What are the management options for ear barotrauma?

Management of Ear Barotrauma

The primary treatment for ear barotrauma includes decongestants, analgesics, and pressure equalization techniques, with more severe cases requiring medical intervention such as myringotomy or surgical repair. 1

Initial Management

• Decongestants (oral pseudoephedrine or topical oxymetazoline) can help reduce congestion and facilitate middle ear pressure equalization, though evidence for their effectiveness is mixed 2
• Analgesics should be provided for pain management as ear barotrauma often presents with otalgia (ear pain) 2
• Pressure equalization techniques should be taught to patients to prevent recurrence:
  • Valsalva maneuver (pinching nose and gently blowing)
  • Toynbee maneuver (swallowing with pinched nostrils)
  • Frenzel maneuver (contracting throat muscles with closed glottis) 1, 3

Management Based on Severity

Mild Cases

• Rest and observation with symptomatic treatment using analgesics 1
• Oral decongestants may be beneficial for adults with recurrent ear pain during air travel 2
• Nasal decongestant sprays taken before pressure changes may help, though one study showed oxymetazoline didn't produce statistically significant reduction in symptoms 2

Moderate Cases

• Consider short-term corticosteroid therapy for reducing inflammation, especially if there's evidence of laryngeal edema 4
• Pressure-regulating ear plugs (PREP) can slow the rate of pressure changes in the external auditory canal and improve subjective comfort, though they don't improve Eustachian tube function 5

Severe Cases

• Myringotomy (surgical incision in the tympanic membrane) may be necessary to relieve pressure and prevent further damage 1
• ENT specialist consultation is recommended for cases with hearing loss, severe vertigo, or tympanic membrane perforation 1, 6
• In cases of inner ear barotrauma with vestibular symptoms, bed rest and vestibular suppressants may be needed 6

Special Considerations

Diving-Related Barotrauma

• Middle ear barotrauma is the most common diving-related injury, occurring in more than 50% of experienced divers 3
• Proper equalization techniques during pressure changes are essential to prevent recurrence 1, 3
• Contrary to traditional advice, limited evidence suggests that patients who have experienced inner ear barotrauma may be able to resume diving after proper retraining on Eustachian tube function maximization techniques 7

Aviation-Related Barotrauma

• Symptoms typically occur during descent rather than ascent 2
• Pre-flight use of decongestants may be beneficial for adults with history of ear pain during air travel 2
• Children may not benefit from oral pseudoephedrine for prevention of in-flight ear pain 2

Prevention Strategies

• Avoid diving, flying, or pressure exposure when experiencing upper respiratory infections or allergies 1
• For those with recurrent issues, consider pressure-regulating ear plugs which can improve subjective comfort during pressure changes 5
• Proper training on equalization techniques is crucial, especially for divers 3, 7
• Avoid high-pressure oxygen insufflation as it can cause further barotrauma 1

Cautions and Pitfalls

• Underwater administration of nasal decongestants carries risks including disorientation, loss of buoyancy, coughing, sneezing, and laryngospasm 3
• High-flow oxygen therapy should be used cautiously due to risk of barotrauma 4
• Even shallow dives or small pressure changes can cause significant barotrauma 4
• Patients with asthma or other airway narrowing conditions have increased risk of pulmonary barotrauma during pressure changes 4