What Is Middle Ear Barotitis And How Is It Treated?

More and more people are exposed to changing air pressure in the cabins of machines. The air pressure in the planes is lower than we are used to at sea level, and this can result in a condition known as barotite  . In this article, we will explain what barotitis of the middle ear is and how it can be treated.

According to a 2019 report by the International Air Transport Association (IATA), the total number of passengers worldwide in 2018 was 4.3 million. During the flight, a large proportion of passengers feel discomfort in their middle ear, which occurs when the aircraft quickly ascends to the correct flight altitude or during the landing of the aircraft.

In most cases, this discomfort is temporary, but some people do not get the middle ear pressure equalized. This condition is called middle ear barotitis .

Below you can read more about barotite and its treatment.

What exactly is middle barotitis?

Middle ear barotitis is also known as middle ear barotrauma. As already mentioned, this is an imbalance of pressure in the middle ear that causes pain and even damage to the ear. This happens more often in children.

To better understand this, the following is a general review of the ear so that we can prevent and treat this ailment.

How does the middle ear work?

The middle ear is an inflatable space separated from the outside by two structures: the tympanic membrane on the one hand and the eardrum on the other. The latter separates the middle ear from the pharyngeal area.

The pressure inside the middle ear must be the same as the ambient pressure in order for the eardrum to vibrate and fulfill its hearing function. When yawning or swallowing, the eardrum opens momentarily, causing airflow to equalize the pressure.

When the eardrum does not function properly, a pressure difference is created between the middle ear and the external environment, which can lead to barotrauma.

The most common cause of barotrauma is air travel. Other causes include diving, climbing or the use of overpressure chambers.

What happens on the plane?

Passenger aircraft have pressurized cabins and cockpits, the pressure in them being the same as at an altitude of 2-3 kilometers, where the pressure is lower than at sea level. As the aircraft rises and falls, the air pressure changes and as a result, the pressure in the middle ear must also change.

This change should be gradual and level off when swallowed, with air moving spontaneously to or from the middle ear through the ear canal. When this does not happen, it causes pressure and stretching in the eardrum, causing pain and hearing loss.

Bruising and bleeding can also occur in the eardrum. In addition, fluid may form in the middle ear, and in the worst case, the eardrum may burst. The ears seem to be locked and can ring.

Middle ear barotitis: what to do

Most mild ear damage heals on its own over time,  including the rupture of the eardrum, as long as the function of the ear canal returns to normal. Usually, the hearing also returns.

In some cases, your doctor may prescribe oral congestion medications, antihistamines, and even antibiotics. All of these help keep the eardrum open. The use of painkillers, in turn, helps reduce pain.

In some rare cases, a fistula may also develop in the ear, which is an abnormal connection between the middle and inner ear. It may cause dizziness. In such an emergency, an ear-throat assessment of the need for surgical treatment is required.

A myringotomy (a small incision in the eardrum) and a tympanostomy (a tube is placed in the eardrum) help prevent barotitis in the middle ear and equalize pressure. They are also used as a form of treatment as they help to empty the secretions.

What precautions can we take when traveling by plane?

If we travel by plane,  we can help equalize the pressure during takeoff and landing to reduce ear discomfort or damage. This is accomplished using some of the following methods:

• Yawning or Valsalva maneuver,  i.e. relatively strong exhalation with airways closed.
• Grinding and repeated ingestion of chewing gum.
• Eating bitter candies.
• Babies can suck a baby bottle or pacifier.
• Oral congestion medications, antihistamines, and nasal sprays can sometimes be used before the flight, as long as they are prescribed by a doctor.
• Experts have designed earplugs to reduce pressure changes, but their real benefits have not yet been demonstrated.

If you need to travel by plane, it is recommended that you seek advice from a pediatrician or ear-nose-throat doctor. Prevention of middle ear barotitis, especially in people with allergies or some form of inflammation, is key to improving well-being in flight.