What Is Barotitis Media and How Can You Treat It?
Barotitis media refers to a lesion in the middle ear caused by pressure changes (usually in aircraft cabins). In most cases, it's not too severe, and goes away on its own, soon after you get off the plane.
The increase in international air travel means that more and more people have to deal with the changing air pressure is an aircraft cabin. Air pressure in planes is lower than what we experience at sea-level, and, as a result, it can trigger a situation known as barotitis media.
According to the 2019 report of IATA, the International Air Transport Association, the total number of passengers worldwide in 2018 was 4.3 million. A large number of them experience discomfort in the middle ear, which develops when the plane climbs quickly to reach its cruising altitude, or during its descent.
In most cases, this discomfort is momentary, but other people are unable to balance the pressures in the middle ear. This is called barotitis media.
Read on to find out what it is and how to treat it.
This condition is also known as barotrauma. As we mentioned, it’s an imbalance of the pressures in the middle ear that causes pain and even injury in the ear. This occurs more frequently in children.
To understand these things better, we need to address some general concepts about the ear that will help us to know how to prevent or treat this condition.
How does the middle ear work?
The middle ear is an air-filled space, separated from the outside by two structures. On the one hand, we have the tympanic membrane or eardrum and, on the other hand, the Eustachian tube. The latter separates the middle ear from the pharyngeal region.
The pressure inside the middle ear has to be the same as that of the environment for the tympanic membrane to vibrate and fulfill its function in hearing. Momentarily, when we yawn or swallow, the Eustachian tube opens briefly, which causes a flow of air, this balancing the pressures.
When the Eustachian tube isn’t functioning properly, then pressure differences develop between the middle ear and the outside environment. This can lead to barotrauma.
The most frequent cause of barotrauma is flying in an aircraft. However, there are others too, such as diving, climbing, or the use of hyperbaric chambers.
What happens on a plane?
Commercial aircraft have pressurized cabins, with the same pressure that exists between altitudes of 7,000 and 10,000 feet. This is less than the pressure that exists at sea level. As the plane ascends and descends, the atmospheric pressure changes and, as a consequence, the pressure in the middle ear must also change.
This change should be gradual and balanced if we swallow normally. The air will then move spontaneously into or out of the middle ear, through the Eustachian tube. However, when this doesn’t occur, then this causes pressure and stretching in the tympanic membrane, causing pain and hearing loss.
Bruising or bleeding may develop in the tympanic membrane. Fluid can also form in the middle ear, and, in the worst of cases, the eardrum can rupture. There is a feeling of tension in the ear, and the person may experience tinnitus.
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Most mild ear injuries will heal on their own over time, including the rupture of the tympanic membrane. However, this depends on the Eustachian tube returning to normal. Hearing usually recovers, as well.
On some occasions, a doctor may prescribe oral decongestants, antihistamines, and even antibiotics. All of these will help keep the Eustachian tube free. The use of analgesics will help to diminish the pain, too.
In a few situations, a fistula can occur. This is an abnormal communication between the middle and inner ear and causes dizziness. In an emergency like this, an otolaryngology specialist must intervene to evaluate the need for surgical repair.
Myringotomy (a small surgical incision made in the tympanic membrane) and tympanostomy (placing a tube in the eardrum) help to prevent barotitis media and balance the pressures. They’re also used as a treatment, as they help drain the exudates.
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If we travel by plane, we can help balance the pressures during the ascent and descent, to limit discomfort or injury. This is possible by using any of the following methods:
- Yawning or performing a mild Valsalva maneuver, an exhalation effort while keeping the airway closed.
- Chewing gum and swallowing frequently.
- Eating sour candies.
- Babies can suck on a bottle or pacifier.
- Sometimes, oral decongestants, antihistamines, and nasal sprays can be used before flying, as long as they’re prescribed by a doctor.
- Experts have designed earplugs to decrease pressure changes, but their actual benefit hasn’t yet been proven.
If you need to fly, then it’s advisable to visit your pediatrician or ENT specialist for advice. Preventing barotitis media, especially in the case of people with allergies or who are undergoing some kind of infection, is key to improving your well-being when flying.