“Airplane ear”—A neglected yet preventable problem

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.

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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 agammaavates the problem further [6].

Figure 2.  Imbalance of air pressure in the middle ear.

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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