Ear Membrane Damage Due to External Air Pressure Change
You may remember the feeling of fullness and stuffiness in the ears that occurs when many people travel by plane, especially when the plane descends. Sometimes we can feel the same things when driving downhill very quickly or diving into the sea. When the external pressure changes, the closed spaces in our body can be affected by the pressure changes. This can occur especially in our sinuses and middle ear, which are surrounded by hard walls. During aircraft travel, especially when the aircraft is descending, the external pressure increases. Generally, there are systems that allow the aircraft to descend slowly and to adjust the cabin pressure so that there is no rapid pressure increase in the cabin. Pressure equalization in the middle ear can become more difficult, especially when the plane descends rapidly.
Why Does Barotrauma of the Middle Ear and Eardrum Occur When Aircraft Descends?
When the plane is taking off, the external pressure decreases and when the middle ear pressure is higher than the external pressure, the mouth of the Eustachian tube, which is the tube-shaped structure responsible for the ventilation of the middle ear, is opened passively, air is transferred from the middle ear to the nasopharynx, reducing the middle ear pressure and equalizing it with the external ambient pressure. In other words, even though you may have fallen asleep and not swallowed, during the plane ascending period, air is expelled from the Eustachian tube and passive pressure equalization is automatically achieved. Even if our nose is blocked, there are usually no signs of serious barotrauma in the middle ear during flight departures. Conversely, during descent, the external pressure increases and the Eustachian tube is normally passively closed. The eustachian tube opens only during movements such as swallowing, yawning, and the valsalva maneuver. In other words, when the external pressure increases, the middle ear pressure may become less than the external pressure, and in this case, the eardrum is gradually pushed inwards, causing symptoms such as ear pain, a feeling of congestion, and hearing loss. If the patients are asleep and these symptoms occur during the descent of the plane, these symptoms can be eliminated by waking up, drinking water, closing the nose after breathing, pumping air into the ears (valsalva maneuver), swallowing. can bring it into position.
Barotraumatic Eardrum Damage Mechanism
As I explained above, in simple terms, it can be described as the increase in external pressure during a descending plane flight, the inward retraction of the eardrum due to insufficient increase in middle ear pressure, and the occurrence of a series of damage ranging from bleeding to perforation in the membrane. Depending on the amount and severity of the external pressure increase, varying amounts of damage may occur.
It is appropriate for patients with nasal congestion, eustachian tube dysfunctions, and previous ear problems after a flight to be examined by an otolaryngologist before the flight.
Auricular Pressure Trauma Causes and Risk Factors
The risk of pressure trauma to the eardrum during air travel increases if:
- Nasal congestion and the following conditions that cause nasal congestion
. upper respiratory tract infection
. turbinate hypertrophy
. adenoid hypertrophy
. nasal polyp
. allergic rhinitis attack
. septum deviation
. intranasal mass lesions
. intranasal drug addiction (rhinitis medikomentosa)
- Structural causes of the Eustachian tube itself and causing dysfunction
- Rapid descent of the aircraft and rapid increase in external pressure
- Previous eardrum barotrauma
Eardrum Barotrauma Symptoms
The symptoms may vary depending on the amount and duration of the pressure increase and the lack of ventilation in the middle ear. The following symptoms may occur in association with pressure trauma in the middle ear during air travel:
- Sensation of pressure in the ear
- Hearing loss
- Bleeding from the ear (occurs when the membrane is perforated)
- With severe barotrauma, damage to the inner ear and neural-type hearing loss may also occur.
|In the photograph above, the eardrum of a patient who developed ear pain, hearing loss, and a feeling of stuffiness in the ear after airplane travel is seen. There are membrane retraction, dark red bleeding areas inside and behind the membrane.
Precautions for Eardrum Barotrauma
Patients who have previously had problems with the eardrum associated with air travel should pay attention to the following recommendations to prevent this situation from recurring:
- When there is a condition that causes nasal congestion, such as a viral upper respiratory tract infection or allergic rhinitis, do not travel without taking medical treatment and consulting your doctor.
- If you have had nasal surgery, do not travel by plane without consulting your doctor if you have nasal congestion.
- Even without a condition that causes nasal congestion; airplane ear can occur, and as a general recommendation, you can reduce the chance of barotrauma-related eardrum damage by following the following:
. you can use a nasal decongestant spray before the flight (1 hour before and before the descent announcement)
. If you have had severe ear pain during a flight before, you can also take an oral decongestant tablet in addition to the nasal decongestant spray (consult your doctor).
. You can consume the foods and beverages that you have with you during the flight or that are offered to you after the descent announcement (water can be drunk little by little)
. chewing gum (swallowing rather than opening and closing the mesh allows the mouth of the Eustachian tube to open and close, which may facilitate air entry from the Eustachian tube into the middle ear)
. During descent, when a feeling of stuffiness and pain in the ear begins, the valsalva maneuver can be performed (see detailed video and explanation below)
. Using Otovent Balloon (you can find detailed video and explanation below)
Pushing the Eardrum with the Valsalva Maneuver (Equalization of Pressure in the Middle Ear) Video
(Eardrum collapse - What is the Valsalva maneuver? - Pressure therapy in the ear - Pressure ear plugging)
After breathing through the mouth, the nose is closed and the eardrum is pushed outward by pushing air into the nose, which is called the "Valsalva Maneuver".
As can be seen when pressure trauma to the eardrum occurs during upper respiratory tract infections, diving and airplane travel; It can also be seen in eustachian tube insufficiency where middle ear aeration is affected. It can be found together in children with adenoid hypertrophy, middle ear fluid (serous otitis media) and in adult patients in case of nasal congestion.
During the Valsalva Maneuver, there is also an increase in intracranial pressure and should not be done without consulting a physician. The patient who has undergone eardrum surgery, nose surgery or any other surgical intervention should definitely do this maneuver in consultation with a physician.
Using Otovent Nasal Balloon to Prevent Barotraumatic Eardrum Damage
"Otovent Balloon", which is a simple and beautiful device based on the principle of inflating the balloon and pumping air into the middle ear through an apparatus placed in the nostril, makes this maneuver a game, especially for children who cannot perform the valsalva maneuver. provides an increase in pressure. This device is not suitable for patients with active nasal or middle ear infections, patients with vascular problems such as brain aneurysms, to use these devices without consulting a doctor.
The link where you can find the product usage and video on this subject >> https://www.otovent.co.uk/what-is-otovent-for/
Diagnosis of Eardrum Barotrauma
Diagnosis can be made by questioning the symptoms that occur after the recent plane trip in the history of the patients, and by observing the following examination findings after the ear examination:
- Bleeding areas in the eardrum
- Image of blood and bloody fluid in the middle ear behind the membrane
- Perforation of the eardrum with the edges turned inwards and bleeding
- Blood flowing from the hemorrhagic perforation in the membrane extending to the external auditory canal
Apart from these, hearing tests may be requested in patients with severe symptoms, and in the audiometry test, conductive hearing loss usually occurs, but in severe barotrauma, additional sensorineural hearing loss and mixed hearing loss can be detected due to inner ear damage. Bleeding or fluid filling the cells in the middle ear cavity and masoid bone can be detected on imaging.
Eardrum Barotrauma Treatment
In barotraumatic eardrum damage, it is ideal to protect patients from a second barotrauma and delay the flight. Depending on the existing damage and symptoms, the following treatment recommendations can be applied:
- Use of oral and nasal decongestant drugs
- Protection of the ear from water contact (placement of Vaseline cottons in the ear canal or swimming plugs can be used)
- Use of antibiotic ear drops
- Use of oral antibiotics
- Treatment of possible conditions that cause upper respiratory tract infection, allergy or nasal congestion (recommendations for increasing body resistance in patients with upper respiratory tract infections, prolonging the rest period, consuming hot, warm drinks by mouth, using nasal seawater sprays from the nose ... )
- Chewing gum
The link group that contains the articles I have previously prepared about barotrauma on this website >> https://www.ent-istanbul.com/search?q=barotrauma (you can click more posts at the bottom of the page)
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47