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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Ear Nose and Throat Disorders Barotrauma


Barotrauma is damage to the middle ear caused by unequal air pressure on the two sides of the eardrum. Normally, the Eustachian tube, which connects the middle ear and the back of the nose, helps maintain equal pressure on both sides of the eardrum by allowing outside air to enter the middle ear. When outside air pressure changes suddenly?for example, during the ascent or descent of an airplane or a deep-sea dive air must move through the Eustachian tube to equalize the pressure in the middle ear. These fast changes in altitude cause air pressure changes and can trigger barotrauma.


Airplane ear can occur in one or both ears. Airplane ear signs and symptoms may include:

  • Moderate discomfort or pain in your ear
  • Feeling of fullness or stuffiness in your ear
  • Muffled hearing or slight hearing loss


If airplane ear is severe or lasts more than a few hours, you may experience:

  • Severe pain
  • Pressure in your ear similar to being underwater
  • Moderate to severe hearing loss
  • Ringing in your ear (tinnitus)
  • Spinning sensation (vertigo)
  • Vomiting resulting from vertigo

  • Bleeding from your ear


Air pressure changes in flight


When an airplane climbs or descends, the air pressure in the environment changes rapidly, and normal function of the Eustachian tube doesn't occur quickly enough.


Air pressure effects on your ear


When air pressure on one side of your eardrum is out of balance with that on the other side, a number of things can happen in the middle ear, depending on the severity and duration of the pressure difference.

The eardrum stretches and doesn't vibrate correctly, resulting in muffled or impaired hearing.

The stretching of the eardrum causes a feeling of pressure or pain.

If the air pressure imbalance persists, fluids from the middle ear tissues may fill the space in an attempt to equalize the pressure.

If the pressure is severe or prolonged, the eardrum may rupture.

Small blood vessels (capillaries) in the middle ear may rupture and cause mild bleeding behind the eardrum.

Either of the small membrane-covered openings of the inner ear (oval window and round window) may rupture.


Other causes

Ear barotrauma is also a common problem with scuba diving, because the water pressure on the outside of the ear is greater than the air pressure of the middle ear.

You may also experience a minor case of barotrauma while riding an elevator in a tall building or driving in the mountains.

Being slapped or hit on the ear also can cause a rapid change in pressure within the ear. This type of barotrauma can, for example, affect a water skier hitting the surface of water at high speed.



Airplane ear usually isn't serious and responds to self-care. Long-term complications may occur when the condition is serious or prolonged or if there is damage to middle or inner ear structures. Rare complications may include:

  • Permanent hearing loss
  • Chronic tinnitus

Tests and diagnosis

Diagnosis is made usually on the history and on examination of your ear with a lighted instrument (otoscope). Signs of airplane ear might include a slight outward or inward bulging of your eardrum. If your condition is more severe, a tear in the eardrum or a pooling of blood or other fluids behind the eardrum can be seen.

If you're experiencing a spinning sensation (vertigo), there may be damage to structures of your inner ear. A hearing test (audiometry) to determine how well you detect sounds and whether the source of hearing problems is in the inner ear.


Treatments and drugs

For most people airplane ear is easily corrected with self-care strategies. When the symptoms persist, you may need treatments to equalize pressure and relieve symptoms.


You may be prescribed medications or directed  to take over-the-counter medications to control conditions that may prevent the Eustachian tubes from functioning well. These drugs may include:

  • Decongestant nasal sprays
  • Oral decongestants
  • Oral antihistamines

Self-care therapies

Along with your drug treatment, you can use a self-care method called the Valsalva maneuver. To do this, you pinch your nostrils shut, close your mouth and gently force air into the back of your nose, as if you were blowing your nose. Once the medications have improved the function of the Eustachian tubes, use of the Valsalva maneuver may force the tubes open.


Surgical treatment of airplane ear is rarely necessary. However, an incision in your eardrum (myringotomy) is made to equalize air pressure and drain fluids.

Severe injuries, such as a ruptured eardrum or ruptured membranes of the inner ear, usually will heal on their own in time. Surgery may be needed in rare cases to repair them.


These are few tips to avoid airplane ear:

  • Yawn and swallow during ascent and descent. Yawning and swallowing activate the muscles that open your Eustachian tubes. You can suck on candy or chew gum to increase how often you need to swallow.
  • Use the Valsalva maneuver during ascent and descent. Gently blow, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times, especially during descent, to equalize the pressure between your ears and the airplane cabin.
  • Don't sleep during ascents and descents. If you're awake during ascents and descents, you can do the necessary self-care techniques when you feel pressure on your ears.
  • Reconsider travel plans. If possible, don't fly when you have a cold, sinus infection, nasal congestion or ear infection. If you've recently had ear surgery, talk to your doctor about when it's safe to travel.
  • Use an over-the-counter decongestant nasal spray. If you have nasal congestion, use a nasal decongestant about 30 minutes to an hour before take-off and landing. Avoid overuse, however, because nasal decongestants taken over several days can increase congestion.
  • Cautious use of oral decongestant pills. Oral decongestants may be helpful if taken 30 minutes to an hour before an airplane flight. However, if you have heart disease, a heart rhythm disorder or high blood pressure or if you've experienced possible medication interactions, avoid taking an oral decongestant unless your doctor approves.
  • Take allergy medication. If you have allergies, take your medication about an hour before your flight.
  • Use filtered earplugs. These earplugs slowly equalize the pressure against your eardrum during ascents and descents. You can purchase these at drugstores, airport gift shops or your local hearing clinic.
  • Drink plenty of water to avoid dehydration. Staying well hydrated will help avoid irritation of the nasal passages and throat and help ensure better function of the Eustachian tubes.
  • Avoid alcohol and caffeine. Beverages with alcohol or caffeine can dehydrate you. They also constrict your blood vessels and may increase the risk of ruptured capillaries.


If you're prone to severe airplane ear and must fly often, your need surgically placed tubes in your eardrums to aid fluid drainage, ventilate your middle ear and equalize the pressure between your outer ear and middle ear.

Helping children prevent airplane ear

These additional tips can help young child avoid airplane ear:

  • Encourage swallowing. Give a baby or toddler a beverage during ascents and descents to encourage frequent swallowing. A pacifier also may help.
  • Prevent pain. To help control pain or discomfort, give a child acetaminophen (Tylenol, others) 30 minutes before descent. If you're on a long flight that allows enough time for two doses, you may give a child a dose before the ascent and descent. Usually doses must be four to six hours apart and there are limits to how many doses can be taken in a 24-hour period. Read the label carefully and ask your doctor for recommendations.
  • Avoid decongestants. Decongestants aren't recommended for young children.