Barotrauma

What is barotrauma?

• Barotrauma is an injury that is caused by pressure changes. The pressure changes happen between an area of your body, and the pressure of air or water around you. This pressure change traps air, which builds up inside a body part or organ. Body parts where this can occur include your ears, sinuses, and teeth. Sinuses are hollow spaces in the skull found behind the bones of your forehead, cheeks, and eyes. Body organs where barotrauma can occur include your lungs, stomach, and bowels (intestines). Barotrauma is also called ear, sinus, lung, or gut squeeze.
  
  
• Barotrauma signs and symptoms may go away without treatment, or you may need treatment or surgery. Treating barotrauma may decrease problems such as pain and dizziness, or make them go away. In some cases, you may have lasting problems, such as hearing loss, caused by barotrauma.

What causes barotrauma?

With barotrauma, trapped air increases the pressure in a body area and causes symptoms such as ear pain. The trapped air causes tissues to swell up, and blood vessels may burst. When this happens, the signs and symptoms of barotrauma get worse. Any of the following may cause barotrauma:

• Scuba diving: Ear and sinus squeeze occur when you swim up (ascend) or down (descend) too fast while scuba diving. This can cause tooth pain if you already have a cavity or problems with your teeth. Holding your breath, or not breathing out when ascending may cause barotrauma. You can also get lung, diving mask, or gut squeeze. Diving mask squeeze happens if you do not breathe out through your nose when descending. Diving suit squeeze may occur when you wear a tight-fitting dive suit to scuba dive.
  
  
  • Valsalva's maneuver: This is an action that may be done while scuba diving to help you hear better if one or both ears feel plugged. This action moves air from the back of the nose and throat to the ear. The Valsalva's maneuver may not always work to clear your ears. If you keep trying hard to do the maneuver when it is not working, you may get ear squeeze.
    
    
  
  
• Traveling by aircraft: Changes in air pressure when flying in an airplane may cause ear squeeze. This is most likely to happen as the plane takes off and lands.
  
  
• Blast injuries: The force caused by an explosion can hurt body parts and organs. Changes that occur to air pressure when dynamite or another explosive blows up can cause barotrauma.
  
  
• Ventilator machine: This machine helps you breathe if you have trouble breathing on your own. Getting oxygen through a ventilator when you have asthma or a bad lung injury may cause lung squeeze.
  
  
• Hyperbaric oxygen treatment: This treatment is also called HBOT. HBOT removes air bubbles from blood vessels or tissues. This can be caused by decompression sickness. Decompression sickness ("the bends") happens when a diver comes up too quickly from a lengthy or deep dive. HBOT can also be used to help certain wounds heal, and for other reasons. During this treatment, you go into a closed metal chamber, and breathe in high-pressure oxygen. People who have a lung disease are a higher risk of getting barotrauma if they have HBOT treatments.

What may increase my risk of getting barotrauma?

If you have had barotrauma in the past you are at a higher risk of getting it again. If you have had a lung injury called spontaneous pneumothorax, your risk of getting barotrauma is higher. If you smoke, you are also at a higher risk. The following are factors that increase your risk of getting barotrauma while scuba diving:

• A hole in the wall that separates the right and left sides of the heart is called right to left shunt. This heart condition places you at a higher risk of getting barotrauma.
  
  
• An upper respiratory infection (cold) or polyp (growth) in your nose increases your risk of getting ear and sinus squeeze. Hardened wax in the ear canal may also increase your risk for ear and sinus squeeze. These problems trap air inside your ear, causing your eardrum and sinuses to swell during scuba diving.
  
  
• Asthma and lung diseases can cause trouble breathing when you dive. Trapped air in your lung causes it to stretch too much, and can result in pulmonary barotrauma.
  
  
• Problems with your stomach or anus increase your risk of having gut squeeze. If trapped air cannot escape as it should, it can cause barotrauma as you ascend (come up) from a dive.

What are the signs and symptoms of barotrauma caused by scuba diving?

Your signs and symptoms may appear right after diving, or may show up slowly over time.

• Ear squeeze: One or both of your ears may get ear squeeze. Your ear may hurt, and feel plugged and full. You may hear or feel your ears pop when you swallow, yawn, or chew. Fluid or blood may come out of your ear. You may hear ringing in your ear (tinnitus), and you may have trouble hearing. You may be unable to move the muscles of your face to smile or frown. The pupils (black circles) in your eyes may move in odd ways, and you may feel dizzy and sick.
  
  
• Gut squeeze: You may have stomach pain that spreads to your legs. Your stomach may feel full, and you may burp and pass gas more than usual. You may have trouble having a bowel movement, and you may have blood in your stool.
  
  
• Lung squeeze: Lung squeeze can causes chest pain, trouble breathing, and dizziness. You may cough up blood. Your hands and feet may turn cold, and your lips and nails may turn very light-colored.
  
  
• Mask and suit squeeze: Mask squeeze can cause your eyes to feel sore, and your face may swell up. You may have trouble seeing or see red spots, and your face may look bruised. Dive suit squeeze can cause an itchy rash, and red or purple skin patches.
  
  
• Sinus and tooth squeeze: Sinus squeeze can cause sharp pain in your cheeks or between your eyes. You may have a headache in your forehead or at the back of your head. You may also get nosebleeds. Tooth squeeze causes a toothache.

What are the signs and symptoms of barotrauma caused by air travel?

Signs and symptoms may come when the airplane is taking off or landing, and may be in one or both ears. Your ears may hurt, and feel like they are plugged and full. Your ears may pop when you swallow, yawn, or chew. You may feel dizzy, and sick to your stomach. Fluid or blood may come out of one or both ears.

What are the signs and symptoms of barotrauma caused by HBOT?

You may have signs and symptoms during or after an HBOT treatment. You may have pain in one or both ears, feel dizzy and sick to your stomach. You may get a sudden toothache. You may hear or feel your ears pop when you move your jaw, such as when yawning. You may have new chest pain, and sudden trouble breathing.

What are the signs and symptoms of barotrauma caused by a blast injury?

Signs and symptoms can show right after the blast, or they can show up later.

• Signs and symptoms that appear right away: You may feel dizzy, and have chest pain and sudden trouble breathing. Your hands and feet may be cold, and your lips and nails may turn pale (light-colored). You may cough up blood.
  
  
• Signs and symptoms that appear later: You may feel sick to your stomach and begin to vomit (throw up). Your ears may hurt, and blood of fluid may come out of them. You may hear ringing in your ears, or be unable to hear at all. You may have stomach pain that spreads to your legs. There may be blood in your stool, and you may have trouble having a bowel movement.

How is barotrauma diagnosed?

Your caregiver will ask you questions about your health and activities. He will need to know when your symptoms started. Tell your caregiver if you have other medical conditions or if you are taking any medicine. Your caregiver will do a physical exam. He may ask you to chew, swallow, or yawn to release air from your ears. Caregivers may collect samples of your blood or urine to be tested. You may also need any of the following tests:

• Ear tests:
  
  
  • Hearing tests: These are tests to measure what sound levels you can hear. Pure tone audiometry and speech audiometry will show if you have hearing loss. Tympanometry is a test to check if your middle ear can send sound to your inner ear. For this test, your caregiver will insert a probe (small tube) that makes a sound in your ear. Tests may be done to learn if your cochlea is damaged. The cochlea is part of your inner ear, and is the main organ for hearing.
    
    
  • Otoscopy: Your caregiver will use an otoscope to look at the different parts of your ear. An otoscope is a cone-like lens that uses light to see inside your ear canal.
    
    
  • Vestibular function tests: The vestibula is a part of the inner ear that helps you keep your balance. These tests check for damage to the vestibula. For this test, you are asked to look in certain directions, and change your body position.
  
  
• Computed tomography scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your bones, lungs, stomach, intestines, and blood vessels. You may be given dye before the pictures are taken. The dye is usually given through a vein (blood vessel) to help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish.
  
  
• Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures of your abdomen, ear, lungs, and sinuses may be taken. You will need to lie still during this test. The MRI machine contains a very powerful magnet. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
  
  
• X-ray: Your caregiver may take pictures of your sinuses to check for fluid. This test also shows if the bones around your sinuses are broken. This test also checks for air that should not be in your abdomen (stomach) or other body areas.

What medicines may be used to treat barotrauma?

• Analgesics: These medicines help decrease pain.
  
  
• Antibiotics: These medicines kill germs and treat infection. Your caregiver may give this to you if you have a torn eardrum or sinus infection.
  
  
• Decongestants: These medicines help dry up fluid in your nose. They also decrease swelling of the lining of your nose and sinuses. These medicines may be given to you if you have ear or sinus squeeze.
  
  
• Laxatives: These medicines make your stool softer to prevent straining (pushing) while having a stool. Straining may increase the pressure inside your brain. Your caregiver may give you this if you have ear squeeze.
  
  
• Steroids: These are medicines that decrease swelling of the lining of your ear, nose and sinuses.

What other treatments may be used for barotrauma?

Signs and symptoms of barotrauma may go away without treatment, but you may need to rest for a period of time. You may also need to stop scuba diving for a time, or in some cases, forever. You may need to avoid air travel for a period of time. If treatment is needed, you may need one or more of the following:

• Ear canal cleaning: Your caregiver may need to remove earwax to release air pressure in your ears.
  
  
• Treatment for tinnitus: Your caregiver may give you a device to put in your ears, which will decrease the ringing that you hear. Biofeedback therapy uses patches of electric current to relax your face and neck muscles. Your caregiver may also use transcutaneous electrical nerve stimulation (TENS) therapy. This uses an electrical current placed on the skin near your ears. Tinnitus retraining therapy may also be done to help you learn not to hear any ringing sounds.
  
  
• Oxygen: If you have lung squeeze, you may need extra oxygen. You may need to breathe into a face mask to get more oxygen as your lungs heal.
  
  
• Hyperbaric oxygen treatment: You may need to go inside a chamber, and breathe in high-pressure oxygen if you have lung barotrauma. You may need to have more than one HBOT treatment.
  
  
• Surgery: If an organ or body part has been hurt by barotrauma, you may need surgery to repair it. If you need to have any of the following surgeries, ask your caregiver for more information about it:
  
  
  • Myringotomy: During this surgery, a small cut is made into your eardrum to release pressure. Your caregiver may do this if your ears are plugged up and painful.
    
    
  • Needle decompression: A needle is put into your chest to make an opening so that trapped air can come out.
    
    
  • Sinus surgery: You may need sinus surgery to widen the sinus openings.
    
    
  • Thoracostomy: During this surgery, a cut is made into your chest to remove air caused by lung squeeze. A tube may be placed in your chest, and left in for a period of time.
    
    
  • Tympanoplasty: If you have a torn eardrum, this surgery may be done to attach it back into place.

What are Valsalva's and Frenzel's maneuvers?

The Valsalva's maneuver is an action that 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 way 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 the risk of getting barotrauma while traveling by air?

• Avoid air travel if you have an upper respiratory infection (cold), or an ear infection.
  
  
• 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 for 24 hours (one day) after skydiving.
  
  
• Avoid sleeping when the plane takes off or lands. Sit up while flying on an airplane, rather than lying down.
  
  
• Swallow, yawn, move your jaw sideways, chew gum, and sip fluids while flying on an airplane. Do these actions 3 to 4 times as the plane takes off, and repeat them as it lands.
  
  
• Try the Valsalva's maneuver to clear your ears as the airplane is landing if jaw movements have not worked. The Frenzel's maneuver may also be tried as a plane takes off, and as it lands.
  
  
• 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.

What can I do to decrease the risk of getting barotrauma while 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 do not scuba dive.
  
  
• Do not scuba dive for two weeks after the signs and symptoms of a cold or infection have gone away.
  
  
• Drink enough liquids before diving. Men 19 years and older should drink about three liters of liquid each day (about 13 eight-ounce cups). Women 19 years and older should drink about two liters of liquid each day (about nine, eight-ounce cups). Avoid eating large meals or drinks that may make you gassy, such as soda, before diving.
  
  
• Do not wear earplugs or tight-fitting dive hoods.
  
  
• 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.
  
  
• When diving, follow the guidelines given on dive tables and dive computers. These guidelines tell you how long to wait before diving again, and before flying in an airplane.
  
  
• Wait for a period of time after scuba diving before you exercise or take a hot bath.

What are the risks of having barotrauma?

• Barotrauma can cause air bubbles to form and go to areas of your body. Air bubbles may go into your skin and cause a rash, skin dimpling, or purple skin patches. They may also cause your skin to swell up. Swelling may occur in your neck and spread to your shoulders, face, or chest. It can cause voice changes and other problems. Air bubbles may go into your joints and cause pain and swelling. Joints are the places in your body where two bones meet, such as your knees and elbows. Air bubbles may damage your nerves and you may have trouble seeing. You may also be unable to move the muscles of your face, such as when you smile.
  
  
• Air bubbles may damage your spinal nerves, causing pain or trouble moving your arms and legs. Air bubbles may enter your blood, and block your blood vessels. If this happens, blood and oxygen will not be able to get to body areas where it is needed. If air bubbles travel to your heart, you may have an irregular heartbeat or a heart attack. If a body part or organ is damaged, it may not get better. If the bones around your sinuses break, air bubbles may enter your brain. This causes changes in how you act and think. You may feel very tired, faint (pass out), or have seizures (convulsions). Air bubbles in your brain can cause a coma (when you cannot be woken up), or you may die.

When should I call my caregiver?

Call your caregiver if you have any of the following after scuba diving, air travel, a blast injury, or an HBOT treatment:

• You get dizzy or throw up.
  
  
• You have a headache, face pain, or feel like one or both of your ears are blocked or painful.
  
  
• You have pain in your anus.
  
  
• You have very painful joints or muscles.
  
  
• Your face, or your legs and feet swell up.
  
  
• Your stomach hurts, is swollen, or you feel sick to your stomach.

When should I seek immediate care?

Seek care immediately or call 911 if you have any of the following after scuba diving, air travel, a blast injury, or an HBOT treatment:

• Fluid or blood is coming out of your ear or nose.
  
  
• Skin changes, such as a rash, or red or purple patches.
  
  
• You cough out blood, or have sudden shortness of breath or chest pain.
  
  
• You feel sleepy all the time, there are changes in the way that you act, or you are having trouble thinking clearly.
  
  
• You have odd eye movements, or you have trouble keeping your balance.
  
  
• You have trouble hearing or cannot hear anything.
  
  
• You lose feeling in your arms or legs.
  
  
• Your neck, shoulders, or chest swell, and your voice changes.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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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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