Barotrauma to the Ear
The Eustachian tube (ET) opens and closes during chewing, yawning and swallowing. The primary function of the ET is to equalize pressure between the middle ear (space under the eardrum) and the external environment (nasopharynx). Ear barotrauma occurs when the Eustachian Tube fails to equalize acute changes in pressure, resulting in a variety of possible signs/symptoms. Most people have experienced mild ear barotrauma at some point in their lives, typically with altitude changes, driving in the mountains or scuba diving. Mild symptoms include ear pain or fullness, plugged/muffled hearing and a sense of being off-balance. More severe ear barotrauma can result in development of fluid under an intact eardrum, acute tympanic membrane rupture or inward displacement of the ossicular chain (hearing bones). Such displacement of the stapes (hearing bone closest to the inner ear) can cause inner ear concussion or formation of a perilymph fistula – resulting in varying degrees of sensorineural hearing loss and dizziness.
Several treatment options aimed at improving ET dysfunction (ETD) may be recommended depending on the severity of the symptoms. Most cases of ear barotrauma will resolve spontaneously without any treatment, but it is difficult to predict how long the recovery time will be. If it is linked to upper respiratory infections or allergies, symptoms generally improve when the cold or allergies have resolved. Swallowing and chewing helps. Oral or nasal decongestants as well as nasal corticosteroid sprays are sometimes prescribed to help open the Eustachian tubes, and antihistamines may be recommended if allergies are the cause.
For long-term or severe cases, two surgical options are available. A tiny slit (myringotomy) may be made into the eardrum to allow the pressure to equalize and to remove any fluid present in the middle ear. This slit usually heals quickly, so the pressure may build up again if the underlying cause of ETD is ongoing. Another option is to insert an ear tube after the slit has been made. The ear tube will usually remain in place for 6 – 18 months. In adults, both procedures can often be done in the office with a topical anesthesia placed on the eardrum. A brief general anesthetic is needed for children. Should symptoms suggest the presence of a perilymph fistula, accurate diagnosis and treatment can require middle ear exploration surgery.
Why Choose Us
- Dr. Abraham Jacob, Medical Director for Ear & Hearing (E&H) at the Center for Neurosciences (CNS), is fellowship trained in Otology, Neurotology, and Cranial Base Surgery. He is the first and most experienced Neurotologist in Tucson.
- Dr. Jacob was a founding member of the University of Arizona (UA) Department of Otolaryngology prior to his departure and transition to CNS. At UA, he was Vice Chair of ENT and held the rank of full Professor with Tenure. He has an international reputation as an expert for treating ear diseases.
- Dr. Jacob transitioned his practice to the Center for Neurosciences in early 2017 as he felt that the new environment helped him to optimize delivery of personalized ear and lateral skull base care.
- Many cases of barotrauma resolve on their own or can be treated by primary care physicians; however, more serious conditions such as persistent middle ear fluid, tympanic membrane perforations and perilymph fistulas require an otologist like Dr. Jacob for optimal management. Dr. Jacob is a national expert in management of ear diseases and brings tertiary care Otology/Neurotology to Tucson. E&H @ CNS offers comprehensive audiology and diagnostic services like fiberoptic examinations of the nasopharynx (back of the nose), microscope examinations of the ear, and MR imaging to rule out retrocochlear mass lesions. When required, Dr. Jacob can also perform both -office and operating room procedures for the management of ear barotrauma.