Ear barotrauma is a common cause of ear pain. Barotrauma causes damage to the drum from pressure. A pressure gradient needs to exist across the drum for it to cause a problem. This means higher pressure on one side and lower on the other. High or low pressure on it's own doesn't cause damage. Here are some causes of ear barotrauma.

Mountain climbing. When you go up a mountain you are further from sea level. This means that there is less atmosphere above your head pressing down on you. The pressure outside the ear is lower. You need to equalise the pressure in your middle ear space to stop a gradient forming, with high pressure on the inside and low pressure on the outside. Air escapes down the Eustachian tube into the nasal cavity. The pressure is equalised. Problems arise when you have an infection or allergy affecting your nasal passages. A simple cold or an allergy such as hayfever can be enough to cause inflammation. This stops the Eustachian tube opening and prevents you equalising the pressure. Your eardrum stretches and causes pain. Your hearing becomes muffled because you're eardrum cannot vibrate properly. If you carry on going up the mountain your eardrum may burst. If this happens the pain is relieved and the pressure across the drum is equalised. The hole can take up to 2 months to heal.

Flying. When you go up in an aeroplane the pressure around you drops. This is for the same reasons described above. Pressurised cabins may be better but there is still a slight drop in pressure. Air-conditioning in aeroplanes can make the problem worse. They can dry out the usually damp mucous membranes and cause inflammation in the nose. Barotrauma can be milder. If the drum does not rupture it may just be left a little inflamed and sore. The Eustachian tube in babies and young children is narrow and more likely to be blocked than those of an adult. This may be the reason that some little children are more likely to cry during ascent and descent in an aeroplane. A recent study showed that ear barotrauma is the commonest medical disorder to occur on an aeroplane.

Ear infection. Having an infection of the middle ear can cause ear barotrauma. The middle ear space which is usually full of air fills with pus. This increases in volume and causes stretching and damage to the eardrum. Sometimes it will burst, relieving the tension and resulting in a rush of blood and pus. Infection in the ear stops the Eustachian tube from opening. Otherwise the fluid is allowed to drain into the nasal passage.

Allergy. Allergy is another common cause of inflammation in the ear, nose and throat. If you have allergic symptoms it is well worth taking steroid nasal spray such as beclomethasone as well as some antihistamines. This can help to reduce swelling and may be enough to stop the problem.

Prevention. Ear barotrauma can be prevented in a number of ways. Firstly you could simply avoid that which is causing the problem. Assuming you still want to fly or scuba-dive there are a few things that you can do. If you are going to fly then you can take anti-inflammatories such as ibuprofen. These reduce pain as well as inflammation. This might be enough for you to be able to equalise the pressure in your middle ear. If you reduce the inflammation your Eustachian tube may drain the pus. You could try decongestants such as pseudoephedrine and Olbas Oil. These may also help to reduce inflammation.

It is possible to open the Eustachian tube by popping the ears. Alternatively you could perform a Valsalva manoeuvre. You can hold your nose and strain as though you are bearing down whilst on the toilet. Yawning can also help to open the tubes. If you can, you can help by protruding your jaw at the same time. This helps to pull the tubes open.

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If you are going scuba-diving you should not use anti-inflammatories and decongestants. Some people use them to enable themselves to dive when they can't equalise their ears. They can in fact make the situation worse. It is very tempting for a diver who is keen to dive when they have a blocked nose to use these remedies in order to enable them to descend. Unfortunately eardrum rupture is much more likely on the way back up. The effects of the anti-inflammatories may wear off whilst under the water. This means that the driver may not be able to equalise the pressure. On the inevitable ascent, the eardrum bursts. Ruptured eardrum can be more significant for a keen diver as it is an absolute contraindication to diving. If they were to dive with a ruptured ear drum then permanent deafness can occur. This is because there is no barrier to protect the delicate middle and inner ear structures from the pressure of the water.

Dr Toby Bateson for www.zenplugs.com