Barotrauma: Symptoms, Causes & Treatment

Barotrauma is an injury caused by a change in air or water pressure. It most commonly affects the ears during air travel, scuba diving, or rapid changes in altitude and may cause ear pressure, headache, or dizziness.

Although ear barotrauma is the most common type, barotrauma can also affect other parts of the body that contain air or gas. When it affects the lungs or gastrointestinal tract, it may lead to complications such as pneumothorax, pulmonary bleeding, or gastrointestinal rupture.

Treatment for barotrauma depends on the part of the body affected and the severity of the injury. It may include pain relievers, decongestants, rest, oral corticosteroids in selected cases, oxygen therapy for suspected pulmonary barotrauma or an arterial gas embolism, or surgery for serious injuries.

Common symptoms

The main symptoms of barotrauma include:

• Ear pain

• A feeling that the ear is plugged or blocked

• Ringing in the ear or hearing loss

• Dizziness or vertigo

• Bleeding or fluid draining from the ear

• Difficulty breathing

• Nosebleeds

• Weakness

• Loss of consciousness or disorientation

Other possible symptoms include joint or back pain that worsens over time or with movement, headache, chest pain, nausea, and vomiting.

Barotrauma symptoms vary depending on the part of the body affected. A primary care physician or otolaryngologist should evaluate symptoms that are severe, persist, or include hearing loss, vertigo, breathing difficulty, chest pain, confusion, or loss of consciousness to confirm the diagnosis and determine the appropriate treatment.

Confirming a diagnosis

Barotrauma is diagnosed by a primary care physician, otolaryngologist, or emergency medicine physician based on the symptoms, medical history, physical examination, and recent activities, such as air travel or scuba diving.

Additional testing depends on the part of the body affected and the severity of the symptoms. According to the CDC, respiratory or neurologic symptoms after diving require prompt medical evaluation because they may indicate pulmonary barotrauma or an arterial gas embolism.

The doctor may order a chest X-ray or CT scan if a pneumothorax or another chest injury is suspected, or head imaging when neurologic complications are a concern. Blood tests, an electrocardiogram (ECG), or other tests may also be used to evaluate possible complications.

Main types

Barotrauma is classified into different types based on the part of the body affected and includes:

1. Ear barotrauma

Ear barotrauma, also known as barotitis media, is the most common type of barotrauma. It occurs when pressure in the middle ear is different from the pressure in the surrounding environment, such as during air travel or when quickly ascending or descending a mountain at a high altitude.

2. Pulmonary barotrauma

Pulmonary barotrauma occurs when there is a difference between the pressure inside the lungs and the pressure outside the body. It may happen during a rapid ascent or descent while diving at great depths or during mechanical ventilation in people with chronic respiratory conditions.

This type of barotrauma can cause serious complications, including decompression sickness, an air embolism, pneumothorax, or pulmonary bleeding.

3. Gastrointestinal barotrauma

Gastrointestinal barotrauma may occur during scuba diving. It may also be caused by trauma to the chest or abdomen or by positive-pressure mechanical ventilation.

Possible causes

The main causes of barotrauma include:

• Air travel, especially during takeoff or landing

• Rapid ascent or descent while diving

• Prolonged or deep dives

• Rapidly ascending or descending a mountain at a high altitude

• Performing the Valsalva maneuver with the head lowered, which may cause air to be swallowed

• Drinking carbonated beverages before diving or chewing gum during a dive

• Not exhaling through the nose into the diving mask during descent

• Swallowing air while ascending from a dive

• Chest trauma

• Positive-pressure mechanical ventilation

Barotrauma may also occur in people with respiratory conditions such as chronic obstructive pulmonary disease (COPD), particularly when mechanical ventilation is required.

These factors may create a difference between the pressure of gas or fluid inside a body cavity and the pressure in the surrounding environment, resulting in barotrauma.

Treatment options

Treatment for barotrauma depends on the part of the body affected and the severity of the injury. A primary care physician or otolaryngologist may recommend pain relievers or decongestants for ear or sinus barotrauma.

Supplemental oxygen may be administered for certain respiratory complications or suspected diving-related gas embolism. More serious injuries may require procedures such as chest tube placement or surgery.

In some cases of ear or sinus barotrauma, a doctor may prescribe oral corticosteroids when symptoms do not improve as expected.