05. OTHER CLINICAL CONDITIONS ASSOCIATED WITH TRAVEL (10%)
          01. Barotrauma

Symptoms:

• “Airplane ear can occur in one or both ears. Common signs and symptoms include:
  • Moderate discomfort or pain in your ear
  • Feeling of fullness or stuffiness in your ear
  • Muffled hearing or slight to moderate hearing loss
• If airplane ear is severe, you might have:
  • Severe pain
  • Increased ear pressure
  • Moderate to severe hearing loss
  • Ringing in your ear (tinnitus)
  • Spinning sensation (vertigo)
  • Bleeding from your ear” ²

Prevention:

• “The simplest way to help clear your ears—particularly when flying—is to swallow. Yawning, chewing gum, or sucking on hard candy can help, especially just before take-off and during descent. You can also try pinching your nose, taking a mouthful of air, blowing gently (not forcefully) against your pinched nose, then swallowing. You’ll know if it worked when you hear a pop, and your ears feel less plugged.
• Babies and children are especially vulnerable to ear blockage because their eustachian tubes are narrower than in adults. Plus, babies cannot intentionally pop their ears, but sucking on a bottle or pacifier can help. You and your children should avoid sleeping during descent because swallowing may not occur often enough to keep up with changes in air pressure.” ¹

Treatment:

• “If you have allergies, take your medications at the beginning of your flight. Over-the-counter nasal sprays or decongestants can also help air travelers to shrink the membranes and help the ears pop more easily. However, if you are pregnant, or have heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness, consult your physician before using these medications. Extended use of decongestant nasal sprays can also cause more congestion than relief, and even result in a type of addiction.
• If your ears fail to open, or if you are experiencing persistent pain in your ears, seek the help of an ENT (ear, nose, and throat) specialist, or otolaryngologist. They may recommend inserting small pressure equalization tubes or a balloon to help dilate your eustachian tubes. Or, they may need to release the pressure or fluid with a small incision in your ear drum.” ¹

Two points on this topic: I will never forget shortly after I graduated from residency I had a new mother bring her baby in for a routine well child check.  We discussed that she was going to be travelling with the baby and I gave some general pediatrician advice about the vaccinations.  When she asked if I had any other specific travel advice I remember blank panic as no one had ever asked me about travelling with a baby before and that wasn’t covered on my boards.  When I stepped out of the room for the nurse to give the vaccines I frantically called my mother and asked for her advice and she very calmly told me to tell the mother to make sure they have a bottle for the baby to suck on.  When I went back in, I told the mother and never forgot that piece of advice.  It seems like common sense now but it absolutely wasn’t at the time when I had never thought about it before.

Additionally, several years later, for a period of time I worked doing hotel housecalls for people who got sick while travelling to the Orlando, mostly Disney and Universal, as those are the big attractions in the area.  Frequently I was called out to see children with ear infections. We would always treat them with antibiotics but also recommend age appropriate antihistamines, decongestants, nasal sprays and try to follow up a week later before they flew home for an ear recheck.  Often, due to travel plans, they would not follow up as directed and I always wondered if their ears were ok getting home.  I did not realize until I was seeing travelers that were sick how common this issue was while traveling. 

References:

1. Ears and altitude (barotrauma). ENT Health. (2022, December 12). https://www.enthealth.org/conditions/ears-and-altitude-barotrauma/

2. Mayo Foundation for Medical Education and Research. (2021, August 21). Airplane Ear. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/airplane-ear/symptoms-causes/syc-20351701