Barotrauma to the ears refers to pressure related damage to the lining of the middle ear most commonly, the eardrum, or the two little windows between the inner ear and the middle ear (round or oval windows). When a rapid change in ambient pressure occurs, and there is some degree of Eustachian tube dysfunction, the pressure in the middle ear cleft varies significantly from ambient atmospheric pressure, causing pressure trauma to the structures mentioned above.


Barotrauma most commonly occurs either due to descent or aircraft descent, skydiving, snorkeling or driving. That is why it is imperative, before undertaking recreational activity such as skydiving snorkeling or diving, that eustachian tube function be assessed by appropriate attempts to auto inflate (pop) the ear. This can be undertaken in one of two ways;

  1. Toynbee’s maneuver: this involves squeezing the nostril firmly closed and swallowing with the mouth closed. This generates a physiologic pressure bolus, which should open the Eustachian tubes and causes pressure change for popping in the middle ear.
  2. Valsalva’s maneuver: this involves squeezing the nostrils together and blowing until the ears pop. The problem with Valsalva’s maneuver is that the pressure generate, particularly by large males, can be very high and occasionally the pressure influx into the middle ear with the opening oof the Eustachian tubes is o great that it can damage the lining, burst the eardrum, or damage the round or oval window.

If you are unable to auto inflate using Toynbee’s maneuver before recreational diving or skydiving, don’t do it.

Barotrauma with plane travel always happens on descent. Most commercially pressurized jets lose most altitude during the 40 minutes prior to landing, this is the time when it is important to frequently and sequentially equalize pressure/ pop your ears on.

For severe cases of barotrauma the middle ear cavity occasionally needs to be ventilated and this involves the performance of a myringotomy and the insertion of a grommet.

If you are suffering from barotrauma or having further questions regarding this topic, please contact Havas ENT Clinics for help.