Most of us have felt ear pain or pressure when flying in an airplane or diving deep underwater. That discomfort, sometimes painful enough to feel like the ear is “injured,” is actually a condition doctors call barotrauma. It happens when there’s a sudden change in air or water pressure, and your ear can’t adjust quickly enough.

Barotrauma is also known as barotitis or aero-otitis, and in severe cases, it can even cause the eardrum to rupture. Interestingly, it’s not just the ears—there’s also something called generalized barotrauma (or decompression sickness), which affects the whole body, especially divers who rise to the surface too quickly.

How the Ear Works with Pressure

Your ear has three main parts:

• The outer ear
• The middle ear
• The inner ear

The middle ear contains the eardrum and is connected to the back of the throat through a tiny passage called the Eustachian tube. This small tube works like a pressure valve—it lets air move in and out to balance pressure.

That “clicking sound” you sometimes hear when swallowing? That’s just a little bubble of air moving through the Eustachian tube to keep things balanced. But when the tube is blocked—by a cold, allergies, or sinus issues—pressure can’t equalize, and barotrauma develops.

When and Why Barotrauma Happens

Barotrauma is most common in two situations:

• During airplane landings, when cabin pressure changes rapidly.
• While scuba diving, especially when a diver descends too quickly.

When pressure outside changes faster than the body can adjust, the eardrum gets pulled inward. This creates pain, a feeling of fullness, or temporary hearing problems. In more serious cases, the middle ear fills with fluid as the body struggles to balance pressure. Doctors call this serous otitis media. If it worsens, the eardrum may burst, leading to bleeding, fluid discharge, and sometimes hearing loss.

Sometimes, the problem doesn’t stop at the ear. The inner ear’s delicate structures, like the cochlea and semicircular canals, can also be affected. When fluid reaches the balance center of the brain, it may cause dizziness and vertigo—a sudden spinning sensation that can be considered a medical emergency.

Who Is at Risk?

• Air travelers are the most commonly affected.
• Children suffer more often because their Eustachian tubes are smaller and clog easily.
• People with colds, allergies, or sinus infections are at higher risk.
• Divers can also face lung barotrauma. If they hold their breath while surfacing, air pockets may form in the lungs, causing bleeding, shortness of breath, and coughing up blood.

Types and Symptoms

Doctors divide barotrauma into two categories:

• Acute (sudden and short-term)
• Chronic (long-term and recurring)

Common symptoms include:

• Severe ear pain
• Ear blockage or pressure
• Ringing or heaviness in the ears
• Dizziness (vertigo)
• Fluid or blood coming from the ear
• Hearing loss

Milder cases usually go away on their own, but severe or long-lasting symptoms need medical attention.

Diagnosis and Treatment

Doctors usually use an otoscope (a small magnifying device) to check the eardrum. If fluid is seen behind the eardrum or if the eardrum looks pulled inward, barotrauma is confirmed.

Most people recover quickly without major treatment. However, in stubborn cases, a doctor may make a small cut in the eardrum to release fluid and equalize pressure. Surgery may also be required if repeated infections or permanent hearing loss develop.

Prevention Tips

The good news? Barotrauma can often be avoided with simple tricks:

• Before flights: Use decongestant sprays or antihistamines if you have allergies or sinus issues.
• During takeoff and landing: Chew gum, swallow frequently, or pretend to chew if gum isn’t available.
• For kids: Keep them awake during landing so they can swallow or yawn, helping the Eustachian tube stay open.
• For divers: Never hold your breath while ascending. Always allow slow, controlled rises.

Earplugs designed for air travel may also help reduce sudden pressure changes, though they don’t work for diving.

A Look at Research in Pakistan

Unfortunately, very little research has been done in Pakistan on this topic. One study from 2007 looked at 100 Navy divers aged 21–48 with diving experience of up to 16 years. The results showed:

• 54% had ear-related problems, including hearing loss, barotrauma, and infections.
• 75% of them experienced inner-ear barotrauma.

This shows how common the problem really is, even though it doesn’t get much attention.

Conclusion

Ear barotrauma may sound scary, but it’s actually very common—and in most cases, it goes away on its own. Still, ignoring it can sometimes lead to serious complications like hearing loss or vertigo. If you travel often, dive, or suffer from frequent sinus problems, a little care can save you a lot of pain. Simple habits like chewing gum during a flight, treating allergies before travel, or using decongestant sprays can make a big difference. And if symptoms get worse—don’t wait. Always check with an ENT specialist to avoid long-term damage.