Barotraumen

Barotraumen, or barotrauma, refers to tissue injury caused by pressure differences between air-filled spaces in the body and the surrounding environment. It most commonly occurs during rapid changes in ambient pressure, such as during flying, scuba diving, or uncontrolled ascent or descent. Barotrauma can affect the middle ear and its surrounding structures, the paranasal sinuses, the lungs, and, less often, dental or alveolar spaces.

The most frequent form is ear barotrauma, resulting from failure to equalize pressure in the middle ear. Sinus barotrauma can cause facial pain and congestion. Pulmonary barotrauma involves the lungs and can lead to chest pain, cough, shortness of breath, subcutaneous emphysema, or pneumothorax. Less commonly, barotrauma may affect dental or facial tissues, particularly with gas-filled spaces or improper sealing of dental devices.

Causes include rapid ascent or descent, improper or failed pressure equalization, congested nasal passages, and the use of positive-pressure ventilation in medical settings. Diagnosis is based on history of a pressure change and examination findings such as a tympanic membrane dysfunction, facial or sinus tenderness, or chest symptoms. Imaging (X-ray or CT) may be used to identify pneumothorax or other complications. It is important to distinguish barotrauma from decompression sickness, which has a different pathophysiology and treatment.

Treatment focuses on relieving the pressure difference and preventing further injury. Ear barotrauma may respond to swallowing, yawning, Valsalva or Toynbee maneuvers, and analgesia; persistent or ruptured tympanic membranes may require medical care. Sinus barotrauma is managed with decongestants and nasal irrigation. Pulmonary barotrauma requires oxygen therapy and monitoring; pneumothorax may necessitate chest tube management. Prevention includes gradual exposure to pressure changes, proper rate of ascent/descent, and avoidance of pressure changes when nasal passages are blocked. For divers, adherence to dive tables and safety stops is essential.