otic barotrauma is most often due to descent in aircraft; it is also seen in divers
differences between middle ear and ambient pressures may cause rupture of superficial vessels in the middle ear. It also causes a secretory otitis media, although in this instance the fluid is believed to be a transudate rather than normal mucus
acute barotrauma is painful - during descent in an aircraft the eustachian tubes ought to be open to allow equalisation of pressure. This is usually accomplished by yawning or sucking boiled sweets. The use of nasal decongestants (e.g. xylometazoline spray) will also help to prevent this problem. Patients with otitis media should not fly (1)
clinical features:
may present with sensations of pressure in one or both ears (ear popping), hearing loss and ear discomfort; in severe barotrauma there may be severe pain and epistaxis
examination reveals fluid behind the ear drum; in severe barotrauma there may be haemorrhagic areas in the drum; conductive deafness may be demonstrated
management:
generally the fluid clears spontaneously over a period of several weeks
the efficacy of treatments such as nasal decongestants, oral decongestants, antihistamines is unclear
antibiotics may help prevent infection in cases of severe barotrauma
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