General Information

DEFINITION--Damage to the middle ear caused by pressure changes.

BODY PARTS INVOLVED--Middle ear; eustachian tube; nerve endings in the ear.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Hearing loss (to varying degrees).
• A plugged feeling in the ear.
• Severe pain.
• Dizziness.
• Ringing noises in the ear.
• Mild to severe pain in the ears, or over the cheekbones and forehead.

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 outside pressure. The negative pressure in the middle ear sucks the eardrum inward. Blood and mucus may later appear in the middle ear. This damage is more likely if you have a nose or throat infection when scuba diving or traveling by air.

RISK INCREASES WITH

• Recent respiratory-tract infection.
• Airplane flight.
• Scuba diving.
• Sky diving.
• High altitude mountain climbers.
• High impact sports.
• Infants and young children who have difficulty in dilating the eustachian tube (by swallowing).

HOW TO PREVENT

• Don't fly or scuba-dive when you have an upper-respiratory infection. If you must fly anyway, use non-prescription decongestant tablets or sprays. Follow package instructions.
• During air travel, while ascending or descending, suck on hard candy or chew gum to force frequent swallowing. Take a moderate-size breath, hold the nose and try to force air into the eustachian tube by gently puffing out the cheeks with the mouth closed (Valsalva maneuver).
• Give an infant a bottle of water or juice while ascending or descending.

What To Expect

DIAGNOSTIC MEASURES

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.

APPROPRIATE HEALTH CARE

• Self-care.
• In most cases, no treatment is necessary and symptoms disappear in hours or days.
• Rarely, surgery to open the eardrum and release fluid trapped in the middle ear. A plastic tube may be inserted through the surgically perforated eardrum to keep it open and equalize pressure. The tube falls out spontaneously in 9 to 12 months.

POSSIBLE COMPLICATIONS

• Permanent hearing loss.
• Ruptured ear drum.
• Middle ear infection.

PROBABLE OUTCOME--With treatment, most cases of barotitis media are reversible without permanent damage or hearing loss.

How To Treat

GENERAL MEASURES--If fluid drains from the ear, place a small piece of cotton in the outer-ear canal to absorb it.

MEDICATION

For minor discomfort, you may use non-prescription decongestants and pain relievers, such as acetaminophen. > Your doctor may prescribe:

Stronger prescription decongestant nasal sprays or tablets. Use for at least 2 weeks after damage. Steroid nasal spray. Antibiotics, if infection is present.

ACTIVITY--Resume your normal activities as soon as symptoms improve.

DIET--No special diet.

Call Your Doctor If

> You have symptoms of barotitis media.

> The following occurs during treatment: