"Airplane ear"-A neglected yet preventable problem.

Abstract

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. Open in a separate window Figure 1. Airplane ear. 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]. Open in a separate window Figure 2. Imbalance of air pressure in the middle ear. The pathophysiology remains the same in cases of scuba diving, in hyperbaric oxygen chambers, and during explosions happening nearby [2].