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Ear barotrauma

Ear barotrauma is discomfort in the ear due to pressure differences between the inside and outside
of the eardrum. It may include damage to the ear.

Preventing ear barotrauma

You can decrease your risk of experiencing barotrauma by taking antihistamines or decongestants before
scuba diving or flying on a plane. You should always check with your doctor and be aware of possible side
effects before taking new medications.

Other steps you can take to prevent or lessen barotrauma include:

descend slowly while diving

swallow, yawn, and chew when you feel symptoms of barotrauma, which can relieve symptoms

exhale through your nose during an ascent in altitude

avoid wearing earplugs while diving or flying

When flying, DO NOT sleep as the plane prepares to land. Repeat the listed steps to open
the Eustachian tube. For infants and small children, nursing or taking sips of a drink may help.

You may need medicine to relieve nasal congestion and allow the Eustachian tube to open. These

Decongestants taken by mouth, or by a nose spray


You may need antibiotics to prevent an ear infection if barotrauma is severe.

You can use nasal decongestants (spray or pill form) before altitude changes. Try to avoid altitude
changes while you have an upper respiratory infection or allergy attack.

Talk to your provider about using decongestants if you plan to scuba dive.
Is the use of decongestants and nose sprays recommended?
Many experienced air travelers use a decongestant pill or an over the counter nasal spray an hour
or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers
with allergy problems should take their medication at the beginning of the flight for the same
reason. However, avoid making a habit of over the counter nasal sprays. After a few days, they
may cause more congestion than relief.

Decongestant tablets and sprays can be purchased without a prescription. However, they should
be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid
disease, or excessive nervousness. Such people should consult their physicians before using these
medicines. Pregnant women should likewise consult their physicians first.

Tips to prevent discomfort during air travel

Consult with your surgeon on how soon after ear surgery it is safe to fly.

Postpone an airplane trip if a cold, sinus infection, or an allergy attack is present.

Patients in good health can take a decongestant pill or nose spray approximately an hour before
descent to help the ears pop more easily.

Avoid sleeping during descent.

Chew gum or suck on a hard candy just before take-off and during descent.

When inflating the ears, do not use excessive force. The proper technique involves only pressure
created by the cheek and throat muscles.

These tips may also be used for people who scuba dive.

Ear Infections and Earaches, Symptoms and Treatment | ENT Doctors & Specialists in Los
Angeles and Beverly Hills

If you would like to speak with one of our ENT specialists about ear infection and earache
symptoms and treatment options, we at OHNI will be happy to schedule an appointment or
phone consultation with you.
Ear Infections And Earaches
What is an ear infection?
An ear infection can be in any three parts of the ear. It can be in the outer ear, the middle ear or
the inner ear. An outer ear infection would be like a swimmers ear, where its very painful, red
and swollen, and there may be fluid coming from the ear. Middle ear infection is when Otitis
Media bacteria get behind the ear drum and cause inflammation and pain. An inner ear infection
can be caused by a virus that infects the brain itself, like Encephalitis, or is isolated to the inner
ear, most commonly giving symptoms of hearing loss or dizziness.

What is otitis media?

Otitis media is inflammation of the middle ear. The middle ear involves the eardrum itself and
the bones or ossicles that help to amplify sound. Most commonly it involves children, and it can
be caused by a blockage of the Eustachian tube, or it can be caused by bacteria that come from
either the nose or the throat and work their way up the Eustachian tube into the middle ear. Otitis
media is very painful, but it can be treated easily with antibiotics.

Why do children have more ear infections than adults?

Children have more ear infections than adults because of their Eustachian tube. Childrens
Eustachian tubes are horizontal, so bacteria can travel from the back of the nose directly into the
middle ear on a simpler path. In adults, the Eustachian tube is more vertical, so its more difficult
for bacteria and fluids to get from the nose and throat up into the middle ear. Thats the simple
reason why children get more ear infections. Bottle feeding or breast-feeding with the baby
laying horizontally allows that fluid to travel easier from the nose or the throat up into the middle
ear, and thats another reason why babies get more infections than adults.

Is otitis media a serious medical problem?

Otitis media is less of a serious medical problem now because of antibiotics, but it is a serious
condition if not treated. It can lead to facial paralysis, brain abscesses and death all from the
simple middle ear infection. Because of the advent of the antibiotics, we receive fewer cases of
patients who have severe complications from otitis media, but otitis media should be taken very
seriously and treated immediately if present or diagnosed by your pediatrician or your internist.

What causes otitis media?

Otitis media is usually caused by bacteria that travels into the middle ear through the Eustachian
tube. It can also be caused by Eustachian tube blockage where a vacuum is formed in the middle
ear and fluid leaks out from the surrounding tissues. Theres always a low level of bacteria
throughout our body, but in a fluid environment the bacteria tend to grow and cause an infection
in the middle ear.

What is acute otitis media?

Acute otitis media is a middle-ear infection. Some of the symptoms are ear pain or fullness.
Commonly acute otitis media is associated with a fever. Patients may also have other symptoms,
such as a flu, a cold or a sore throat. Usually the pain from acute otitis media lasts for about three
to four days and it subsides after that. If patients are given antibiotics, the pain and swelling
usually goes away more quickly.

What is serous otitis media or middle ear effusion?

Serous otitis media is a condition where fluid is in the middle ear space but theres no bacterial
infection. Serous otitis media is often called a Eustachian tube disfunction, where negative
pressure is created in the middle ear and fluid leaks from the capillaries into that space. In and of
itself, its not dangerous, but if left unmonitored it can lead to otitis media, if bacteria get
involved. Or, it can lead to hearing loss if the fluid fills the middle ear completely.

What ear infection symptoms do children and teens experience?

Older children and teens, when they have an otitis media, typically dont have fever but they will
have ear pain. Theyre usually able to communicate that to you more. The first sign of an ear
infection is usually pain. If otitis media is left unchecked, it will eventually develop into a fever,
and other symptoms such as fatigue or throat pain, as the infection spreads.

What should I do if I think my child has an ear infection?

If you think your child has an ear infection, you should see your pediatrician or otolaryngologist
immediately. Typically, if caught early, they can be placed on antibiotics, and the ear infection
usually goes away pretty rapidly. Before you get to see your physician, pain relief is probably the
best thing that you can do. So Tylenol every 4 hours or every 6 hours as prescribed by the
pharmacist will help to relieve the ear pain, but your child should still see the physician to get

How will the doctor diagnose my childs ear infection?

The diagnosis of otitis media occurs with a otologic exam. The doctor will place an otoscope in
the ear, which helps to magnify the ear canal and the eardrum, and look for signs of an ear
infection. The most common sign of otitis media is a bulging red eardrum, or your doctor may
see infection, such as pus in the ear canal. That will let them know that theres an ear infection

How are ear infections treated?

Ear infections are typically treated with antibiotics. Sometimes its antibiotic drops if theres an
outer ear infection or oral antibiotics such as amoxicillin. For severe middle ear infections,
sometimes they require surgery where a small tube is placed through the eardrum to allow fluid
to drain. Ear wicks are also used to treat otitis externa, as when patients have otitis externa, the
ear canal itself is swollen, almost to the point of being closed off. The ear wick is a sponge that
expands the ear canal and allows antibiotic drops to get all the way down to the eardrum and
treat the entire ear canal. Without the otowick, the ear drops would simply just fall out of the ear
and not be able to treat all the bacteria there inside the ear canal itself.

What activities should I avoid if I have an ear infection?

If you have an outer ear infections, an otitis external, avoid getting water in the ear. Thats the
most important thing. The water is a milieu for bacteria to propagate. You should also avoid
putting anything in the ear when you have an ear infection, like Q-tips or your finger, and you
should avoid strenuous blowing of your nose, where you can force more bacteria into the ear.

What is swimmers ear?

Swimmers ear is an outer ear infection caused by water thats been left in the ear canal for a
prolonged period of time. What happens is the water desiccates the ear canal and allows bacteria
to migrate into the soft tissues of the ear. Over time, this develops into an infection that becomes
very painful. Swimmers ear is very common in swimmers because they have the most water
exposure to their ear canals. Some of the symptoms of swimmers ear are itching and a burning
sensation in the outer ear. Theres usually pain to touch at the outer ear as well. You may
experience some redness that involves the cheek area or the neck, and typically you have pain
with opening and closing the jaw. The usual treatment for swimmers ear is to see your
otolaryngologist or a primary care physician who will prescribe eardrops for you.

What are the most common causes of an earache?

The most common causes of earache would be ear infection. Other common causes that we dont
think of are TMJ, which is jaw pain or clicking in the jaw, which is transmitted to the ear. It
could be caused from grinding the teeth at night or stress. Another cause of earache could be a
tumor that involves the neck area, which is transmitted to the ear by common nerves that give
sensation to the area.

Why does a change in air pressure make my ears hurt?

Ear pain caused from change in air pressure is usually due to a problem with the Eustachian tube.
The Eustachian tube helps to balance and relieve pressure within the middle ear itself. Typically,
on a plane flight or if youre at high altitudes, like in the mountains, the air inside the middle ear
expands. If you have problems with the Eustachian tube, which is a pop-off valve for this area,
the air cant get out of your ear and you feel pain or pressure as the air is forced against the

The doctor featured in this informational video is Dr. Jason S. Hamilton, of the Osborne Head &
Neck Institute in Los Angeles, California. He is Board-Certified in Facial Plastic and
Reconstructive Surgery and Otolaryngology/Head and Neck Surgery and a member of the
Academy of Facial Plastics and Reconstructive Surgery.

If you would like to learn more about Dr. Hamilton, view his biography and contact
information on the OHNI main website: ENT Specialists in Los Angeles.