Barotrauma: The Pressure Injury From Flying and Diving That's Usually Minor — but Can Turn Life-Threatening When It Hits Your Lungs or Gut
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD. Last reviewed October 13, 2026. This content is for educational purposes and is not medical advice.
Quick Answer
Barotrauma is a group of conditions caused by sudden or significant shifts in air or water pressure, such as while flying or diving [1]. It can affect the ears, sinuses, lungs or gut [1] [4]. Most cases resolve without treatment [1], and decongestants help ear and sinus barotrauma [1] [4]. Go to the ER for sudden severe belly pain or chest pain.
What the research says
A decongestant pill taken before a flight cut ear symptoms roughly in half, but a nasal spray barely helped. In a randomized, double-blind trial of 124 adults with a history of ear pain during air travel, 34% of those who took 120 mg of pseudoephedrine 30 minutes before departure reported barotrauma symptoms versus 71% on placebo (relative risk reduction 52%, 95% CI 33% to 71%), while oxymetazoline nasal spray led to 64% reporting symptoms (relative risk reduction 10%). Talk with your provider before using any decongestant (Jones et al., Am J Emerg Med, 1998) [5].
Many air travelers don't know how to prevent ear barotrauma. In a survey of 179 air travelers at two UK airports, 84% complained of symptoms while flying and 30% were not aware of any prevention measures, while 86% said more information about prevention would be useful (Mitchell-Innes et al., J Laryngol Otol, 2014) [6].
Evidence for individual remedies is mixed. A review of the three randomized trials on air-travel ear pain found that pseudoephedrine reduced ear pain in adults in one trial but not in children in another, and that oxymetazoline nasal spray taken 30 minutes before descent did not produce a statistically significant reduction in symptoms in adults (Mirza and Richardson, J Laryngol Otol, 2005) [7].
What Is Barotrauma?
Barotrauma is the overarching term for medical conditions caused by sudden or significant shifts in air or water pressure [1]. It refers to the way a sudden change in barometric (air) or water pressure affects your body.
In plain terms, barotrauma happens when air or water pressure changes faster than your body is able to adapt [1]. That can happen while flying in an airplane or scuba diving.
Most barotrauma conditions aren't serious, and their symptoms go away without treatment [1]. But in some instances, barotrauma may be life-threatening and require immediate medical attention [1].
You may experience barotrauma while flying in an airplane or deep-water diving.
What Are the Types of Barotrauma?
Healthcare providers classify barotrauma by the part of your body that it affects. Ear barotrauma is the most common type and often affects the middle ear [1] [4]. Other types may affect your lungs, gastrointestinal tract or sinuses [1] [4].
Type | Also called | Body part affected |
Ear barotrauma | Airplane ear | Your middle ears |
Gastrointestinal barotrauma | — | Your stomach or intestines in your gastrointestinal tract |
Pulmonary barotrauma | — | Your lungs |
Sinus barotrauma | Sinus squeeze or barosinusitis | Your sinuses |
What Does Barotrauma Feel Like?
Barotrauma causes different symptoms. Your symptoms will depend on the part of your body that air and water pressure changes affect.
What does ear barotrauma feel like?
Ear barotrauma (airplane ear) symptoms may include a feeling that your ears are full or stuffed up, dizziness, hearing issues, nausea and vomiting, and severe ear pain [1].
What does gastrointestinal barotrauma feel like?
You may have this condition if you swallow air while doing deep-water diving or scuba diving. Symptoms include belching, belly pain, cramps, a feeling of fullness in your belly, and flatulence (farting) [1] [4].
Rarely, gastrointestinal barotrauma may cause a hole (perforation) in your stomach or your intestines [1]. Symptoms are severe belly pain or nausea and vomiting, and it may hurt when you touch your belly [1]. Go to an emergency room right away if you have these symptoms.
What does pulmonary (lung) barotrauma feel like?
Pulmonary barotrauma can happen during free deep-water or scuba diving. Symptoms often include bloody froth at your mouth, a bloody nose, chest pain, a cough, and shortness of breath (dyspnea) [1].
What does sinus barotrauma feel like?
You may experience sinus barotrauma symptoms while doing free diving or scuba diving. Symptoms may include a bloody nose, facial pain, a headache, and nasal congestion [1].
Type | Key symptoms |
Ear (airplane ear) | Ears feel full or stuffed up, dizziness, hearing issues, nausea and vomiting, severe ear pain |
Gastrointestinal | Belching, belly pain, cramps, feeling of fullness, flatulence; rarely a stomach/intestine hole with severe belly pain |
Pulmonary (lungs) | Bloody froth at your mouth, bloody nose, chest pain, cough, shortness of breath |
Sinus | Bloody nose, facial pain, headache, nasal congestion |
What Causes Barotrauma?
Barotrauma happens when air or water pressure changes faster than your body is able to adapt [1]. That can happen while flying in an airplane or scuba diving.
Setting | How pressure changes |
Flying in an airplane | Cabin air pressure shifts during takeoff, flight, and landing faster than your body adapts |
Deep-water or scuba diving | Water pressure increases with depth; swallowed air and trapped gases affect the gut, lungs, and sinuses |
How Is Barotrauma Diagnosed?
A healthcare provider will ask about your symptoms. They'll ask if symptoms started after you did things like fly in an airplane or diving. A provider will do a physical exam. They'll use different tests to diagnose specific barotrauma types [1].
Type | How it's diagnosed |
Ear barotrauma | An otoscope (a special lighted instrument) looks inside your ear to check eardrum damage, signs of infection or other issues; a hearing test or an MRI scan to view your inner ear may follow |
Gastrointestinal barotrauma | Chest X-ray and CT scan if the provider suspects a GI rupture |
Pulmonary barotrauma | Arterial blood gas test, chest X-ray, and EKG |
Sinus barotrauma | Examination of your nose, an endoscopy to look inside it, and a CT scan for images of your sinuses |
How Is Barotrauma Treated?
Treatment depends on the barotrauma type. Potential treatments include nasal decongestants for ear and sinus barotrauma, and hyperbaric oxygen therapy and IV fluids for pulmonary barotrauma [1]. You may need more intensive treatment if you have severe symptoms.
Typically, people don't need treatment for gastrointestinal barotrauma. The exception is when the condition causes a perforation that requires surgery [1] [4].
Type | Treatment |
Ear barotrauma | Often none needed; nasal decongestants |
Sinus barotrauma | Nasal decongestants |
Pulmonary barotrauma | Hyperbaric oxygen therapy and IV fluids; more intensive treatment for severe symptoms |
Gastrointestinal barotrauma | Usually no treatment; surgery if a perforation occurs |
When should I seek emergency care?
You should talk to a healthcare provider if ear or sinus barotrauma symptoms don't go away or if they get worse. Call 911 right away if you have chest pain, trouble breathing, confusion, weakness, numbness or loss of consciousness after diving, because these can signal a lung injury or air bubble in the blood (arterial gas embolism). But gastrointestinal and pulmonary barotrauma may cause complications that can be life-threatening [1].
MEDICAL EMERGENCY — Go to an emergency room right away if you have gastrointestinal barotrauma with sudden severe belly pain, or pulmonary barotrauma with chest pain or shortness of breath.
What's the Outlook?
Your prognosis or expected outcome depends on your situation. For example, if you have airplane ear, you may not need any treatment. But you may need surgery if barotrauma damages your eardrum [1].
If you have a form of barotrauma, a healthcare provider is your best resource for information. They'll tell you what you can expect.
Can Barotrauma Be Prevented?
Yes, in most cases, you can prevent barotrauma.
If you're flying on an airplane, invest in special earplugs. Chew gum, yawn or blow your nose to protect your ears from air pressure changes [1].
If you scuba dive, follow safe diving practices [1]. That will help you reduce the risk of gastrointestinal, pulmonary and sinus barotrauma. Organizations like the Divers Alert Network (DAN) offer safe diving practice training [1].
What's the Bottom Line?
Barotrauma is your body's protest against pressure that changes too fast — and it mostly shows up as that familiar stuffed-up ear feeling on a flight. Most cases are minor and clear up on their own. But the lung and gut versions are a different story: chest pain, shortness of breath, or sudden severe belly pain after diving are emergency signs that can be life-threatening. The good news is that prevention is simple — protect your ears in the air, follow safe diving practices in the water — and treatment, when it's needed, is well established. If pressure changes have left you with symptoms that don't go away, talk to your healthcare provider.
Explore Rinnit.com's library of clear, practical health guides — from ear health and travel medicine to diving safety and emergency care.
Frequently Asked Questions
What is barotrauma?
Barotrauma is the overarching term for medical conditions caused by sudden or significant shifts in air or water pressure. It happens when pressure changes faster than your body is able to adapt.
What causes barotrauma?
Air or water pressure changing faster than your body can adapt — most often while flying in an airplane or scuba diving.
What are the types of barotrauma?
Four, classified by the body part affected: ear barotrauma (airplane ear, the most common, affecting the middle ear), gastrointestinal barotrauma (stomach or intestines), pulmonary barotrauma (lungs), and sinus barotrauma (sinus squeeze or barosinusitis).
What are the symptoms of ear barotrauma?
A feeling that your ears are full or stuffed up, dizziness, hearing issues, nausea and vomiting, and severe ear pain.
Can barotrauma affect my stomach or intestines?
Yes — gastrointestinal barotrauma can happen if you swallow air while deep-water or scuba diving. Symptoms include belching, belly pain, cramps, a feeling of fullness, and flatulence. Rarely, it can cause a hole in your stomach or intestines.
What are the symptoms of pulmonary (lung) barotrauma?
Bloody froth at your mouth, a bloody nose, chest pain, a cough, and shortness of breath. It can happen during free deep-water or scuba diving.
What does sinus barotrauma feel like?
A bloody nose, facial pain, a headache, and nasal congestion — often while free diving or scuba diving.
Is barotrauma serious?
Most barotrauma conditions aren't serious, and their symptoms go away without treatment. But gastrointestinal and pulmonary barotrauma may cause complications that can be life-threatening.
How is it diagnosed?
A provider asks about your symptoms and whether they started after flying or diving, does a physical exam, and orders type-specific tests — an otoscope exam, hearing test, or MRI for the ear; chest X-ray and CT scan for the gut; arterial blood gas, chest X-ray, and EKG for the lungs; and nasal exam, endoscopy, or CT scan for the sinuses.
How is it treated?
It depends on the type: nasal decongestants for ear and sinus barotrauma; hyperbaric oxygen therapy and IV fluids for pulmonary barotrauma (more intensive treatment for severe symptoms); usually no treatment for gastrointestinal barotrauma — unless a perforation requires surgery.
When should I go to the emergency room?
Go right away for sudden severe belly pain with gastrointestinal barotrauma, or chest pain or shortness of breath with pulmonary barotrauma — these can be life-threatening. Talk to a provider if ear or sinus symptoms don't go away or get worse.
Will airplane ear go away on its own?
Often, yes — if you have airplane ear, you may not need any treatment. But you may need surgery if barotrauma damages your eardrum.
Can barotrauma be prevented?
Yes, in most cases. When flying, invest in special earplugs and chew gum, yawn or blow your nose to protect your ears. When scuba diving, follow safe diving practices (training from organizations like the Divers Alert Network) to reduce the risk of gut, lung and sinus barotrauma.
Who is at risk for barotrauma?
Anyone flying in an airplane or doing deep-water or scuba diving, since both situations produce air or water pressure changes faster than the body may be able to adapt.
What should I do if I've been exposed to big pressure changes?
Contact your healthcare provider if you've experienced significant air and water pressure changes that might affect your health.
Related Reading
Airplane Ear (Ear Barotrauma): Why Your Ears Clog on Flights and What Actually Helps: the most common form of barotrauma explained.
Chest Pain: Symptoms, Causes & Treatment: understanding the pulmonary barotrauma red flag.
References
Cleveland Clinic. Barotrauma. Cleveland Clinic. Updated April 29, 2025. https://my.clevelandclinic.org/health/diseases/22071-barotrauma
Battisti AS, et al. Barotrauma. In: StatPearls [Internet]. StatPearls Publishing. Last updated June 26, 2023. PMID 29493973. https://www.ncbi.nlm.nih.gov/books/NBK482348/
Moon RE. Pulmonary Barotrauma. Merck Manual Professional Version. Updated June 2025. https://www.merckmanuals.com/professional/injuries-poisoning/injury-during-diving-or-work-in-compressed-air/pulmonary-barotrauma
Moon RE. Barotrauma. Merck Manual Consumer Version. Updated July 2025. https://www.merckmanuals.com/home/injuries-and-poisoning/diving-and-compressed-air-injuries/barotrauma
Jones JS, et al. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel. Am J Emerg Med. 1998;16(3):262-4. PMID 9596428. https://doi.org/10.1016/s0735-6757(98)90097-3
Mitchell-Innes A, et al. Air travellers' awareness of the preventability of otic barotrauma. J Laryngol Otol. 2014;128(6):494-8. PMID 24896105. https://doi.org/10.1017/S0022215114001145
Mirza S, et al. Otic barotrauma from air travel. J Laryngol Otol. 2005;119(5):366-70. PMID 15949100. https://doi.org/10.1258/0022215053945723
Medical disclaimer
The information in this article is for general informational purposes only and is not intended as professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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