Ear barotrauma: ear pain after flying or diving, and what helps

Ear barotrauma is the pain, pressure and muffled hearing you get when the air inside your middle ear cannot keep up with a change in outside pressure. Most people know it from the descent of a flight or the first metres of a dive. It usually settles as the ear equalises, but some cases need a GP or urgent help, and a few damage the eardrum or the inner ear.

What is ear barotrauma?

Behind your eardrum is a small air-filled space, the middle ear. A narrow passage called the Eustachian tube links it to the back of your nose. When you swallow or yawn, the tube briefly opens, and the pressure on both sides of the eardrum evens out.

When outside pressure changes quickly, that system can fall behind. The StatPearls review of ear barotrauma explains that pressure rises as someone moves down through a column of air, as an aircraft passenger or in a hyperbaric chamber, or down through water as a diver. If the tube stays shut, the eardrum is pushed inwards and the middle ear lining is strained. That is middle ear barotrauma, sometimes called ear squeeze.

The Chelsea and Westminster Hospital NHS leaflet on Eustachian tube dysfunction describes the underlying problem as a prolonged failure to equalise pressure in the middle ear. A cold or blocked nose makes that failure more likely, because the swollen lining around the tube stops it opening easily.

What are the symptoms of ear barotrauma?

StatPearls describes the first sensation as fullness or dullness in the ear that progresses to discomfort. You might notice:

• ear pain, often worst during a descent
• muffled or dull hearing, often described as being underwater
• a blocked or full feeling in the ear
• ringing in the ear (tinnitus)
• dizziness
• popping or clicking noises

If pressure keeps building, the eardrum can tear. The Divers Alert Network notes that a ruptured eardrum may relieve the pain but can cause vertigo and hearing loss. NHS guidance on a perforated eardrum lists hearing loss, a ringing or buzzing sound, earache, and clear fluid, blood or pus leaking from the ear, and names a sudden change in air pressure, such as flying, among the causes.

Occasionally the injury reaches the inner ear, which handles hearing and balance. StatPearls lists hearing loss, tinnitus, sensitivity to sound, vertigo, nausea and vomiting as possible signs, and says anyone with nerve-related hearing loss or new vertigo after a pressure change should be referred to an ear, nose and throat specialist.

How do you clear your ears when flying?

StatPearls stresses equalising early and often, before the pressure difference builds. On a flight the descent is usually harder than the climb, because air has to get into the middle ear as cabin pressure rises.

• Swallow, yawn or chew. The Chelsea and Westminster leaflet suggests yawning or opening your mouth wide, and says eating and drinking can also help the tube move.
• Pop your ears gently. This is the Valsalva manoeuvre. The leaflet describes taking a deep breath, pinching your nose, closing your mouth and gently popping your ears, and it warns against being very forceful.
• Never force it. StatPearls explains that a forceful Valsalva against a blocked tube can transmit pressure towards the inner ear, and the Divers Alert Network warns that it may injure the inner ear.
• Ask a pharmacist about decongestants. A decongestant may help if you are blocked up. NHS guidance on decongestants says sprays and drops should not be used for more than 5 days at a time, and that some people should ask a pharmacist or GP first, including anyone taking other medicines or with high blood pressure, heart problems or glaucoma, and pregnant women.

If you have a heavy cold and a flight booked, speak to a pharmacist or GP before you travel.

What about diving?

Divers meet larger and faster pressure changes than air passengers. StatPearls names Eustachian tube dysfunction and middle ear barotrauma as the two most common complications of scuba and commercial diving.

The Divers Alert Network explains that a diver who cannot equalise feels discomfort first, which can progress to severe pain, and that further descent only makes it worse. Its prevention advice is blunt: do not dive when congested. In practice:

• start equalising at the surface and keep going throughout the descent
• if your ears hurt, stop descending and do not push on through the pain
• never force a Valsalva
• see a doctor for worsening pain, fever or discharge after a dive

Ear symptoms after a dive are not always barotrauma. The Divers Alert Network's guide to decompression illness lists joint pain, numbness, tingling, weakness, dizziness and confusion among its symptoms. If ear problems come with any of those, treat it as a diving emergency and call 999.

How is ear barotrauma treated?

Most mild middle ear barotrauma settles as the Eustachian tube starts working again. While it does, NHS advice on earache suggests paracetamol or ibuprofen and a warm flannel on the ear, and not putting cotton buds or anything else inside it.

The Chelsea and Westminster leaflet notes that over-the-counter decongestants may help if there is blockage, that a GP may prescribe a steroid nasal spray for persistent inflammation, and that symptoms lasting more than 3 weeks should be investigated by a specialist.

If the eardrum has torn, the NHS says it usually heals on its own within 2 months. Keep water out of the ear, avoid swimming, and do not blow your nose hard while it heals. A GP may prescribe antibiotics to prevent infection, and a small operation is sometimes needed if the hole does not close.

When should you see a GP or get urgent help?

Call 111 or ask for an urgent GP appointment if:

• earache has lasted more than 2 to 3 days, or is getting worse
• fluid is coming from your ear, or there is swelling around it
• you have a very high temperature, or feel hot, cold or shivery
• you have any hearing loss or change in your hearing

NHS guidance on hearing loss also advises an urgent GP appointment or 111 for sudden hearing loss in one or both ears. Vertigo, a spinning sensation, or hearing loss after a flight or dive should be checked promptly rather than left to see if it settles.

Why does ear clearing matter in a hyperbaric chamber?

A hyperbaric chamber raises the pressure around your whole body, so your ears do the same work they do on a descent. StatPearls names middle ear barotrauma among the most common complications of clinical hyperbaric oxygen treatment.

A 2023 Cochrane review of HBOT trials for late radiation injury found a higher risk of ear barotrauma with HBOT than in control groups that were not pressurised (4 randomised trials, 357 participants), but no clear increase when controls had sham pressurisation (2 trials, 158 participants). A 2017 review of HBOT side effects reported middle ear barotrauma rates varying from about 2 to 84 percent across studies, and said that education, training and active coaching during compression can help reduce cases.

At HBOT Medics, the single-person soft-shell chamber operates at 1.5 ATA. Pressure is raised gradually, and before every session the operator explains how to clear your ears and how to communicate. If your ears will not clear, tell the operator, who can slow or pause the pressure change, and you can ask to stop. Our guides to what happens during treatment and what happens in an HBOT session walk through the hour step by step.

Ears and sinuses are part of screening too. A current infection, congestion or difficulty clearing your ears can make pressurisation uncomfortable or unsuitable that day, and recent ear surgery needs review first. Our page on who HBOT is not suitable for explains how those answers are handled. If you are blocked up on the day of a session, contact the clinic before you travel.

The short version

Equalise early and gently, and never force your ears. Do not dive with a cold. Get advice for ear pain lasting more than 2 to 3 days, and prompt help for discharge, hearing loss or vertigo. If you are thinking about hyperbaric oxygen therapy and have had ear trouble before, mention it on your declaration. No referral needed. Medical consultation included. You can see available times whenever you are ready.