Barotrauma

Barotrauma pertains to body damages due to increased air or water pressure. This is common during air travel and scuba diving with the ear usually affected. Decompression sickness is a term referring when the whole body is affected. ^[1]     

Causes

When the pressure inside and outside the body are significantly different, barotrauma may result. The middle ear is connected to the outside thru a thin canal called Eustachian tube. ^[1] When this tube becomes obstructed, the pressure in the middle ear is different than that of the outside of eardrum. The result is ear barotrauma. ^[2]

In riding a plane, barotrauma often occurs during landing. The change in pressure produces a vacuum in the middle ear that drags inwardly the eardrum. The result is pain and muffled sound as if the ear is stuffed.   ^[2] In scuba diving, barotrauma may happen due to the following: ascending without freely exhaling, rapid climbing to the surface, prolonged underwater diving, holding breath when going up the surface, repeated dives within 24 hours and riding a plane after diving. ^[3]

Since altitude change causes barotrauma, a person may experience it when driving in the mountains. Other causes include congested nose due to allergy, colds and respiratory infection. ^[2]

Risk Factors

The following increases the chance of a person to have barotrauma ^[2]:

·         smoking

·         being young or being old

·         congested nose

·         damaged Eustachian tube due to scarring or tumor

·         ear obstruction

·         oral-facial clefts

·         fatigue

·         dehydration

·         being overweight

·         inborn anomalies of the sinus drainage system and Eustachian tube  

Symptoms

The manifestations depend which body part is involved. In ear barotrauma, the symptoms are: ear pain or discomfort, sensation of clogged ear, dizziness, loss of hearing, ear discharge and ear bleeding (rare). Sinus barotrauma presents with nosebleed, headache, toothache and sinus pressure. If there is pulmonary barotrauma or air embolism, symptoms may be: headache, agitation, confusion, loss of consciousness, seizure, coughing up of blood, chest pain, shortness of breath, hoarseness and partial paralysis. In decompression sickness, symptoms include swelling, skin rashes, chest pain, cough and involvement of muscles, joints, tendons and the nervous system. ^[3]

Diagnosis

Obtaining medical history and physical exam are essential. Laboratory exams depend on the involved part of the body. ^[3]

Treatment

Barotrauma is treated depending on the body involvement and the extent of damage. When symptoms of ear barotrauma are felt, a person may yawn, chew gum or suck on candy. Some preventive measures may help like avoiding to sleep during plane landing and slow ascending and descending in scuba diving. ^[2]

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: Weakly in favor (HBOT is effective in treating Barotrauma)

Grade of Evidence: Moderate quality of evidence

* www.gradeworkinggroup.org

References:

1 http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/28053.html

2. http://www.nlm.nih.gov/medlineplus/ency/article/001064.htm

3. http://www.thirdage.com/hc/c/barotrauma-causes