Barotrauma – Causes, Symptoms & Treatment


Many people experience sudden severe pain in their ears and dizziness during the landing approach of an airplane, at the end of a mountain trip in a gondola or in the middle of a dive. These symptoms could indicate middle ear barotrauma . This is triggered by the changed pressure, which cannot be compensated for.

What is barotrauma?

Barotrauma is caused by excessive pressure differences. In the process, tissues of the body are damaged because the pressure in the environment rises or falls too much. Air-filled chambers in the body are particularly susceptible to this. Therefore, the ear is most commonly affected by barotrauma, but the sinuses and lungs are also susceptible.

However, the excess or negative pressure can cause injuries in many other parts of the body. The exact magnitude of the barotrauma depends on the corresponding absolute magnitude of the pressure change and the rate at which the pressure rises or falls.


Barotrauma is caused by rapid changes in ambient pressure and the body’s inability to equalize pressure. During landing approaches in airplanes, diving, or cable car rides in the mountains, there are mainly situations in which the pressure conditions suddenly change. This means that the pressure of the environment is much higher or lower than in the specific organs.

  • Barotrauma while diving

Diving most often results in pressures that are too different to make it difficult to equalize. The pressure is already twice as high at a water depth of ten meters. In the case of previous illnesses such as a cold , sinusitis or allergies , it is even more difficult for those affected to equalize the pressure in the middle ear due to the swollen mucous membrane. The result is the painful and uncomfortable barotrauma.

  • Barotrauma while flying

The air pressure decreases when flying with increasing altitude, which means that there is overpressure in the middle ear. This is compensated for via the connection between the ear/nose and throat area. The pressure is increased to the equivalent pressure at sea level within about 15 minutes during the landing approach.

The difference in pressure can be equalized if the nose is pinched shut and the air is pressed into this nose. Failure to equalize pressure can result in barotrauma.

  • Ear plugs and bathing cap

Earplugs are also a cause of barotrauma in the external ear canal. Because they often seal the ear canal so tightly, the ear is unable to equalize the pressure. Tight-fitting bathing caps often have the same effect.

  • barotrauma of the lungs

The reason for the dangerous barotrauma of the lungs is often that the air pressure becomes too low, for example when the breathing apparatus is not working properly or the ambient pressure drops, which cannot be compensated by exhaling.

  • Tooth barotrauma

For example, barotrauma can occur in the tooth due to a poor filling.

Symptoms, Ailments & Signs

Anyone who suffers from barotrauma usually complains of severe and stabbing pain in the ears , since the excess or negative pressure in the body cavity of the relevant organ, for example the middle ear, causes tissue injuries. Severe dizziness and severe nausea are also common .

The latter can lead to vomiting . In addition, barotrauma can cause an acute middle ear infection. In more severe cases, even bleeding in the middle ear or retraction of the eardrum is possible. When the eardrum is severely damaged, it can rupture due to excessive stretching, sometimes resulting in hearing loss as a long-term consequence of barotrauma . Barotrauma can also cause tinnitus.

Diagnosis & History

In the case of a barotrauma in the area of ​​the ears or paranasal sinuses, the examinations are mainly carried out by the ENT doctor. In addition to the anamnesis (conversation), these include, for example, the inspection of the nose and throat area, hearing tests , an examination of the ears, ultrasound and computed tomography .

All of this can provide information about the severity of the disease. Which examinations are necessary depends on the findings. In some cases, however, it may also be necessary for the doctor to first look at the vital functions, for example in the case of barotrauma of the lungs.


In most cases, barotrauma causes discomfort in the ears, eyes, or even teeth. Barotrauma often occurs in a small form when flying in an airplane when the pressure changes and can press on the eardrum. In this case, the symptom disappears on its own and there are no further complications.

Barotrauma can rupture the eardrum due to a lack of pressure equalization. This causes severe pain and hearing loss in the patient. As a rule, the eardrum can no longer be treated because there is no specific treatment of the eardrum. However, hearing can be restored by using a hearing aid.

If you have problems with your nose, sprays can be used to prevent swelling. If the lungs are damaged during barotrauma, treatment by the doctor must be carried out immediately. Depending on the cause of the symptom, irreversible damage can occur here, which in the worst case can lead to death.

Due to the barotrauma, diving under water is no longer possible or life-threatening for most people. If the symptom is treated promptly, there are no further complaints or complications.

When should you go to the doctor?

If barotrauma is suspected, a specialist should be consulted as soon as possible. By examining the ear canal, the ENT doctor can determine whether there is a tear in the eardrum. Further examinations then provide information about the severity of the trauma and the therapy options. Whether it is a barotrauma can be recognized by the typical symptoms. Severe and stabbing ear pain, dizziness and nausea indicate an injury to the middle ear.

In this case, a visit to the doctor is absolutely necessary. An ENT doctor must be consulted at the latest in the event of tinnitus or increasing hearing loss. Barotrauma most commonly occurs when diving or flying, but can also be caused by wearing earplugs or a bathing cap.

Extreme athletes and people who use appropriate aids should speak to their family doctor directly if they have an earache. If the symptoms are particularly intense or increase rapidly, a visit to the hospital is recommended. In any case, if barotrauma is suspected, a competent doctor must be consulted immediately.

Treatment & Therapy

If barotrauma is suspected, a specialist should be consulted as soon as possible. In the case of the ear, for example, the doctor can see whether a ruptured eardrum was caused by the lack of pressure equalization . Otherwise, painkillers and decongestants are used for barotrauma.

If the eardrum has been damaged, the reduction in hearing that may have occurred as a result can be compensated for with a hearing aid. A decongestant nasal spray can provide relief from sinus barotrauma.

Lung barotrauma requires immediate intensive care because it is life-threatening. First of all, if necessary, the vital processes of the body must be ensured before the doctor takes care of further pressure damage. Some injuries resulting from barotrauma may even require surgery.

Outlook & Forecast

With early diagnosis and medical treatment, the patient with barotrauma has a good prognosis. The chances of recovery decrease the later treatment is given and the more severe the symptoms are.

In severe cases, tinnitus or hearing loss can occur. Medical care is not required for mild barotrauma. The patient can rest sufficiently and should avoid the triggering situation. In the future, he should initiate changes in the circumstances so that the pressure release of the height differences is reduced.

A moderate degree of severity of the barotrauma is treated with medication with good treatment success. Painkillers and ear drops are given, which provide relief and then healing within a few days or weeks. Severe barotrauma can rupture the eardrum. The larger the crack, the weaker the ability to hear later on.

If the patient has pre-existing hearing conditions or if hearing remains poor after the barotrauma has resolved, a hearing aid is needed . The prognosis worsens once the lungs are involved. In order not to cause permanent damage to lung activity, intensive care treatment must be given immediately. The good prognosis is also reduced if there is already a tear in the eardrum. Therefore, after experiencing barotrauma for the first time, the patient should avoid recurrence of the disease.


Barotrauma can be prevented when diving by ruling out an inflammatory infection prior to all dives. Even a harmless cold can have serious consequences under water. Divers should not take any decongestants if they have a cold or runny nose, for example to enable the dive.

During the dive, the medication can become ineffective and cause problems. If ear pain becomes noticeable, you should never dive deeper. With repeated attempts to equalize pressure, it is important to abort the dive.

It is helpful to drink a lot before and during the overcoming of great heights with corresponding pressure differences. The nasal mucosa should be kept moist with a nasal spray to avoid barotrauma.

You can do that yourself

Barotrauma should always be diagnosed and treated by a doctor first. The symptoms can be alleviated with a few home remedies and measures.

Rest and cooling are recommended as first-aid measures. Ice packs or frozen vegetables relieve pain and reduce swelling in the inner ear. On the other hand, further pressure equalization should be avoided, as this can possibly aggravate the injury. Bed rest and avoidance of loud noises make more sense . Medicinal herbs such as arnica or the anti-inflammatory comfrey can be used to accompany this.

After consultation with the doctor, natural remedies can be used either as medicinal preparations or in the form of home-made teas, tinctures and ointments. However, the agents mentioned should never be applied directly to the pinna or ear canal, as this can cause inflammation.

If the symptoms persist despite all measures, you should speak to your doctor. Barotrauma is often caused by a tear that needs to be treated surgically. After the surgical procedure, diving should be temporarily avoided. The responsible doctor can provide further tips and measures for a speedy recovery.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.