Airplane Ear - Know It All!

Editorial

All you need to know about Ear Barotrauma.

Know your ailment well, so you can manage it better!!

Here we come with Airplane ear today!

What is Airplane Ear?

Airplane ear is also known as Ear Barotrauma or barotitis media or aerotitis media.

The transient pain within your ear when you’re flying is the airplane ear, usually during fast altitude changes during the flight. The airplane ear can be cured by a few tricks caused by the change of air pressure within the cockpit.

Barotrauma to the ear, also called aero-otitis or barotitis, may occur on an aeroplane as the aircraft descends for landing. Ear barotrauma may also occur as scuba divers descend. In the middle ear that pushes the eardrum forward, the pressure adjustment will produce a vacuum. This will cause pain and noises can be muffled. Your ear is going to feel stuffed and you may feel like you need to “pop” it.

The middle ear will fill with clear fluid in more serious cases of barotrauma when the body attempts to equalise the pressure on both sides of the eardrum. This fluid is absorbed into the lining of the inner ear from blood vessels which can only exit if the Eustachian tube is open. Serous otitis media is considered the fluid behind the eardrum. Similar to a middle ear infection, it may cause discomfort and hearing problems.

In serious cases of ear barotrauma, the eardrum can rupture (break), causing bleeding or fluid leakage from the ear. Hearing failure may result from a ruptured eardrum. In extreme situations, a leak between the deepest structures of the ear (the fluid-filled bony canals called the cochlea and semicircular canals) and the inner ear space can be created by friction. This deep leak is referred to as a fistula. The balancing centre will be disturbed if this happens, resulting in a spinning or sinking feeling called vertigo. Emergency surgery may involve this complication.

The most common medical condition identified by air travelers is barotrauma. When they fly, that is much more likely to happen to people who have colds, asthma, or illnesses. In infants, it is normal because their Eustachian tubes are smaller than those of adults and become more readily blocked.

There may also be barotrauma in the lungs, although this is not seen by air travelers. Rarely, as the diaphragm moves suddenly in a “gasping” effort, it happens in divers who catch their breath. The key muscle used in respiration is the diaphragm. A vacuum in the lungs is produced by this type of barotrauma which can result in bleeding into the lung tissue. The artificial breathing devices used in hospital intensive care units to help patients breathe are the source of a more common type of barotrauma in the lungs. In this situation, because of elevated air pressure inside the lungs, air sacks (alveoli) in the lungs may be ruptured or scarred. A complex medical problem is a ventilator-associated barotrauma.

What causes Airplane Ear?

The airplane ear happens when the air pressure in the middle ear and the air pressure in the atmosphere do not align, stopping the regular vibration of the eardrum (tympanic membrane). The air pressure is controlled by a narrow passage called the Eustachian tunnel, which is attached to the middle ear.

The air pressure varies easily as an aircraft rises or descends. The Eustachian tube is frequently unable to respond rapidly enough, allowing aeroplane ear symptoms to develop. The Eustachian tube expands by swallowing or yawning and allows the middle ear to absorb more oxygen, equalising the air pressure.

And, ear barotrauma can be caused by:

  • Scuba Diving
  • Oxygen hyperbaric chambers
  • Nearby blasts, such as in a combat zone,
  • In a tall building while traveling in the mountains, you can even encounter a mild case of barotrauma when using an elevator.

What are the symptoms of Airplane Ear?

Either or both ears may have an airplane ear. Signs and symptoms that are typical include:

  • Moderate pain or irritation in the ear
  • Sensation of fullness or stuffiness in the ear
  • Muffled hearing or mild to severe loss of hearing

If the airplane’s ear is extreme, you might have:

  • Extreme discomfort
  • Increased pressure in the ear
  • Low to serious Loss of Hearing
  • Ringing in the ear of yours (tinnitus)
  • Sensation flipping (vertigo)
  • Bleeding from an ear of yours

What are the Risk Factors of Airplane Ear?

Any disorder that obstructs or restricts the operation of the Eustachian tube can increase the risk of an airplane ear.

Popular risk considerations include:

  • A short Eustachian tube, especially for babies and toddlers
  • Common cold The common cold
  • Infection of the Sinus
  • Fever in hay (allergic rhinitis)
  • Infection of the middle ear (otitis media)
  • During ascending and descent, sleeping on an aircraft, so you do not yawn or chew, which can equalise the pressure

What are the Complications of Airplane Ear?

Typically, the airplane’s ear is not critical and responds to self-care. When the disease is acute or chronic or where there is a disruption to middle or inner ear tissues, long-term effects will rarely arise.

Rare complications of Airplane ear may include the following

  • Permanent hearing loss
  • Ongoing (chronic) tinnitus

How is Airplane Ear diagnosed?

A moderate case of ear barotrauma can be diagnosed on your own and you do not need to see a doctor. When you are unaware of your signs or if your symptoms last a long time, your middle ear should be checked by a doctor using an illuminated magnifying instrument called an otoscope to see if the eardrum is being pushed inward. Often, transparent fluid behind the eardrum may be hard to see. Your doctor can squeeze a puff of air into your ear canal if the accumulation of fluid is not visible. You potentially have fluid behind the eardrum if the eardrum does not move properly. With an otoscope, a perforated eardrum may be detected by looking at the ear.

What is the treatment for Airplane Ear?

For most people, airplane ear usually heals with time. When the symptoms persist, you may need treatments to equalize pressure and relieve symptoms.

Medications

Your doctor might suggest you take:

  • Decongestant nasal sprays
  • Oral decongestants

To ease discomfort, you can take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), or an analgesic pain reliever, such as acetaminophen (Tylenol, others).

Self-care therapies

With your drug treatment, your doctor will instruct you to use the Valsalva maneuver. To do this, you pinch your nostrils shut, close your mouth and gently force air into the back of your nose, as if you were blowing your nose.

Surgery

Surgical treatment of airplane ear is rarely necessary. Even severe injuries, such as a ruptured eardrum or ruptured membranes of the inner ear, usually heal on their own.

However, in rare cases, an office procedure or surgery might be needed. This might include a procedure in which an incision is made in your eardrum (myringotomy) to equalize air pressure and drain fluids.

How can Airplane Ear be prevented?

For airplane ear avoidance, follow these tips:

  • During ascending and descent, yawn and swallow. These activate the muscles that open up the channels of Eustachia. In order to help you swallow, you should suck on sugar or chew gum.
  • During ascending and descent, use the Valsalva manoeuvre. Blow softly, as if your nose is blowing, while pinching your nostrils and holding your mouth sealed. Repeat many times to equalise the pressure between your ears and the aeroplane cabin, especially during descent.
  • During takeoffs and landings, do not relax. While you are awake during ascents and descents, when you sense pressure between your head, you should execute the requisite self-care strategies.
  • Re-consider arrangements for flying. Don’t fly if you have a flu, sinus infection, nasal inflammation or ear infection, if possible. Speak to the doctor on whether it’s safe to drive if you’ve had ear surgery recently.
  • Using a nasal spray that is over-the-counter. Using a nasal spray from 30 minutes to an hour before takeoff and landing if you have nasal congestion. However, prevent overuse, as nasal sprays taken for three to four days can increase congestion.
  • Cautiously use decongestant tablets. If taken from 30 minutes to an hour before an aeroplane flight, decongestants taken by mouth can help. However, stop taking an oral decongestant if you have heart disease, a heart rhythm condition, or elevated blood pressure, if you are pregnant.
  • Taking medicine for allergies. Take your prescription about an hour before your flight if you have allergies.
  • Try earplugs that are screened. During ascents and descents, certain earplugs slowly equalise the pressure on the eardrum. At drugstores, airport gift shops or a hearing centre, you can buy these. To release pain, though, you will always need to yawn and swallow.
  • Your doctor can surgically insert tubes in your eardrums to help fluid drainage, ventilate your middle ear, and equalise the pressure between your outer ear and middle ear if you are prone to extreme aeroplane ears and must travel frequently or if you are getting hyperbaric oxygen therapy to heal wounds.

References:

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https://www.mayoclinic.org/diseases-conditions/airplane-ear/diagnosis-treatment/drc-20351707

https://my.clevelandclinic.org/health/diseases/17929-airplane-ear/living-with

https://www.health.harvard.edu/a_to_z/barotrauma-a-to-z

https://www.webmd.com/healthy-aging/qa/is-airplane-ear-muffling-your-hearing

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779601/