Other hearing diseases

Ear barotrauma (airplane ear)

Ear barotrauma causes ear pain, pressure, and temporary hearing changes during flying or diving when pressure cannot equalize properly. Learn symptoms, causes, and prevention tips.

Reviewed by

Dr. Thomas Tedeschi, Au.D.

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What is a barotrauma?

Symptoms

Causes

Treatments

Prevention

What is a barotrauma?

You know when you’re riding in an elevator or plane, and the sudden change in air pressure affects your body? Barotrauma ear (also called otitic barotrauma or eardrum barotrauma) occurs when there is a pressure imbalance between the air in the middle ear and atmospheric pressure outside. This can stress the eardrum and surrounding tissues, causing discomfort and, while rare, potential injury.

“Airplane ear” may come to mind, but the barotrauma meaning extends to any situation with rapid pressure changes, such as scuba diving, hiking in the mountains, and more.¹

Key takeaways

Ear barotrauma happens when pressure changes faster than your Eustachian tube can equalize. Flying, diving, and altitude changes are common triggers.
Symptoms range from ear fullness and muffled hearing to severe pain.
Most cases are resolved within hours using equalization techniques. Ear popping exercises, yawning, and swallowing help open the Eustachian tube.
Learn when it’s necessary to seek medical care. Warning signs include fluid drainage, persistent hearing loss, or fever.
Prevention is key—stay awake during airplane descent and use pressure-relieving techniques. Avoid flying with active colds or sinus infections whenever possible.

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Ear barotrauma symptoms

Ear barotrauma symptoms are similar to those of airplane ear symptoms, but can range from mild discomfort to severe pain, depending on the degree of pressure and individual sensitivity.

Common ear barotrauma symptoms include:

Pressure in the ear and sensations of ear fullness or blockage
Ear pain that’s sharp, dull, or throbbing
Feeling like your ears are “stuffed” or underwater
Muffled hearing or temporary reduction in hearing acuity
Tinnitus (ringing, buzzing, or humming sounds in the ears)
Dizziness or mild vertigo in more severe cases

The intensity of ear pain and barometric pressure can fluctuate with changes in altitude, underwater descent, or even weather. Pressure in one ear may be more pronounced than pressure in the other.

Middle-ear barotrauma (MEB)

Middle-ear barotrauma, also known as ear squeeze barotrauma, is the most common form of ear barotrauma. It occurs when pressure changes affect the space behind the eardrum. The middle ear is ventilated through the Eustachian tube, which connects to the back of the throat. But when this tube is blocked or cannot equalize pressure quickly enough, the eardrum can be pushed inward or outward, causing injury.

Symptoms of middle-ear barotrauma may include:

Pain during pressure changes, particularly during aircraft descent or diving
Feeling like the eardrum is being stretched or pulled
Fluid accumulation behind the eardrum, which may continue to persist
In severe cases, bleeding into the middle ear space or eardrum rupture
Temporary conductive hearing loss due to fluid or membrane damage

Inner ear barotrauma (IEB)

Inner ear barotrauma is less common, although more serious than middle-ear barotrauma. It occurs when extreme pressure differences damage the inner ear, including the cochlea and vestibular system. This requires immediate medical attention to prevent permanent hearing loss or balance disorders.

Symptoms specific to inner ear barotrauma include:

Sudden, severe hearing loss
Ongoing vertigo or severe dizziness
Nausea and vomiting associated with vestibular disturbance
Tinnitus that is more constant than in middle ear cases
Balance problems that persist even after other symptoms improve

If you experience these symptoms, particularly sudden hearing loss or severe vertigo, you may need to consult an ENT or other physician about a perilymph fistula—an abnormal opening in the inner ear that can occur from severe pressure trauma.

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Ear barotrauma causes

Barotrauma of the ear can occur in situations where atmospheric pressure changes faster than the Eustachian tube can adapt. The Eustachian tube typically opens during swallowing, yawning, or chewing, allowing air to flow through the middle ear to equalize external pressure. But if the Eustachian tube is overwhelmed, barotrauma can occur.

Common barotrauma ear causes include:

Flying: The most frequent cause, typically during airplane descent when cabin pressure increases rapidly.
Diving: Scuba diving exposes the ears to significant pressure changes during rapid descent or ascent.
Change in altitude: From ascending mountains to riding elevators in tall buildings, these changes in altitude usually cause milder symptoms than flying or diving.
Hyperbaric oxygen therapy: Inner or middle ear barotrauma in hyperbaric oxygen therapy can occur when patients breathe pure oxygen in a pressurized chamber for medical treatment.
Forceful nose blowing or sneezing: If the mouth and nose are closed, this can create sudden pressure changes.

Risk factors for barotrauma include:

Congestion from colds, allergies, or sinus infections, which can block the Eustachian tube
Anatomical variations in the Eustachian tube structure
Recent ear surgery
Chronic nasal or sinus conditions

Important note: While barotrauma itself does not directly cause ear infections, it can lead to prolonged Eustachian tube closure, which may result in fluid accumulation and subsequent middle ear infection.

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Ear barotrauma treatments

Ear barotrauma treatment depends on the severity of the condition and whether symptoms are resolved on their own or require medical intervention. Most cases respond well to at-home ear barotrauma remedies or common airplane ear treatments, but severe cases need medical care. The goal of treatment is to equalize pressure, reduce pain and inflammation, and prevent complications such as infection or permanent damage.

For mild cases, ear barotrauma home remedies can relieve symptoms. These work by helping the Eustachian tube open and equalize pressure.

Valsalva maneuver: Gently blow air through the nose while pinching the nostrils closed, keeping the mouth shut, and redirecting air into the Eustachian tubes. Use gentle pressure to avoid damaging the inner ear.
Toynbee maneuver: Pinch the nose closed and swallow simultaneously, which uses a different muscular mechanism to open the Eustachian tubes.
Frenzel maneuver: Pinch the nostrils and close your throat while pushing the tongue back, creating pressure that forces air into the middle ear—a technique used by scuba divers.²
Frequent yawning or swallowing: This activates the muscles that open the Eustachian tube. Chewing gum or sucking on candy also helps encourage you to swallow more and open those muscles.
Warm compresses: While it does not directly address the pressure imbalance, applying gentle heat to the affected ear can improve blood flow and reduce discomfort.

These techniques are most effective when done during the pressure change itself or immediately afterward. If symptoms persist for hours despite these measures, see a doctor.

Unfortunately, at-home remedies don’t provide an instant ear barotrauma cure, but medications can help. Medicine for ear barotrauma can include:

Decongestants reduce swelling in the nasal passages and Eustachian tube openings.
Antihistamines help if allergies affect your Eustachian tubes by reducing inflammation and mucus production.
Nasal corticosteroid sprays can help in cases of chronic Eustachian tube problems or congestion, as prescription nasal steroids can reduce inflammation.
Over-the-counter pain relievers such as ibuprofen or acetaminophen help with ear pain and inflammation associated with barotrauma.
Wax-softening ear drops may provide additional relief from blockage. However, traditional ear drops are typically not effective for barotrauma since the problem is behind the eardrum in the middle ear.

Always consult a healthcare provider before using medicine for ear barotrauma, especially for children, pregnant individuals, or if you have cardiovascular conditions. Some decongestants can raise blood pressure or interact with other medications.

What to do if ear barotrauma won’t go away

At-home remedies not providing relief? It’s a similar process for when airplane ear won’t go away. If symptoms like pain or hearing loss linger for more than two days, it’s best to see a healthcare provider. Especially if you experience:

Severe pain after taking over-the-counter pain relievers
Hearing loss for more than 24 to 48 hours
Fluid draining from the ear, particularly if it’s bloody or clear
Fever, increased pain, or thick yellow-green discharge
Severe or persistent vertigo that interferes with daily activities
Any symptoms indicating inner ear damage, such as lingering hearing changes or balance problems

Treatment for complicated barotrauma may include prescription-strength medications, procedures to drain fluid from the middle ear, or surgery to place tympanostomy tubes in chronic cases.

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How long does ear barotrauma last?

That depends on how mild or severe your ear barotrauma is and whether complications develop.

Typical ear barotrauma recovery times are:

Mild: Within a few minutes to a few hours after pressure equalizes. Discomfort may linger for a day, but full recovery is quick.
Moderate: Depending on the fluid behind the eardrum or the inflammation, symptoms typically last 24 to 48 hours. Middle ear barotrauma recovery can take a few days with appropriate self-care.
Severe: With eardrum rupture, fluid accumulation, or secondary infection, recovery can take one to two weeks or longer. Medical treatment is often necessary.
Inner ear barotrauma recovery: Damage to the inner ear is more serious. Some of its symptoms, including vertigo, may improve within weeks to months. However, hearing loss from inner ear injury can be permanent.

Ear barotrauma diagnosis and prevention

An ear barotrauma diagnosis is typically made through examination and patient history. A healthcare provider will examine the eardrum for signs of retraction, bulging, fluid behind the tympanic membrane, or perforation, and they will order tests if necessary.

Starting with prevention is the most effective approach. Ear barotrauma prevention strategies include:

Staying awake during aircraft descent: Perform your remedies instead of sleeping through landing.
Use decongestants beforehand: Take oral decongestants or use nasal sprays 40 to 60 minutes before takeoff if you have congestion.
Barotrauma earplugs: Specialized filtered earplugs designed for air travel help slow the rate of pressure change at the eardrum, giving the Eustachian tube more time to equalize. While evidence for their effectiveness is mixed, many travelers find them helpful.
Equalization techniques: Learn the Valsalva, Toynbee, or Frenzel maneuvers before situations involving pressure changes.
Avoid flying with upper respiratory infections: If possible, postpone air travel if you have a cold, sinus infection, or severe allergies.

For scuba divers: Descend slowly, equalize early and often (before pain occurs), and never dive with congestion or Eustachian tube dysfunction.

For infants and children: Infants have narrow Eustachian tube passageways, making them more susceptible to barotrauma during air travel.³ To alleviate symptoms in infants, feed them (bottle or breastfeed) during takeoff and landing to open their Eustachian tubes through swallowing. Keep the baby upright during feeding to prevent choking. For older toddlers, offer a sippy cup, pacifier, lollipops, chewing gum, or snack during pressure changes. Never force equalization maneuvers on young children—their ear structures are delicate.

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FAQs about ear barotrauma

In most cases, no. Mild to moderate barotrauma causes temporary discomfort but resolves without lasting effects. Severe barotrauma, while rarer, can bring complications such as eardrum rupture, persistent hearing loss, or inner ear damage.

The majority of barotrauma cases heal completely within hours to days. Permanent damage is rare but can occur in severe cases if the inner ear is affected, a perilymph fistula develops, or treatment is delayed. Seek medical attention for severe symptoms to reduce the risk of permanent issues.

Barotrauma itself does not directly cause ear infections. However, it can lead to complications, such as dysfunction of the Eustachian tube, which can lead to an infection. When the Eustachian tube is blocked, fluid can accumulate in the middle ear space—a breeding ground for bacteria. This secondary infection requires separate antibiotic treatment and should be managed by a healthcare provider.

It is not recommended to fly with active barotrauma symptoms because additional pressure changes can worsen symptoms and extend recovery time. If you must fly—and symptoms are mild—make preventive action a part of your travel plans and perform equalization techniques throughout the flight.

However, if your symptoms are severe, such as hearing loss, fluid drainage, or suspected eardrum rupture, do not fly until cleared by a healthcare provider, as that will increase the risk of complications.

Yes, in most cases, mild ear barotrauma resolves as pressure equalizes and the Eustachian tube returns to normal. However, “on its own” does not always mean without your own action. Performing equalization maneuvers, using decongestants (if appropriate), and avoiding further pressure changes all facilitate natural healing. Severe barotrauma may not resolve without medical intervention, especially if complications occur.

Many people search for how to sleep with ear barotrauma because the pain and pressure can make rest extremely difficult. Elevating your head with extra pillows can help reduce congestion and promote drainage of the Eustachian tubes.

If only one ear is affected, try sleeping on the opposite side to reduce pressure on the injured ear. A warm compress can provide comfort and reduce inflammation, or taking an over-the-counter pain reliever 40 minutes before sleep can also help. If ear pain significantly affects your sleep or worsens at night, this may be a sign of infection. In that case, consult a healthcare provider.

Sources

¹“Barotrauma.” Harvard Health Publishing, 21 May 2024, www.health.harvard.edu/a_to_z/barotrauma-a-to-z.

²“Scuba Diving: Decompression Illness and Other Dive-Related Injuries.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Apr. 2025, www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/scuba-diving-decompression-illness-and-other-dive-related-injuries.html.

³“Ears and Altitude (Barotrauma).” ENT Health, American Academy of Otolaryngology–Head and Neck Surgery Foundation, 24 Jan. 2024, www.enthealth.org/conditions/ears-and-altitude-barotrauma/.