Barotrauma of the ear

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Barotrauma is an injury caused by increased air pressure, such as during airplane flights or scuba diving. Barotrauma can cause ear pain or damage to the eardrum.
The eardrum separates the ear canal and the middle ear. If air pressure in the ear canal from outside air and air pressure in the middle ear change rapidly or are unequal, the eardrum can be damaged. Normally, the eustachian tube, which connects the middle ear and the back of the nose, helps maintain equal pressure on both sides of the eardrum by allowing outside air to enter the middle ear. When outside air pressure changes suddenly—for example, during the ascent or descent of an airplane or a deep-sea dive—air must move through the eustachian tube to equalize the pressure in the middle ear. (See also Barotrauma.)
If the eustachian tube is partly or completely blocked because of scarring, a tumor, an infection, the common cold, or an allergy, air cannot move in and out of the middle ear. The resulting pressure difference causes pain and often hearing loss and may bruise the eardrum or even cause it to rupture and bleed. If the pressure difference is very great, the oval window (the entrance into the inner ear from the middle ear) also may rupture, allowing fluid from the inner ear to leak into the middle ear (a perilymph fistula). Hearing loss or vertigo occurring during descent in a deep-sea dive suggests that such leakage is taking place. The same symptoms occurring during ascent suggest that an air bubble has formed in the inner ear.