Definition

Barotrauma is the pain or discomfort that is felt with a difference in air or water pressure between the outside environment and the inside of the body.

Any part of the body that contains air can be sensitive to these pressures:

• Ear (most common)—affecting structures in the middle ear
• Sinus—air-filled facial sinuses surround the bones in the skull
• Pulmonary (most critical)—lungs

Causes

Normally air moves easily between outside and inside of the ear, sinuses, and lungs, helping to maintain a balance of pressure. Imbalances may be created with:

• Sudden or severe changes in surrounding pressure
• Blockages in the body’s air cavities

The imbalance of pressure causes the air inside your body to shrink or swell. This is what can cause pain and damage.

Risk Factors

Activities that can expose someone to significant pressure changes include:

• Airplane travel
• Scuba diving, particularly:
  • Ascending (going up to the surface) without exhaling freely
  • Swimming quickly to the surface when diving
  • Holding your breath when ascending
  • Underwater diving for an increased period of time
  • Repeated dives within 24 hours
  • Flying in an airplane after diving
  • Having air pockets in equipment (such as masks and dry suits)
• Mechanical ventilation —use of a machine to move air into and out of the lungs (associated with pulmonary trauma)
• Exposure to shock waves from an explosion

The inner ear is connected to outside air through tubes to keep inner and outer pressure balanced. Blockages and congestion in these tubes increase the risk of ear barotrauma because the inside pressure is not allowed to change to match the outside pressure. These tubes may be blocked or limited by:

• Congestion from allergies or colds
• Middle ear infections—more common in younger children
• Defects of eustachian tube (small tube that runs from the middle ear to the back of the nose and upper throat and helps stabilize internal and external pressures)
• Damaged or blockage of eustachian tube—resulting from scarring or a tumor
• Cleft palate or lip

Similarly, blockages in the sinuses will block the flow of air from outside to inside the body. Sinuses may be impaired by:

• Nasal congestion from a sinus infection, cold, or allergies
• Structural defects of the sinuses or their drainage system

Pulmonary barotrauma may be more likely in those with damage from previous or current lung conditions.

Other factors that may affect the ability for air spaces in the body to work properly include:

• Smoking
• Dehydration
• Obesity

Symptoms

Symptoms will depend on what areas are affected.

Ear barotrauma may cause:

• Discomfort or pain in one or both ears
• Feeling as though your ears are clogged
• Feeling of pressure in your ears
• Lightheadedness
• Ringing in the ear— tinnitus
• Temporary hearing loss
• Rarely, bleeding from the ear

Complications include long-term or permanent hearing loss, ear infection, or a perforated eardrum.

Sinus barotrauma may cause:

• Sinus pressure and/or pain
• Feeling of fullness in the head
• Nasal bleeding
• Headaches
• Tooth pain

Pulmonary barotrauma may cause:

• Shortness of breath
• Chest pain
• Feeling of fullness in the chest
• Pain that radiates to the neck and/or shoulders
• Lightheadedness
• Confusion
• Seizure
• Degrees of consciousness
• Coma

Potential complications can include pneumothorax and stroke.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done to look for irritation or tissue damage. Barotrauma may be suspected based on your recent activities, such as air travel or scuba diving.

Ear structures will be visually examined

Suspected pulmonary barotrauma may be evaluated with:

• Chest x-ray
• CT scan
• MRI scan
• Lung perfusion scan
• Pulmonary function tests to measure lung function
• Pulse oximetry—to measure the amount of oxygen in the blood

Treatment

Pulmonary barotrauma is serious and needs immediate medical attention. Treatment will depend on the specific lung problem that is present, such as a collapsed lung.

The following measures can also prevent barotrauma. Treatment options include the following:

Prevention

To help reduce your chance of barotrauma during:

Divers Alert Network http://www.diversalertnetwork.org/

Health Canada http://www.hc-sc.gc.ca

Barotrauma. The Merck Manual Professional Edition website. Available at:
http://www.merckmanuals.com/professional/injuries_poisoning/injury_during_diving_or_work_in_compressed_air/barotrauma.html
Updated May 2013. Accessed November 3, 2014.

Brandt MT. Oral and maxillofacial aspects of diving medicine. Military Medicine. 2004;169:137-141.

Ears and altitude. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/content/ears-and-altitudeearsAltitude.cfm
Updated February 2, 2012. Accessed November 4, 2014.

Newton HB. Neurologic complications of scuba diving. Am Fam Physician. 2001;63(11):2211-2218.