Barotitis Media

GENERAL INFORMATION:

What is barotitis media? Barotitis media, also known as ear squeeze, is an injury to the middle ear (area behind your eardrum). This occurs when the eustachian tube becomes blocked. This tube connects your middle ear to the back of your nose and throat. Trapped air that cannot move in and out builds up inside the middle ear. When this happens, the blood vessels and tissue that line the inside of your middle ear swell up. Barotitis media may go away on its own, or you may need treatment for it. Signs and symptoms of barotitis media may take up to one month to go away. You are more likely to get barotitis media again if you have had it once.

What causes barotitis media? Barotitis media happens when you go through sudden changes in altitude (height). Any of the following may cause barotitis media:

• Being in an aircraft that goes down too fast.
  
  
• Swimming up (ascending) or down (descending) too fast while scuba diving.
  
  
• Falling fast while skydiving.
  
  
• Having a medical problem and then getting hyperbaric oxygen treatments place you at a higher risk of getting barotitis media.

What are the signs and symptoms of barotitis media?

• Increased air pressure in your middle ear may cause ear pain and fullness. You may feel dizzy or hear ringing in your ears. You may have trouble hearing, or not be able to hear at all. Blood may come out of one or both of your ears, or your nose. You may have trouble moving one side of your face.
  
  
• Your signs and symptoms may be mild, or very bad. They may show up during or right after activities such as scuba diving or flying on an airplane. Signs and symptoms may also show up hours after an activity. Symptoms may be there all of the time, or they may come and go.

How is barotitis media diagnosed? Caregivers may ask you if you have travelled on a plane or went scuba diving recently. Your caregiver will ask you if you have any medical problems, and when your symptoms started. Your caregiver may ask you to chew, swallow, or yawn to release trapped air from your middle ear. He may also ask you to do certain procedures, such as Valsalva's or Frenzel's maneuvers. Tell your caregiver if you are taking any medicine. You may have any of the following tests:

• Audiometry: This test measures what sound levels your ears can pick up. Ask your caregiver for more information about audiometry.
  
  
• Otoscopy: Your caregiver will use an otoscope to look at your eardrum and middle ear. An otoscope has a cone-shaped lens that uses a light source to see inside your ear.
  
  
• Tympanometry: This is a test to check if your middle ear is able to send sound to the inner ear. Your caregiver will put a probe (small tube) into your ear to measure air pressure and sound.

How is barotitis media treated? Do not scuba dive until your signs and symptoms go away. If your eardrum has burst or other damage has happened to your ear, do not dive until after it has healed. You may also be given the following:

• Medicines:
  
  
  • Analgesics: These are medicines that help decrease your ear pain. Some analgesics may also be used to decrease swelling and fever (high body temperature).
    
    
  • Antibiotics: These are medicines that kill germs and treat infection. Your caregiver may give this to you if you have a torn eardrum.
    
    
  • Decongestants: These medicines help dry up fluid in your nose.
    
    
  • Steroids: These are medicines that decrease swelling in the lining of your nose. Your caregiver will tell you to spray it into your nose and sniff slowly.
  
  
• Surgery:
  
  
  • Myringotomy: During this surgery your caregiver will make a small cut in your eardrum. This is done if your ears feel plugged and very painful. Ask your caregiver for more information about myringotomy.
    
    
  • Tympanoplasty: This is surgery to attach your torn eardrum back in place. You will have trouble hearing if this surgery is not done. Ask your caregiver for more information about tympanoplasty.

What are Valsalva's and Frenzel's maneuvers? The Valsalva's maneuver is an action that you can try, which may help your ears open up (clear your ears). Move your head forward and bend your neck slightly, so that your chin is tilted slightly down. Turn your head away from the ear that feels plugged or is painful. Pinch your nose and close your mouth. Gently push air out as if you are blowing your nose. This may cause your ears to clear. If your ear does not feel like it is clear, or you feel pain, stop trying this maneuver. The Frenzel's maneuver is another action that you can try, which may help clear your ears. This action is done by pinching your nose closed, and saying "k" over and over again.

What can I do to decrease my risk of getting barotitis media?

• When you are traveling by air:
  
  
  • Avoid air travel if you have an upper respiratory infection (cold), or an ear infection.
    
    
  • Avoid sleeping when the plane takes off or lands.
    
    
  • Swallow, yawn, move your jaw sideways, chew gum, and sip fluids while flying on an airplane. Do these actions three to four times as the plane takes off and lands.
    
    
  • Try the Valsalva's maneuver to clear your ears as the airplane is landing if swallowing, yawning and moving your jaw has not worked. The Frenzel's maneuver may also be tried as a plane takes off or lands.
    
    
  • Follow guidelines that tell you how long to wait to fly on an aircraft after scuba diving. Scuba divers should always follow the guidelines given on dive tables and dive computers.
    
    
  • Wait to fly on a plane until 24 hours (one day) has passed after skydiving.
    
    
  • Ask caregivers about a device that may help you clear your ears while flying in an airplane. The device is put into one nostril, and the other nostril is closed by pressing on it. You blow air through the nostril with the device in it to fill a balloon.
  
  
• When you are scuba diving:
  
  
  • See your caregiver before you scuba dive. He may see if you are able to clear your ears easily. If you are not able to clear your ears, caregivers may suggest that you avoid scuba diving.
    
    
  • Do not scuba dive for two weeks after the signs and symptoms of a cold or infection have gone away.
    
    
  • Learn how to swallow, yawn, and move your jaw sideways while scuba diving.
    
    
  • Do the Valsalva's maneuver three times at every meter for the first five meters as you descend. If you feel that your ears are plugged or painful, slowly ascend. Repeat the Valsalva's maneuver as you slowly descend. If this action does not clear your ears, stop doing it.

How can medicine help prevent barotitis media? Ask your caregiver if you should use the following medicines. Use these medicines only if your caregiver directs you to, and take them only as directed:

• Decongestants: This medicine may be used to decrease signs and symptoms such as having a stuffy and runny nose. This medicine may be used for some people before scuba diving. It may decrease the risk of getting barotitis media, or decrease how bad the signs and symptoms are. If you have a cold or sinus infection already, do not use this medicine to decrease your symptoms so that you can dive. This medicine can be used before traveling by airplane if you have signs and symptoms of a cold. Decongestants can also be used to treat barotitis media.
  
  
• Antihistamines: This medicine is used to decrease signs and symptoms such as sneezing, watery eyes, and a runny nose. Do not use these medicines before scuba diving.

When should I call my caregiver? Call your caregiver if:

• You have a fever and feel dizzy after diving.
  
  
• You have new ringing in your ear after diving or traveling in an aircraft.
  
  
• Your ear feels plugged and painful after diving or traveling in an aircraft.

When should I seek immediate care? Seek care immediately or call 911 if:

• Your dizziness or ear pain gets worse.
  
  
• Fluid or blood comes out from your ear or nose after scuba diving.
  
  
• You have sudden trouble hearing or you cannot hear anything after skydiving, scuba diving, or flying in an aircraft.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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