Barotitis Media: Causes And Treatment

Barotitis media refers to the lesion of the middle ear caused by changes in pressure. In most cases, it is mild and resolves on its own once the airplane flight is over. However, it is an important and common disorder these days.

The amount of air flights has increased significantly globally. This means that more and more people are faced with the atmosphere inside a cabin, with reduced pressure compared to that at sea level. This can then trigger a situation known as medium barotite. We will detail more in the rest of this article.

According to the 2019 report from IATA, the International Air Transport Association, the total number of passengers globally in 2018 was 4.3 million.

Many of them experience discomfort in the middle ear which develops when the plane climbs rapidly,  after take-off, in order to reach its cruising altitude. Or during the descent, before landing.

In the majority of cases, the discomfort is momentary. But, in other cases, there may be an inability to balance the pressures in the middle ear. This is called medium barotite.

What is barotite mean?

It is also known as barotrauma . As we mentioned,  this is an imbalance of pressures in the middle ear  which results in injury to the ear. This entity is more common in children.

For a better understanding, we need to cover some general concepts about the ear which will also allow us to understand how to prevent and treat the injury.

How does the ear work?

The middle ear is a space filled with air, separated from the outside by two structures. On the one hand, there is the tympanic membrane or the 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 must match that of the environment so that the tympanic membrane can vibrate and thus perform its hearing function . Momentarily, when yawning or swallowing, there is a brief opening of the eustachian tube which causes air to flow, then balancing the pressures.

When the eustachian tube is not functioning properly, pressure differences develop between the middle ear and the outside environment. Which can lead to barotrauma. Its most common cause is airplane theft. There are others as well, such as diving, climbing or the use of a hyperbaric chamber.

What happens on an airplane?

The planes have pressurized cabins with a pressure equal to that which is between 7,000 and 10,000 feet above sea level. Which is lower than the pressure that exists at sea level. As the plane goes up and down, the air pressure changes and, therefore, so does the pressure in the middle ear.

This change should be gradual and balanced during swallowing, as air spontaneously enters or leaves the middle ear through the eustachian tube. If not, the tympanic membrane is forced and stretched, causing pain as well as hearing loss.

Also, it can cause bruising or bleeding of the tympanic membrane, exudate can form in the middle ear, and sometimes rupture of the eardrum. Some people also describe a feeling of tension in the ear and tinnitus.

What to do in case of medium barotitis?

Most lesions heal on their own over time. Including rupture of the tympanic membrane. As long as the function of the eustachian tube returns to normal. Usually, hearing is also restored.

In some cases, oral decongestants, antihistamines or even antibiotics are necessary. All of these techniques will help keep the eustachian tube free. Likewise, the use of analgesics aims to reduce pain.

Rarely, a fistula can occur. This is an abnormal communication between the middle and inner ear. This will cause dizziness. In this emergency situation, an otolaryngologist should intervene and assess the need for surgical repair.

The myringotomy (small surgical incision made in the tympanic membrane) as well as the tympanostomy or ventilation tube (placement of a tube in the eardrum) prevent the appearance of barotitis media, by balancing the pressures. These techniques are also used as a treatment because they help to drain the exudates.

What are the precautions to take for air travel?

When traveling by plane, it is possible to help balance pressures during ascent and descent, in order to limit discomfort or injury. Here are some tips:

• Yawn or perform a light Valsalva maneuver: exhaling effort while keeping the airways closed.
• Chew gum and swallow frequently.
• Eat sour candy.
• Babies can suckle from a bottle or a pacifier.
• Oral decongestants, antihistamines, and nasal sprays can be used before flying. Provided they are prescribed by a doctor.
• Earplugs have been designed to decrease pressure variations but their real benefit has not yet been studied.

Finally, if you have to fly, it is best to consult a pediatrician or an otolaryngologist for advice. Preventing barotitis media, especially in the case of people who are allergic or suffering from any infection, is the key to improving transport well-being.