Barotrauma - A guide to Hearing Loss

This is a type of condition in which unequal air pressure within the ear stretches and tightens the ear drum leading to pain and discomfort. One example of this is the pain and discomfort experienced by travellers during a flight. This usually occurs during take off and landing and is a result of a change in air pressure within the cabin. This change affects the balance of air pressures within the outer, middle and inner ear which puts a strain upon the tissues (and eardrum) within the ear.

If you have flown then you may have experienced that feeling of blocked ears, or find that your hearing is fizzy or muffled in some way. This build up of pressure can be rather painful unless your ears ‘pop’which immediately relieves this pressure.

This is also a problem for divers. If you are a keen scuba diver then you may be prone to this condition especially at a lower depth. This is also a problem for swimmers when diving to the bottom of a pool.

And it can even occur in a lift. Strange as this may seem; if you are in a lift which is descending through a series of levels then you can experience a change in air pressure which may cause this problem.

How does air pressure work within the ear?

There are pockets of space within your ear through which air flows. These exist on either side of your ear drum.

The ear drum is located in the middle ear and acts as a halfway point between the outer and inner ear.

Air flows towards the middle ear via a slim channel within the inner ear called the Eustachian tube which runs from the ear to the back of the nose. This tube is usually closed but opens when you yawn, swallow or chew. These actions allow air to flow up and down this tube.

There is a space within the outer ear in which air flows into from external sources.

The air in both these spaces is usually evenly balanced which enables the ear drum to transmit sounds (by vibrating) towards the brain. These sound waves travel towards the brain via the inner ear (cochlea and auditory nerve) where they are transformed into electrical signals. These signals can then be read by the brain.

But if this air pressure changes, due to a high (or low altitude) or from diving to a great depth then barotraumas will occur. As the air pressure outside the ear changes then this is reflected by an increase of air pressure within the middle ear. The ear drum contracts and the resulting tension cause pain and discomfort.

A tight ear drum means that it is unable to vibrate and so transmit sounds towards the inner ear.

Symptoms of barotraumas An impaired ear drum means impaired hearing: your ears will feel as if they are blocked which muffles your hearing. And you may not be able to hear low frequency sounds. In some cases you may find that your balance is affected and you may experience nausea or even vomiting. However these are short-lived and have no lasting effects. You are more prone to this condition if you have a cold or an ear infection. If you have a cold or ear infection and are looking to fly then ideally you wouldn’t. But if you have booked a holiday or fly as part of your job then this isn’t an option.

Treatment for barotraumas

The following precautions may help during flying:

• Yawning or swallowing during take off and landing.
• Sucking sweets when the plane begins to descend. Barley sugars were considered ideal for this but any boiled sweet will do.
• Hold your nose, close your mouth, take a deep breath in and breathe out gently. This will force air into your Eustachian tube which will cause your ears to pop. This tends to resolve the problem but repeat it more than once if you have to. Also known as the ‘valsalva manoeuvre’.
• Make sure you are awake when the plane is landing. Yawn and swallow to encourage air flow within the ear.

And for scuba divers:

• Make sure you ascend and descend slowly. This is important to prevent ‘the bends’but will enable the air pressures within the ear to equalise themselves.
• Try the valsalva manoeuvre (see above).

It goes without saying that you mustn’t dive if you have a cold, ear infection or some other illness. If you are a frequent flier then the tips mentioned above should help. But if they don’t then antihistamine tablets or a decongestant nasal spray may help. This is a temporary condition which usually clears without any ill-effects. In a few severe cases the ear drum may rip (perforate) but tends to heal itself after a period of time.