Barotrauma

Barotrauma refers to tissue damage in the body caused by pressure differences between an unventilated space within the body and the surrounding gas or fluid. It occurs when there is an imbalance between the pressure inside a body cavity and external pressure. This condition is very common during takeoff and landing of flights as well as during diving.

Depending on the affected part of the body, several types of barotrauma are distinguished, with the most common being:

• Ear barotrauma: the most frequent type.
• Pulmonary barotrauma: the most severe type, mainly occurring during diving.
• Mask barotrauma: affects the part of the face covered by a diving mask.
• Sinus barotrauma: damage to the paranasal sinuses.
• Gastrointestinal barotrauma: affects organs in the abdominal cavity.

Symptoms

The symptoms of barotrauma depend on the affected tissues:

• Ear barotrauma:
• Discomfort or pain.
• Sensation of pressure or congestion.
• Hearing loss.
• Tinnitus: ringing in the ears.
• Vertigo and disorientation.
• Bleeding in severe cases.
• Pulmonary barotrauma:
• Chest pain.
• Feeling of suffocation.
• In some cases, blood-stained sputum or blood-tinged foam in the mouth.
• Hoarseness or voice changes if the vocal cord nerves are compressed.
• Mask barotrauma:
• Bloodshot and red eyes.
• Bruised skin.
• Sinus barotrauma:
• Facial pain.
• Headaches.
• Sensation of congestion or pressure in the face.
• Nosebleeds.
• Extreme skin sensitivity on the cheeks.
• Gastrointestinal barotrauma:
• Abdominal distension.
• Pain and cramps.
• Burping and flatulence.

Causes

When the surrounding air or water pressure suddenly increases, it is transmitted evenly throughout the blood and body tissues, which do not compress as they are mostly liquid. However, the gases contained within the lungs, middle ear, or sinuses compress or expand as external pressure increases or decreases. This process can cause tissue damage.

In the case of the ear, the pressure difference between the external environment and the interior causes the Eustachian tube, which regulates pressure, to fail to react in time, resulting in inward bulging of the eardrum, which may rupture.

Pulmonary barotrauma occurs because air subjected to high pressure compresses, causing each breath taken in high-pressure environments to contain more air molecules. As pressure decreases, this inhaled air expands and its volume increases, leading to lung overinflation. This overinflation can rupture the pulmonary alveoli, allowing air to escape. This mainly happens during diving when holding one’s breath while ascending with a scuba tank.

Mask barotrauma occurs because the pressure inside the diving mask does not equalize with the water pressure during descent. Consequently, the mask acts as a suction cup, causing nearby blood vessels on the surface of the eyes or face to dilate, leak fluid, rupture, and bleed. The digestive tract can be affected by barotrauma when improper breathing or techniques used to stabilize ear or sinus pressure cause small amounts of air to be swallowed during pressure changes.

Risk Factors

Factors that increase the risk of barotrauma include:

• Small or blocked Eustachian tube.
• Nasal congestion from a common cold.
• Middle ear infection (otitis media).
• Allergic rhinitis.
• Upper respiratory tract infection.
• Pulmonary disorders.

Complications

Pulmonary barotrauma can have severe consequences:

• Pneumothorax: The lung collapses as air escaping from the lungs expands into the space between the lungs and the rib cage (pleural space).
• Subcutaneous emphysema: Air escapes from the lungs into the tissues surrounding the heart (pneumomediastinum) or the neck.
• Arterial gas embolism: If air enters the blood vessels, it can obstruct blood flow in an artery due to air bubbles. This is one of the leading causes of death among divers.

Ear barotrauma can lead to:

• Middle ear infection due to eardrum rupture, causing pain and discharge.
• Permanent hearing loss if barotrauma persists for a long time, as eardrum damage may be severe.
• Chronic tinnitus.

Excess mask pressure, in rare cases, can cause posterior eye hemorrhage and result in vision loss. Additionally, though very rarely, air reaching the digestive tract may lead to stomach or intestinal perforations.

Prevention

To minimize the risk of barotrauma, the following measures should be taken to compensate for pressure differences during diving or flying:

• Using pressurized air tanks when diving.
• Exhaling inhaled air during ascent.
• Exhaling through the nose inside the diving mask.
• Yawning or swallowing to open the Eustachian tube.
• Performing the Valsalva maneuver during takeoff and landing: exhaling air with the mouth and nose closed.
• Avoiding the use of earplugs while diving.
• Using special filtered earplugs for flights: these contain filters that act as valves to balance pressure.

Which Doctor Treats Barotrauma?

Barotrauma can affect different parts of the body, so it may be treated by specialists in aerospace medicine, otolaryngology, pulmonology, or thoracic surgery.