Gutovitz S, Weber K, Kaciuban S, Colern R, Papa L, Giordano P. Middle ear pressure and symptoms after skydiving. Aviat Space Environ Med 2008; 79:533–6. Objectives: Altitude-related otic barotrauma and its symptoms have been identified from air-travel, scuba diving, and hyperbaric chambers, but not in skydiving. It is not known whether skydiving-related otic barotrauma could cause symptoms severe enough for medical attention or be implicated in skydiving-related accidents. This study assessed the effect of altitude change on middle ear pressures in skydivers by comparing changes in pressure before and after a skydive, pressure changes in those who developed middle ear symptoms vs. those who did not, and pressures in those who attempted equalization vs. not. Methods: This prospective observational cohort enrolled skydivers on random days in Deland, FL. A tympanometer was used to measure middle ear pressures in decapascals (daPa) on the ground before and after skydiving. Results: Average middle ear pressures in 69 subjects were significantly different before (−23.5 daPa) and after (−70.5 daPa) the skydive. There were 13 subjects (18.8%) who had middle ear symptoms after descent, but there were no statistically significant differences in ear pressure changes in those with (−57.5 daPa) and without (−44.2 daPa) symptoms after their jump. There was, however, a significant difference in pressure in those jumpers who did (−32.7 daPa) and did not (−75.7 daPa) equalize successfully after their jump. Conclusions: Rapid skydiving descent from high altitudes causes negative middle ear pressure changes. The ability to equalize ear pressures after a jump had a large impact on the change in ear pressure. However, the change in middle ear pressure was not associated with the presence of middle ear symptoms.