Barotitis Media

What is Barotitis media?

Barotitis media is an inflammation of the middle-ear caused by sudden changes in barometric pressure, such as that which occurs while flying. Air, trapped in the middle-ears and sinuses at ground level pressure, needs to be able to escape via the eustachian tubes and sinus ducts to the air passages at the back of the throat. If the sinus ducts or eustachian tubes are blocked with mucus, as during a head cold, equalizing pressure in this way can be difficult or impossible. If equalization is prevented or delayed, minor damage can occur. Tiny blood vessels can rupture in the walls of the middle-ears, or in the membranes lining the inside of the sinuses. Displacement and stretching of the eardrum (tympanic membrane) may be accompanied by redness, swelling (edema), and bruising of the mucous membrane of the middle-ear. Air travelers are the largest group at risk for barotitis media, but scuba divers face similar problems. Barotitis media may also occur in any condition in which there is injury to the eustachian tube.

Causes

• Damage caused by sudden, increased pressure in the surrounding air, such as occurs in the rapid descent of an airplane or while scuba diving. In these activities, air moves from passages in the nose into the middle ear to maintain equal pressure on both sides of the eardrum. If the tube leading from the nose to the ear (eustachian tube) doesn't function properly, pressure in the middle ear is less than the outside pressure. The negative pressure in the middle ear sucks the eardrum inward. Blood and mucus may appear later in the middle ear. This damage is more likely if you have a nose or throat infection when scuba diving or traveling by air.
• Trauma to external or middle ear (boxing, water skiing, accidents, etc.)

How is it diagnosed?

• History: Symptoms may include severe earache, a spinning sensation (vertigo), some hearing loss, and a temporary ringing in the ear (tinnitus).
• Physical exam may reveal a perforated eardrum (tympanic membrane) with fluid accumulation, or the membrane may have a purplish hue.
• Tests: There are no tests required to establish this diagnosis.

How is Barotitis media treated?

In most cases, symptoms wear off within hours or days without treatment. Individuals are advised to keep soapy and dirty water out of the ear. If symptoms persist, oral or topical decongestants are given. If an infection develops or there is drainage from the ear, antibiotic eardrops may be necessary. When a perforated eardrum (tympanic membrane) does not heal within three months, a paper patch may be used to cover the hole. If the patch fails, the membrane may need to be surgically repaired (tympanoplasty).

What might complicate it?

Although the pressure changes experienced during ordinary airline flights are unlikely to rupture the eardrum, it can happen to high altitude pilots and scuba divers. Complications can also include infection.

Predicted outcome

This is a self-limited condition. Both the pain and hearing loss resolve with time.

Alternatives

Conditions with similar symptoms include acute otitis media secondary to a bacterial infection and inner ear decompression sickness.

Appropriate specialists

Otolaryngologist.

Last updated 8 August 2015