From the Guidelines
Sudden bilateral ear pain after jumping into water is most commonly caused by barotrauma, also known as ear squeeze or external ear canal barotrauma, which occurs when water pressure pushes against the eardrum, creating a pressure difference between the middle ear and the external environment. This condition is supported by the most recent and highest quality study available, although not directly addressing the question, the updated guideline on tympanostomy tubes in children 1 implies that water precautions are not routinely necessary, suggesting that the risk of barotrauma may not be as significant as previously thought. However, the pain typically results from the eardrum being forced inward when water enters the ear canal rapidly.
Causes and Mechanisms
- The eustachian tube, which normally equalizes pressure between the middle ear and throat, cannot adjust quickly enough during sudden water entry, leading to the pressure difference and subsequent pain.
- Water pressure pushing against the eardrum forces it inward, causing discomfort or pain.
- The situation can be exacerbated by factors such as deep diving, swimming in lakes or non-chlorinated pools, or dunking one's head in soapy water, as mentioned in earlier guidelines 1, though these are more relevant to children with tympanostomy tubes.
Treatment and Prevention
- Treatment usually involves over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (200-400mg every 6-8 hours) for discomfort.
- Gentle ear drying with a hairdryer on low setting held several inches away can help alleviate the pain.
- Prevention is key - using earplugs designed for swimming, performing the Valsalva maneuver (pinching your nose closed while gently blowing) before jumping, or wearing a swim cap that covers the ears can reduce the risk of barotrauma.
- If pain persists beyond 24 hours, is severe, accompanied by hearing loss, dizziness, or drainage from the ear, medical attention should be sought immediately as these could indicate a ruptured eardrum or infection 1.
Given the updated guideline 1, the approach to managing and preventing ear pain after jumping into water should focus on individual risk assessment rather than routine precautions, emphasizing the importance of monitoring for symptoms and seeking medical attention if they persist or worsen.
From the Research
Causes of Sudden Bilateral Ear Pain
- Sudden bilateral ear pain after jumping into water can be caused by several factors, including:
- Barotraumas of the inner ear, which can occur due to the pressure change when diving into the water 2
- Traumatic eardrum perforation, which can happen during water activities such as diving or swimming 2
- Inner Ear Decompression Sickness (IEDCS), which can occur after a shallow scuba dive, although this is less common 3
- Water penetration into the middle ear through ventilation tubes in children can also cause ear pain, although this is not likely to occur when surface swimming in clean chlorinated swimming pools 4, 5
Risk Factors
- Swimming in polluted waters or cold water can increase the risk of ear problems, including exostoses and otitis externa 2, 6
- Failing to take ear protective measures during winter swimming can increase the risk of external auditory canal exostoses 6
- Having a history of ear infections or chronic otitis media can also increase the risk of ear problems when swimming 2, 5