Ear & Balance
Ear pain after diving? You may have sustained an ear barotrauma!
February 1, 2020
I recently saw a patient, Ms A who suffered from blocked ears and ear pain after taking her first diving lesson. It occurred during her dive. She was worried that she might have sustained a permanent injury to her ears. She denied any ear discharge, giddiness, headaches or nasal symptoms. She did give a history of having ear discomforts during flights.
On clinical examination, there was a collection of blood in both her middle ears, just behind her ear drums. This resulted in a conductive hearing loss which was confirmed on a hearing test (audiometry). I explained to Ms A that she sustained a barotrauma to her middle ear and reassured her that the blood behind her ear drum (known medically as hemotympanum) will resolve on its own with time.
Picture of Ms A’s right ear drum with blood behind it (reddish hue)
Picture of Ms A’s left ear drum with blood behind it
Picture of a normal left ear canal and ear drum
Upon review in the clinic about a month later, Ms A was happy that her symptoms have resolved and her hearing is now back to normal. A clinical examination showed complete resolution of the blood in her middle ear. She was advised to take precautions to avoid such situation in the future.
What is ear barotrauma?
It is a condition in which one experiences ear symptoms (usually discomfort, blockage, pain or giddiness) as a result of exposure to changes in pressure in the environment (usually from a change in altitude)
What causes ear barotrauma?
The Eustachian tube is a bony-cartilaginous tube that connects the middle ear to the back of the nose (area known as nasopharynx). It helps to equalize the pressure the pressure in the middle ear and that of the outside environment. Maneuvers to actively open the Eustachian tube includes Valsalva maneuver (trying to “pop” your ear by blowing out against a pinched your nose and closed mouth), yawning, chewing and crying.
In ear barotrauma, the Eustachian tube fails to cope with the change in pressure. When this occurs, there is a difference in pressure across the ear drum (look at the figure below). The pressure difference can be large enough to cause blood vessels and ear drum to rupture.
Figure taken from “Koriwchak MJ, Werkhaven JA. Middle ear barotrauma in scuba divers. Journal of Wilderness Medicine, 5, 389-398 (1994)”
Who are at risk of ear barotrauma?
There are 3 main groups of people who might be at risk of ear barotrauma:
- People with Eustachian tube dysfunction
People who has problems equalizing their ears during flight or in areas of high altitude (E.g. in a tall building or mountains) are more likely to sustain ear barotrauma. It is likely that their Eustachian tubes are not functioning as efficiently as they should.
- People with problems with their nose
As one of the Eustachian tube opening is in the nose, if nasal allergies, colds or sinus infection, you may be more likely to sustain an ear barotrauma.
- Young children and babies
Eustachian tubes in children and babies are smaller, less matured and positioned in a way such that they are not as effective as adult Eustachian tubes. Babies and young children in a plane often cry during take off or landing as this helps open their Eustachian tubes to cope with the change in pressure.
What can I do to prevent ear barotrauma?
People at risk of ear barotrauma should avoid exposing themselves to situations that result in a sudden change in atmospheric pressure (E.g. diving, taking frequent airplane flights). If these situations are unavoidable, some precautions that may help include during the change in pressure:
- Taking decongestants or antihistamines half an hour to 1 hour before flight / diving
- Treat underlying nose problems
- Ventilation tubes placed in the ear drums for people who fly frequently
What is the treatment for ear barotrauma?
Fortunately, majority of ear barotrauma does not need any treatment and recovers fully on its own. During this period, patients should avoid exposing themselves to significant pressure changes in the environment such as diving or taking a flight.