nostrils closed and the mouth shut
Suck on candy
When flying, do not sleep as the plane prepares to land. Repeat the listed steps to open the Eustachian tube. For infants and small children, nursing or taking sips of a drink may help.
Scuba divers should go down and come up slowly. Diving while you have allergies or a respiratory infection is dangerous. Barotrauma may be severe in these situations.
If self-care steps do not ease discomfort within a few hours or the problem is severe, you may need to see a health care provider.
You may need medicine to relieve nasal congestion and allow the Eustachian tube to open. These include:
Decongestants taken by mouth, or by a nose spray
You may need antibiotics to prevent an ear infection if barotrauma is severe.
Rarely, surgery may be needed if other treatments do not work to open the tube. In this procedure, a surgical cut is made in the eardrum to allow pressure to become equal and fluid to drain (myringotomy).
If you must change altitude often or you are prone to barotrauma, you may need to have surgery to place tubes in the ear drum. This is not an option for scuba diving.
Barotrauma is usually noncancerous (benign) and responds to self-care. Hearing loss is almost always temporary.
Ashutosh Kacker, MD, BS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.