Managing Pressure Changes in the Middle Ear

Techniques and Tools for Managing Pressure Change

The Tools…

Ear Planes: These patented pressure-regulating earplugs insert into the outer ear to help reduce discomfort often associated with pressure changing activities such as air travel and hyperbaric therapy. EarPlanes consist of two elements: a silicone ear plug and a ceramic pressure regulator. The silicone earplug has four circumferential rings which provide an airtight seal between the product and ear canal of the outer ear. The ceramic element is a controlled porosity filter, one end of which is exposed to the rapidly changing external pressure outside the body and the opposite end exposed to the newly formed air chamber between the tympanic membrane and the ear plug. Thus, as the air pressure change; a pressure differential is created across the ceramic filter, causing air to flow through the filter along the pressure gradient. The filter acts to impede the flow of air into and out of the ear canal, thus slowing down the pressure change in the middle ear and alleviating pain and potential injury.

**A Note About Regular Earplugs: Regular earplugs are not ever to be considered a suitable substitute regardless of the type or manufacturer. Without the pressure regulator system contained in Ear Planes, the typical earplug completely prevents the change in pressure to enter the outer ear. This is twofold problematic: if the ear plug falls out during pressurization then all of the pressure change is exerted on the tympanic membrane in one moment without the ability to equalize through the Eustachian tube; on the other hand, if the ear plug stays in and the Eustachian tube opens through yawning, swallowing, or some other action; the tympanic membrane will once again have all of the pressure change exerted on it at once. Only this time it will be from the middle ear side. In conclusion, the everyday, standard, run-of-the-mill earplug is contraindicated for hyperbaric.

Nasal Decongestants: These are helpful tools especially when a person complains of sinus pain and/or is having a hard time breathing through their nose due to congestion. Outside of these two instances a nasal decongestant serves little purpose in the hyperbaric arena. Most nasal decongestants are simply vasoconstrictors, a class of compounds which cause blood vessels to constrict. In the case of a nasal vasoconstrictor, they help restrict circulation to the mucous membranes that line the nasal passages. It’s these mucous membranes that are responsible for the inordinate amount of mucous production when you have a cold or sinus infection. These products can be purchased over the counter for only a few dollars and can be a great short term solution for keeping therapy on the move during an acute sickness. Note: These usually take a little bit of time to get working, 30 minutes is typically sufficient. Therefore this is not something to take just minutes prior to a session. Plan in advance and don’t leave it up to chance!

The Techniques…

Valsalva Maneuver: This technique is generally the most effective of the manual techniques used alone. This simple technique involves blocking the airways and forcibly attempting to exhale. In other words, while keeping your mouth closed and pinching your nose shut, attempt to blow air out your nose. No air should come out your mouth or nose, if this occurs then you are not properly pinching your nose nor applying the technique properly for that matter. When done properly, as the chest cavity volume decreases during the attempted exhale, the resulting increased pressure can help to open the Eustachian tube and equalize the middle and outer ear pressure.

**Warning: This technique should not be abused. One does not need to attempt to exhale very hard in order for the technique to be effective. In fact, should one continue to keep the airway closed and forcibly attempt and continue to forcibly attempt; there is a risk of rupturing the eardrum from the middle ear out.

So, although it was stated that this is generally the most effective of the manual techniques; the other techniques such as yawning and swallowing don’t carry the risks and in most cases are amply effective. Reserve the Valsalva maneuver for when you need it. Just don’t wait until you need it to learn how to effectively apply it.

Yawning: Although not necessarily something under your direct control, the Eustachian tube does open when you yawn. But guess what… You’re in luck! Because simply mimicking a yawn by opening your mouth really wide will accomplish this same task. Yawning has been theorized to be triggered from everything including boredom, lack of oxygen to the brain, and even that they are contagious. In fact you are probably yawning as you read this! In addition it has been demonstrated that it is also an unconscious method your body uses to regulate pressure in the middle ear. For example, some people are known to yawn as the weather changes, that is as the barometric pressure raises or drops. This can also be seen in the hyperbaric arena. Patients often yawn on both the descent and ascent phases of the treatment and It is often asked “why if they are getting so much oxygen, are they yawning? And the answer is that yawning obviously is a multi-purpose stimulus response. Or… maybe hyperbaric is just really boring! Either way, a good yawn can effectively equalize pressure in the ears, and so can a fake yawn as well.

Swallowing: Yes, it really can be this easy; thousands of gum-chewing flight attendants can’t be wrong! Just as when we yawn or open our jaws really wide, swallowing can cause our Eustachian tubes to open, allowing our ears to equalize. Swallowing should be your first conscious method at equalizing your ears. You may find that bringing a bottle of water, some candy, or gum will help with the process… what you choose doesn’t really matter; what matters most is the proactive approach.

Note for New Mothers: Your baby is a little person, and swallowing works just as good for them as it does for us. This is the best method to help your newborn equalize pressure in their ears. Once again, plan ahead… don’t wait for a crying baby before you begin to feed them, begin as soon as or just before the pressure change begins to occur.

Rotating of the Head: Not really a stand-alone technique; however, a method used to enhance any of the other three techniques. This can be used to assist one ear that is giving you a little trouble or for both ears just done in succession from side to side. To apply the technique, simply rotate your head towards the opposite shoulder of the ear you wish to equalize; then do whatever other technique you are most comfortable with while your head is in the rotated position. So, if it were your left ear that you were assisting with equalization then you would rotate your head so that your chin was over your right shoulder. This technique should be utilized prior to attempting the Valsalva maneuver.

One Final Note: It is very important to continue to equalize the ears in small subsequent steps. Should the pressure be allowed to continually increase and the Eustachian tubes not opened, they can become temporarily locked down from the pressure. If this occurs, the pressure change must be relieved in order to get the Eustachian tubes functioning properly before either pressurizing or depressurizing once again. Of course there is no harm in taking steps back in order to get back on track, that’s one of the beautiful things about hyperbaric. Let’s just say it’s unlikely you will get the pilot to land and take-off again just because your ears are bothering you on a plane!

In Conclusion, there are a number of tools and techniques one can use to help equalize the pressure change in the ears as one undergoes a hyperbaric treatment, yet no single tool or technique is any better than the rest. Instead, a combination of tools and techniques based on situation, comfort, and personal choice is superior time and time again. Regardless of your intentions to use any particular method, it is still important that you understand how to apply all of the techniques competently. Otic barotraumas are a real risk of hyperbaric regardless of the treatment pressure. Albeit rare, they are still a risk, a risk that can be greatly minimized through patient education and a proactive approach.

About the Author: Greg Harris is the founder of Hyperbaric Options LLC and has spoken publicly about health & wellness in various settings over the past eight years. Greg has a passion for human potential and is a firm believer that nearly all of the health problems we face today, from degenerative neurological conditions to the common cold, are preventable and reversible. As a health professional, Greg has a unique ability to connect the dots where others have left them scattered; it is this ability to integrate disciplines and think outside of the box that give his lectures and written materials a fresh point of view.