What are the main causes of ear barotrauma?

Ear barotrauma occurs primarily due to rapid changes in external atmospheric pressure, which lead to a pressure imbalance between the middle ear and the surrounding environment. Common causes of this condition include activities involving altitude changes, such as flying, driving in mountainous areas, or scuba diving [1].

The middle ear connects to the back of the nose and the upper throat via the Eustachian tube. The function of this tube is to equalize pressure on both sides of the eardrum. When external pressure changes rapidly, the Eustachian tube may not be able to adapt quickly enough, leading to a sensation of pressure, blockage, or pain in the ear [2].

How do altitude changes affect the ear?

When altitude changes, atmospheric pressure changes accordingly. For example, during aircraft ascent or diving, external pressure increases or decreases significantly. If the Eustachian tube cannot open or close properly to equalize this pressure, negative or positive pressure builds up in the middle ear. This pressure difference can cause the eardrum to stretch or contract, leading to pain and a sensation of blockage. In some severe cases, it may lead to temporary hearing loss or dizziness [1].

Common activities causing barotrauma

• Flying: Air travel is one of the most common causes of ear barotrauma, especially during takeoff and landing, when the greatest altitude changes occur [1].
• Diving: Divers face significant pressure changes underwater, making them particularly susceptible to barotrauma. This can affect the ears and other parts of the body [1].
• Driving in mountains: Driving through high-altitude mountainous areas can also cause pressure changes that affect the ears [1].

The importance of the Eustachian tube in pressure equalization

The Eustachian tube is the key to equalizing pressure in the middle ear. When swallowing or yawning, this tube opens, allowing air to enter or leave the middle ear, thereby equalizing pressure on both sides of the eardrum [2]. If the Eustachian tube is blocked due to a cold, allergies, or sinusitis, its ability to equalize pressure is reduced, increasing the risk of developing barotrauma.

How to reduce the risk of ear barotrauma

To reduce the risk of ear barotrauma, certain preventive measures can be taken. During altitude changes, chewing gum or yawning frequently can encourage the Eustachian tube to open [2]. Decongestants can also be used before flights if you frequently experience ear blockage [2]. In some cases, gently blowing while keeping the nose and mouth closed (the Valsalva maneuver) may help, but extreme caution must be exercised to avoid forcing bacteria into the ear or causing a ruptured eardrum [2].

For more information on protecting your ears during flying and diving, you can visit Barotrauma: Protecting Your Ears During Flying and Diving (Arabic).

Medical references

• Barotrauma
• Ear - blocked at high altitudes