Otic
barotrauma occurring during air travel involves traumatic
inflammation of the middle ear, caused by a pressure difference between the air in the middle ear and the external atmosphere, developing after ascent or more usually descent. The pressure difference occurs because of failure of the eustachian tube to equilibrate middle ear and atmospheric pressures. It is a common problem, presenting with ear fullness,
otalgia and
deafness. Severe cases may result in
tympanic membrane perforation and even round window membrane
rupture. Of three randomized controlled trials, one showed that oral
pseudoephedrine decongestants reduced
otalgia in adults with recurrent ear
pain during air travel, whilst another found that oral
pseudoephedrine did not decrease in-flight ear
pain in children. The third trial showed that
oxymetazoline decongestant nasal spray, taken 30 minutes before descent, did not produce a statistically significant reduction in symptoms of
barotrauma in adults with recurrent ear
pain during air travel. We review the causes, prevention and treatment of this condition.