1.
Introduction
Airplane ear or ear discomfort during flight is common irrespective of ticket price
we pay for our flights according to class. Whether we get extra leg space or extra
facilities during flying in business class, air travelers often face this problem
of airplane ear (Figure 1). Airplane ear is also known as ear barotrauma, barotitis
media or aerotitis media [1]–[5]. Severe earache affects individuals of varying levels
of social determinants of health as it is entirely a physiological phenomenon [3].
Airplane ear is commonly experienced when the airplane is ascending or descending,
which makes it one of the commonest health problems for people travelling in air routes.
2.
Etiology
Generally, airplane ear occurs due to quick changes in altitude and quick changes
in air pressure [4]. In normal physiological conditions, the air pressure in our middle
ear cavity is nearly equivalent to that of the external ear canal. This equalization
of air pressure is maintained physiologically and contributes to regular auditory
function and maintenance of normal balance among individuals.
However, the eustachian tube dysfunction may occur with any changes in pressure and
failure to ventilate through the middle ear space. This may result in outward bulging
of the tympanic membrane causing moderate to severe earache. This phenomenon can be
compared with a bread expanding while baking [3],[5].
Conversely, due to the vacuum effect, if the air pressure inside the middle ear space
reduces rapidly compared to the external ear pressure, the tympanic membrane may be
pulled inside due to the pressure gradient. The eustachian tube becomes flattened
during the pressure changes and it necessitates bringing air into the middle ear (Figure
2). During sudden ascend or descend of an aeroplane, ear cavity pressure is often
decreased complemented by an increase in the cabin compared to the outside air pressure.
In such a scenario, the unusual stretching of the eardrum or tympanic membrane may
precipitate pain in the ear. At the same time, individuals may also experience decreased
hearing abilities and muffled sounds as the eardrum as it becomes unable to vibrate
normally [2]–[4].
The pathophysiology remains the same in cases of scuba diving, in hyperbaric oxygen
chambers, and during explosions happening nearby [2].
3.
Symptoms [3]–[5]
Airplane ear can in occur unilaterally or in both ears. Signs and symptoms of Airplane
air include discomfort, pain, and fullness in ear, and mild to moderate hearing loss
in acute cases. Moreover, for severe cases, affected individuals may experience severe
pain, moderate to severe hearing loss, tinnitus, vertigo, and hemotympanum (severe
form).
Figure 1.
Airplane ear.
4.
Risk factors [3]–[5]
The common risk factors for airplane ear include—small eustachian tube (infants and
toddlers), common cold, acute or chronic sinusitis, allergic rhinitis, otitis media,
and napping on an airplane during rapid pressure change in our middle ear. Permanent
damage may occur in the membranous linings of the middle ear or eustachian tube, which
aggravates the problem further [6].
Figure 2.
Imbalance of air pressure in the middle ear.
5.
Complications
Generally, airplane ear does not pose problems unless there is any structural damage
in the middle ear. Rare complications may include permanent hearing loss and chronic
tinnitus [6],[7].
It is very surprising that despite being a very common condition, no prior preventive
instruction is given by the air hostesses/airplane authority about this phenomenon.
Although the airline authorities provide a lot of instructions to the passengers regarding
emergency landing in the water, power failures, low oxygen supply to the cabin and
so on; airplane ear remains a neglected health issue in aerospace safety measures.
Furthermore, if a baby suddenly cries or elderly adults feel ear discomfort or pain
during rapid descent of ascent of an airplane, then the flight attendants would rush
to the sufferers and offer instructions/help. Sometimes, they may have to manage emergencies
like ear bleeding by apply ear packs. All these health hazards and associated challenges
can be easily prevented if airplane authorities include following preventive instructions
for airplane air with existing life-saving instructions.
6.
Prevention [2],[3],[5]–[15]
6.1.
Primary prevention
(a).
Yawning, chewing and swallowing is helpful: During take-off and landing chewing gum
and swallowing activate the muscles that make patent the eustachian tubes bi-laterally.
(b).
Don't sleep during ascent and descent of flights: If we are awake during the period
of sudden pressure change, we can practice health promotive measures whenever we feel
discomfort on our ears.
(c).
Reschedule travel plans: If possible, it is better to not travel by plane if an individual
is suffering from the common cold, sinusitis, nasal congestion, recent ear surgery
or ear infection.
(d).
Use of earplugs: Earplugs slowly equalize the pressure against our eardrum during
take-off and landing of airplane.
(e).
Use of decongestants: It is helpful if taken before 30 minutes to an hour before the
travel.
6.2.
Secondary prevention[7]–[15]
(a).
Valsalva manoeuvre: The valsalva manoeuvre can be performed by the passengers during
passengers feel ear discomfort in the aeroplane. It (Figure 3) is performed by moderately
forceful exhalation against the closed glottis. Commonly it is done by closing one's
mouth, pinching one's nose shut while pressing out as if blowing up a balloon. This
manoeuvre is often used to clear the ears and sinuses (that is to equalize pressure
between them) during ambient pressure changes. It helps to maintain the air pressure
in the middle air, by contracting several muscles in the pharynx to elevate the soft
palate and open the throat. Especially, the muscle, tensor veli palatini, also acts
to open the eustachian tube and sucking or bulging of eardrum is prevented/corrected
during pressure changes in the flight.
(b).
Bleeding ear: In case of bleeding, immediate ear packing is often recommended, followed
by early exploration in the OT under expert physician is required.
Figure 3.
Valsalva manoeuvre.
6.3.
Tertiary prevention
For frequent fliers, surgically placed tube in the eardrums is generally helpful to
aid fluid drainage in the middle air, particularly for those who are prone to severe
airplane ear. This tube helps in ventilating air to the middle ear, and equalize the
pressure between the outer and middle ear.
7.
Conclusion and recommendations
Airplane ear is a common yet, ignored public health problem. It can be handled effectively
if proper precautions/corrective measures are adopted. Previously in the airlines,
lozenges were offered, which may have helped the passengers to avoid this problem,
but now a days it is less commonly practiced. The airplane authority should explore
socio-culturally appropriate and evidence-based strategies and incorporate them with
the preventive and curative instructions for the passengers. Moreover, the flight
attendants may be trained in recognizing and managing airplane ear alongside other
life-saving instructions to their passengers. It may decrease the air discomforts
and empower the air passengers during air travel.