What barotrauma is most commonly encountered by aircrew at altitude due to pressure changes?

• A. Sinus barotrauma
• B. Middle ear barotrauma
• C. Pneumothorax
• D. Dental barotrauma

Answer: (B)

Pressure changes during altitude exposure challenge air-filled spaces in the head, and the middle ear is the most exposed to these changes. The middle ear must stay at ambient pressure through the Eustachian tube, which connects to the throat. If this tube is blocked or not opening quickly enough—common with nasal congestion or upper respiratory infections—the pressure difference across the tympanic membrane builds as you climb or descend. That mismatch causes pain, muffled hearing, and can even damage the membrane if the pressure is large enough. Because the middle ear directly bears the brunt of these rapid pressure changes and has a relatively small, closed space, it is the most frequent site of barotrauma for aircrew at altitude.

Sinus barotrauma can occur when sinus cavities can’t vent properly, and dental barotrauma involves gas changes in dental spaces, but these are less common in routine altitude pressure changes. Pneumothorax, while serious, is not the typical consequence of normal flight pressure shifts. To reduce risk, ensure you’re not congested before flying, swallow or yawn to help equalize, and use approved decongestants if advised by a clinician. If ear pain or hearing changes persist, seek medical evaluation.