Pain or damage, mainly affecting the middle ear and the facial sinuses, that is caused by changes in surrounding air pressure. Scuba divers and air travellers are the greatest risk of baratrauma.
Aircraft cabin pressure decreases as the plane ascends and increases as it descends. As the aircraft ascends the ears may seem to pop as the air in the middle ear expands and is expelled via the Eustachian tubes, which connect the middle ear to the back of the throat. On descent, the high pressure can push the eardrum inwards and create painful sensations.
Minor pressure damage in the middle ear can cause pain, hearing loss and tinnitus for a few days; damage in the facial sinuses can also cause pain and possibly a discharge of mucus or blood. Symptoms often wear off within hours or days, but treatment may be needed if they persist or worsen. Big changes in pressure can rupture the eardrum.
Barotrauma can be avoided by vigorous swallowing or by forcibly breathing out with the mouth closed and the nose pinched, which is known as the valsalva manoeuvre. This action then equalises the internal and external pressures in the middle ear and sinuses.
If the Eustachian tubes are blocked, as commonly occurs with a cold, use of nasal spray containing a decongestant drug is recommended shortly before the descent of the aircraft. Anyone with a severe head cold should avoid air travel if possible. Children and babies should be breast or bottle fed during descent to encourage swallowing.