barotrauma

Barotrauma is tissue injury caused by pressure differences between gas-filled spaces and surrounding tissues or fluids. It occurs when external pressure changes faster than the body can compensate, or when pressure is applied by mechanical ventilation or medical procedures. It most often affects air-containing cavities such as the middle ear, sinuses, lungs, and subcutaneous tissues.

In divers and air travelers, barotrauma results from rapid ascent or descent, or failure to equalize pressure in the middle ear or sinuses during changes in ambient pressure. In medicine, barotrauma can occur with positive-pressure ventilation or high PEEP, leading to alveolar rupture and air leakage into the mediastinum, pleural space, or subcutaneous tissues.

Common forms include otic (ear) barotrauma presenting with ear pain, fullness, hearing loss, vertigo; sinus barotrauma with facial pain and nasal bleeding; pulmonary barotrauma with chest pain, dyspnea, coughing, and in severe cases pneumothorax, pneumomediastinum, or arterial gas embolism; subcutaneous emphysema may be visible.

Diagnosis relies on history and exam; imaging such as chest radiography or CT can detect pneumothorax or embolism; ear examination and tympanometry can assess middle-ear involvement.

Treatment is supportive and depends on severity. Minor ear barotrauma may resolve with analgesia and decongestants; avoid further exposure. Pulmonary barotrauma requires oxygen and avoidance of barotrauma triggers; pneumothorax may need chest tube; arterial gas embolism requires hyperbaric oxygen therapy. In ventilated patients, lower tidal volumes and plateau pressures; in divers, controlled ascent and recompression if indicated.

Prevention includes gradual pressure equilibration, proper diving practices, and cautious use of positive-pressure ventilation with lung-protective strategies.