Barotrauma
Physical tissue damage from pressure differences in gas spaces.
Barotrauma is tissue damage caused when the pressure inside a gas-filled space in the body differs from the pressure of the surrounding environment. This difference stretches or shears the tissue, either because the gas expands directly or because the pressure imbalance is transmitted through the tissue. The damage can happen when pressure increases (compression) or decreases (decompression). It most often affects the sinuses, middle ear, and lungs, and can also result from external pressure squeezing the body.
The term usually applies when the gas volume was already present before the pressure change. Decompression sickness is a separate condition, caused by gas bubbles forming from dissolved gases in the blood and tissues, and is not considered barotrauma. However, decompression illness includes both decompression sickness and arterial gas embolism from lung overexpansion barotrauma. All these conditions fall under the broader category of dysbarism, which covers any medical problem from changes in ambient pressure.
Barotrauma commonly occurs during scuba diving, free-diving, or airplane travel when ascending or descending, or during uncontrolled decompression of a pressure vessel like a diving chamber or aircraft. It can also be caused by a shock wave. Ventilator-induced lung injury (VILI) is a form of barotrauma from mechanical ventilation, often linked to large tidal volumes and high peak pressures. Overexpansion of an internal gas-filled space may also be called volutrauma.
Organs and tissues easily damaged include the middle and inner ear (barotitis or aerotitis), paranasal sinuses (aerosinusitis), lungs (from either under- or overpressure), eyes (from air spaces in a diving mask or goggles), skin (from air spaces in a diving suit), brain and cranium (temporal lobe injury from temporal bone rupture), teeth (barodontalgia or fractures), genital squeeze with urinary complications from P-valve use, and intestines (from trapped gas expanding during ascent).
When diving, pressure differences come from changes in hydrostatic pressure. A descent of 10 meters (33 feet) doubles the ambient pressure, halving the volume of any flexible gas-filled space, as described by Boyle’s law. Compression barotrauma (squeezes) happens when the volume of gas in a closed space cannot change freely, creating a pressure difference that deforms and ruptures cells. Decompressi
- field
- Medicine, Diving Physiology, Hyperbaric Medicine
- known_for
- Physical damage to body tissues caused by pressure differences between internal gas spaces and the environment
- related_conditions
- Decompression sickness, arterial gas embolism, dysbarism
- common_causes
- Scuba diving, free-diving, airplane travel, mechanical ventilation, explosive decompression
Lore & Background
Barotrauma typically occurs when an organism is exposed to a significant change in ambient pressure, such as when a scuba diver, free-diver, or airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel like a diving chamber or pressurized aircraft. It can also be caused by a shock wave. Ventilator-induced lung injury (VILI) is a condition caused by over-expansion of the lungs by mechanical ventilation and is associated with relatively large tidal volumes and relatively high peak pressures. Barotrauma due to overexpansion of an internal gas-filled space may also be termed volutrauma.
Examples of organs or tissues easily damaged by barotrauma include the middle ear and inner ear (barotitis or aerotitis), paranasal sinuses (aerosinusitis), lungs, eyes (when wearing a diving mask or swimming goggles), skin (when wearing a diving suit), brain and cranium, teeth (barodontalgia), genital squeeze, and intestinal barotrauma. When diving, the pressure differences causing barotrauma are changes in hydrostatic pressure. A descent of 10 metres (33 feet) in water increases ambient pressure by an amount approximately equal to the pressure of the atmosphere at sea level, doubling the pressure on the diver and reducing the volume of a flexible gas-filled space by half, as described by Boyle's law.
Reader's Guide
Barotrauma is significant as a common and potentially serious medical condition affecting divers, aviators, and patients on mechanical ventilation. It represents a distinct category of pressure-related injury, separate from decompression sickness, which involves gas bubbles forming from supersaturated dissolved gases. The term is usually applied when the gas volume involved already exists prior to decompression. Barotrauma can occur during both compression (descent) and decompression (ascent) events, with descent barotrauma caused by preventing free change of volume of gas in a closed space, resulting in cell rupture, and ascent barotrauma caused when the same prevention leads to tension exceeding tissue tensile strength.
Pulmonary barotrauma of ascent, also known as pulmonary over-inflation syndrome (POIS), lung over-pressure injury (LOP), or burst lung, is particularly dangerous as it can lead to arterial gas embolism, pneumothorax, mediastinal, interstitial, and subcutaneous emphysemas. Mechanical ventilation can also cause barotrauma, most commonly associated with acute respiratory distress syndrome, though it can usually be avoided by limiting tidal volume and plateau pressure to less than 30 to 50 cm water column. The Byford Dolphin incident is an example of explosive decompression producing severe barotrauma. Understanding barotrauma is essential for preventing injury in hyperbaric environments, aviation, and critical care medicine.
Did You Know?
- Barotrauma can occur during both compression and decompression events, and is usually applied when the gas volume involved already exists prior to decompression.
- Decompression sickness is not generally considered barotrauma because its bubbles form out of supersaturated solution from dissolved gases.
- Ventilator-induced lung injury (VILI) is a form of barotrauma associated with relatively large tidal volumes and relatively high peak pressures.
- The Byford Dolphin incident is an example of explosive decompression of a hyperbaric environment producing severe barotrauma.
Frequently Asked Questions
What is barotrauma?
Barotrauma is an injury to body tissue that occurs when the pressure inside a gas-filled cavity (like the ears, sinuses, or lungs) no longer matches the pressure of the surrounding environment. The resulting imbalance stretches or shears the tissue, or the gas itself expands and ruptures the structure.
Which parts of the body are most vulnerable to barotrauma?
The middle ear, paranasal sinuses, and lungs are the most commonly injured sites because they contain trapped air that must equalize with outside pressure. External barotrauma can also compress the thorax or abdomen, but the internal gas-space injuries are far more typical.
What activities or situations most often cause barotrauma?
Rapid pressure changes during scuba diving, free-diving, and commercial or private airplane travel are the classic triggers. It can also arise from mechanical ventilation in a hospital setting or from sudden explosive decompression events.
How is barotrauma different from decompression sickness?
Barotrauma is a direct mechanical injury to tissue caused by a pressure mismatch across a gas-filled space, while decompression sickness results from dissolved nitrogen coming out of solution as inert bubbles in blood and tissues during ascent. The two can occur together in a diver but involve entirely different mechanisms.
Can barotrauma happen when pressure is increasing, not just decreasing?
Yes. Both compression (outside pressure rising faster than the body can equalize) and decompression (outside pressure falling, letting internal gas expand) can produce the injury. The key factor is the rate and magnitude of the pressure difference, not the direction alone.
More in Medical emergencies 1-24
Spotted an error? Know more?
This is a living reference — every entry is fact-audited, and reader corrections feed straight into our audit queue. Suggest an edit · See this site's audit record