Aviation Medicine Research Articles

INFLUENCE OF PLASTIC SURGERY OF THE INFERIOR TURBINATE ON THE PATENCY OF THE EUSTACHIAN TUBE

Introduction: Chronic hypertrophic rhinitis is one of the most common diseases in rhinology. Various surgical techniques are used to reduce hypertrophic changes in the inferior turbinates. The aim of our study is to determine the impact of plastic surgery of the lower nasal turbinates, performed by cryoablation or radiocoblation, on the patency of the Eustachian tube and to determine how long the waiting period should be for activities that particularly require patent ear tubes, such as traveling by plane. Material: A total of 70 patients treated at the Department of Otolaryngology of the Military Institute of Aviation Medicine were qualified for the study. Due to the technique of conchoplasty of the lower nasal turbinates, the patients were divided into two groups. Group I consisted of 35 patients, including 15 women and 20 men, aged 24 to 62 (mean 42.67 years), operated on by cryoablation. Group II also comprised 35 patients, including 12 women and 23 men, aged 29 to 69 (mean 44.21 years), operated on by radiocoblation. Methods: Plastic surgeries of the lower nasal turbinates, also known as conchoplasties, were performed under local anesthesia with a cryosurgery machine with the use of a nasal applicator and an apparatus for submucosal coblation with the use of radio waves. The patency of the Eustachian tube was assessed by tympanometry before the operation and 1, 2 and 3 weeks after the operation. Results: No statistically significant (p < 0.001) disturbances of the patency of the Eustachian tubes were observed after conchoplastic surgeries, using both the cryoablation and radiocoablation methods. Conclusions: Conchoplasties of the lower nasal turbinates performed by cryo- and radiocoblation do not impair the patency of the Eustachian tubes. After operations on the lower nasal turbinates, the waiting period for activities that particularly require patent tubes should be two weeks.

ASSESSMENT OF BRAIN BIOELECTRICAL ACTIVITY IN CLINICALLY HEALTHY FLIGHT PERSONNEL AND FLIGHT TRAINING CANDIDATES FOLLOWING COVID-19 INFECTION

Introduction: Electroneurophysiological tests, together with tests to evaluate structures of the central nervous system (CNS), are in neurological diagnostics among the basic additional specialized examinations for diagnostic, therapeutic and certification purposes. The electroencephalographic (EEG) test is one of the methods of elelectroneurophysiological evaluation of the CNS. EEG is a non-invasive objective test of the bioelectrical activity of the brain. Objective: To investigate whether the course of COVID-19 with clinical mild/moderate respiratory tract involvement, in non-hospitalized patients, may affect brain bioelectrical activity. Methods: Eighty-five subjects were selected for evaluation of EEG recordings from clinically initially healthy flight personnel and flight training candidates. Of all the male and female subjects, between 04 January 2021 to 31 January 2022, as part of periodic and qualifying certification examinations at the Military Institute of Aviation Medicine, for the purposes of the Regional Military Aviation and Medical Commission. The selected group consisted of individuals aged 14-60 (average age: 27 years and 6 months), which included 14 women (average age: 24 years and 2 months) and 71 men (average age 29 years and 3.5 months). The subjects were ill with COVID-19 (non-hospitalized) for approximately 3-4 weeks, during the period; June 2020 – December 2021. Routinely made recordings of bioelectrical brain activity with the Grass Technologies EEG TWin 4.5.3 system were visually evaluated. EEG examinations were performed in the supine position, in the before noon hours, in a darkened and acoustically isolated laboratory. Before the study, each person declared min. 6-8 hours of sleep and eating a meal (breakfast). Except for the flight training candidates and one person from flight personnel, all other subjects declared having received one and 29 subjects two SARS-CoV-2 vaccinations, prior to contracting COVID-19. Some subjects had one further revaccination after recovery from the disease. EEG examinations were performed between one and fourteen months after recovery from COVID-19. The mean time between recovery and EEG examination was 6.5 (6.47) months. Results: EEG recordings within normal limits (normal) were found in 79 subjects, while six subjects (7.05%) had abnormal brain bioelectrical activity recordings. Discussion and Conclusion: Infection with SARS-CoV-2 with clinical mild/moderate respiratory tract involvement by initially healthy individuals may adversely affect spontaneous brain bioelectrical activity in some individuals.

Commercial Aircraft-Assisted Suicide Accident Investigations Re-Visited—Agreeing to Disagree?

Background: The number of aircraft-assisted suicides can only be considered a rough estimate because it is difficult and, at times, impossible to identify all cases of suicide. Methods: Four recent reports of accidents occurring in 1997 in Indonesia, 1999 in Massachusetts in the United States, 2013 in Namibia, and 2015 in France related to commercial aircraft-assisted suicides were analyzed. This analysis relied on data extracted from the accident reports that supported aircraft-assisted suicide from the: (a) cockpit voice recorder (CVR) and flight data recorder (FDR), (b) medical history, (c) psychosocial history, (d) toxicology, (e) autopsy, and (f) any methodology that utilized aviation medicine. There are some limitations in this study. Although all analyzed accident investigations followed ICAO Annex 13 guidelines, there is variability in their accident investigations and reporting. In addition, accident investigation reports represent accidents from 1997 to 2015, and during this time, there has been a change in the way accidents are reported. The nature of this analysis is explorative. The aim was to identify how the various aircraft accident investigators concluded that the accidents were due to suicidal acts. Results: In all four accident reports, FDR data were available. CVR data were also available, except for one accident where CVR data were only partially available. Comprehensive medical and psychosocial histories were available in only one of four of the accident reports. Conclusion: To prevent accidents involving commercial aircraft, it is necessary to identify the causes of these accidents to be able to provide meaningful safety recommendations. A detailed psychological autopsy of pilots can and likely will assist in investigations, as well as generate recommendations that will substantially contribute to mitigating accidents due to pilot suicide. Airborne image recording may be a useful tool to provide additional information about events leading up to a crash and thus assist in accident investigations.

This Month in Aerospace Medicine History: March.

This Month in Aerospace Medicine History: March.

Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review.

Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots. Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies. The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots. This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.

An Igor Pro 8.01 Procedure to Analyze Pulse Oximetry during Acute Hypoxia Test in Aircrews.

The recognition of hypoxia symptoms is a critical part of physiological training in military aviation. Acute exposure protocols have been designed in hypobaric chambers to train aircrews to recognize hypoxia and quickly take corrective actions. The goal of the acute hypoxia test is to know the time of useful consciousness and the minimal arterial oxygen saturation tolerated. Currently, there is no computer system specifically designed to analyze the physiological variables obtained during the test. This paper reports the development and analytical capabilities of a computational tool specially designed for these purposes. The procedure was designed using the Igor Pro 8.01 language, which processes oxygen saturation and heart rate signals. To accomplish this, three functional boards are displayed. The first allows the loading and processing of the data. The second generates graphs that allow for a rapid visual examination to determine the validity of individual records and calculate slopes on selected segments of the recorded signal. Finally, the third can apply filters to generate data groups for analysis. In addition, this tool makes it possible to propose new study variables that are derived from the raw signals and can be applied simultaneously to large data sets. The program can generate graphs accompanied by basic statistical parameters and heat maps that facilitate data visualization. Moreover, there is a possibility of adding other signals during the test, such as the oxygenation level in vital organs, electrocardiogram, or electroencephalogram, which illustrates the test's excellent potential for application in aerospace medicine and for helping us develop a better understanding of complex physiological phenomena.

Effects of age on hypoxic tolerance in women

Effects of age on hypoxic tolerance in women

Residual Sleepiness Risk in Aircrew Members with -Obstructive Sleep Apnea Syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a major problem in aviation medicine because it is responsible for sleepiness and high cardiovascular risk, which could jeopardize flight safety. Residual sleepiness after the treatment is not a rare phenomenon and its management is not homogenous in aviation medicine. Thus, we decided to perform a study to describe this management and propose guidelines with the help of the literature.METHODS: This is a retrospective study including all aircrew members with a history of OSAS who visited our aeromedical center between 2011 and 2018. Residual sleepiness assessment was particularly studied.RESULTS: Our population was composed of 138 aircrew members (mean age 50.1 ± 9.6 yr, 76.8% civilians, 80.4% pilots); 65.4% of them had a severe OSAS with a mean Epworth Sleepiness Scale (ESS) at 8.5 ± 4.7 and a mean apnea hypopnea index of 36.2 ± 19.2/h. Of our population, 59.4% performed maintenance of wakefulness tests (MWT) and 10.1% had a residual excessive sleepiness. After the evaluation, 83.1% of our population was fit to fly.DISCUSSION: An evaluation of treatment efficiency is required in aircrew members with OSAS. Furthermore, it is important to have an objective proof of the absence of sleepiness. In this case, ESS is not sufficient and further evaluation is necessary. Many tests exist, but MWT are generally performed and the definition of a normal result in aeronautics is important. This evaluation should not be reserved to solo pilots only.Monin J, Rebiere E, Guiu G, Bisconte S, Perrier E, Manen O. Residual sleepiness risk in aircrew members with obstructive sleep apnea syndrome. Aerosp Med Hum Perform. 2023; 94(2):74-78.

This Month in Aerospace Medicine History: February

This Month in Aerospace Medicine History: February

Cholesterol: An Important Determinant of Muscle Atrophy in Astronauts.

Since cholesterol is not routinely measured in astronauts before and after their return from space, there is no data on the role of blood cholesterol level in muscle atrophy and microgravity. Since the first moon landing, aerospace medicine became outdated and has not pushed boundaries like its rocket engineering counterpart. Since the 2019 astronaut twin study, there has yet to be another scientific breakthrough for aerospace medicine. Microgravity-induced muscle atrophy is the most known consequence of spaceflight. Yet, so far, there is no therapeutic solution to prevent it or any real efforts in understanding it on a cellular or molecular level. The most obvious reason to this unprecedented level of research is due to the small cohort of astronauts. With the establishment of private space industries and exponential recruitment of astronauts, there is more reason to push forward spaceflight-related health guidelines and ensure the safety of the brave humans who risk their lives for the progression of mankind. Spaceflight is considered the most challenging job and the failure to prevent injury or harm should be considered reckless negligence by the institutions that actively prevented sophistication of aerospace medicine. In this critical review, role of cholesterol is analyzed across the NASA-established parameters of microgravity-induced muscle atrophy with a focus on potential therapeutic targets for research.

Aviation Decompression Sickness in Aerospace and Hyperbaric Medicine

INTRODUCTION: The U.S. Navy experienced a series of physiological events in aircrew involving primarily the F/A-18 airframe related to rapid decompression of cabin pressures, of which aviation decompression sickness (DCS) was felt to contribute. The underlying pathophysiology of aviation DCS is the same as that of diving-related. However, based on the innate multifactorial circumstances surrounding hypobaric DCS, in clinical practice it continues to be unpredictable and less familiar as it falls at the intersect of aerospace and hyperbaric medicine. This retrospective study aimed to review the case series diagnosed as aviation DCS in a collaborative effort between aerospace specialists and hyperbaricists to increase appropriate identification and treatment of hypobaric DCS.METHODS: We identified 18 cases involving high-performance aircraft emergently treated as aviation DCS at a civilian hyperbaric chamber. Four reviewers with dual training in aviation and hyperbaric medicine retrospectively reviewed cases and categorized presentations as "DCS" or "Alternative Diagnosis".RESULTS: Reviewers identified over half of presenting cases could be attributed to an alternative diagnosis. In events that occurred at flight altitudes below 17,000 ft (5182 m) or with rapid decompression pressure changes under 0.3 atm, DCS was less likely to be the etiology of the presenting symptoms.CONCLUSIONS: Aviation physiological events continue to be difficult to diagnose. This study aimed to better understand this phenomenon and provide additional insight and key characteristics for both flight physicians and hyperbaric physicians. As human exploration continues to challenge the limits of sustainable physiology, the incidence of aerospace DCS may increase and underscores our need to recognize and appropriately treat it.Kutz CJ, Kirby IJ, Grover IR, Tanaka HL. Aviation decompression sickness in aerospace and hyperbaric medicine. Aerosp Med Hum Perform. 2023; 94(1):11-17.

КЛИНИКО-ЭКСПЕРТНЫЕ ПОДХОДЫ ПРИ ОЦЕНКЕ НАРУШЕНИЙ СЕРДЕЧНОГО РИТМА У ЛЕТНОГО СОСТАВА ГОСУДАРСТВЕННОЙ АВИАЦИИ

The paper is devoted to validation of approaches to evaluation of cardiac rhythm disorders in flying personnel adequate to the present clinical medicine standards and criteria used in medical certification of state aviation pilots. We compared a number of classification criteria in context of their adequacy to the needs of the pilot medical certification community. Clinical classification criteria do not meet in full the requirements of aviation medicine certification. We suggest that cardiac rhythms disorders should be graded with consideration of pilot's functionality.

Oxygen Sense: Creating Embodied Knowledge to Promote Health Innovation in the Royal Air Force, 1939-45.

Chambers that simulate low-oxygen environments saw use by many of the world's air forces during World War II, yet the hypobaric chamber played an equally important role in rapidly adapting air force personnel's cultural mentality and behavior. Behind its German and American rivals in the field of aviation medicine, Britain's Royal Air Force distinctively mobilized the hypobaric chamber to aid its European bombing campaign, shaping aircrew into crude oxygen detectors long before the wide use of cabin pressurization and electronic sensing technology. Physiology, often overlooked by historians, can be usefully reinserted into the story of the world's air forces, taking inspiration from recent histories of technology on the suitability and malleability of human behavior to fit complex systems. "Oxygen sense" shows how embodied knowledge of hypoxia was promoted because it swayed oxygen skeptics. Embodied knowledge eased the integration of aircraft technology with human respiration to become a routine component of flying practice.

This Month in Aerospace Medicine History: January.

This Month in Aerospace Medicine History: January.

К 85-летию профессора Алексея Сергеевича Киселева. О моем отце

The article is devoted to the Russian otorhinolaryngologist, professor of the Kirov Military Medical Academy Alexey Sergeevich Kiselev, a well-known rhinologist and author of probably the best monographs on the history of otorhinolaryngology in Russia. Having come to the Department of Otolaryngology in 1964, he initially engaged in vestibular research, proposed options for training astronauts to the effects of Coriolis accelerations to overcome motion sickness, and was in charge of the acoustic-vestibular laboratory. It was the time of space exploration, and at the department, under the guidance of his teacher, Professor Konstantin Lvovich Khilov, vestibulologists carried out intensive work in the field of aerospace medicine. Since the 1970s A.S. Kiselev studied the etiopathogenesis of otosclerosis and in 1984, in his doctoral dissertation, presented a hypothesis about its role in the genesis of a combination of “causal factors” (cause factors) – the presence of remnants of the embryonic cartilage of the labyrinth capsule, and “conditional factors” (conditional factors) – dysfunction of the endocrine system, hypervitaminosis D, etc. He suggested that the normally inert state of the labyrinth capsule (slowness of bone formation processes) is a “successfully chosen by nature developmental variant” of a very small bone for optimal functioning of the membranous labyrinth located in it. Since the 1990s A.S. Kiselev raised the problem of the “forgotten sinus” – the sphenoidal sinus and, more broadly, latent sinusitis in general in the development of visual and intracranial complications. He was a supporter of active surgical treatment of latent sphenoiditis in rhinogenic visual disorders. Performing surgical treatment on patients with rhinogenic optochiasmal arachnoiditis at the Medical Academy, he showed that in this way it is possible to stop the progression of vision loss in them. He drew attention to hyperpneumatization of the sphenoid bone as a possible symptom of rhinogenic optochiasmal arachnoiditis. Later, he described the "pneumatosinus" of the sphenoid sinus – a pathological variant of hyperpneumatization of the sphenoid bone, without inflammation, going beyond its anatomical boundaries, causing visual disturbances, and proposed a surgical method of its inhibition. Deeply studying rhinological problems, he became a well-known figure among Russian rhinologists and brought up a galaxy of students. For 25 years A.S. Kiselev studied the history of Russian otorhinolaryngology, leaving dozens of excellent articles and monographs. His historical texts are dedicated to outstanding figures in medicine – otiatrist Robert Vreden, Grand Duchess Elena Pavlovna – the founder of the Yeleninsky community of sisters of mercy and the Yeleninsky Clinical Institute, surgeon Pirogov, heads of the first department of otolaryngology in Russia – N. P. Simanovsky, V. I. Voyachek, K. L. Khilov, and many important events in the history of medicine. The cultural and scientific meanings that he drew by studying the lives of these remarkable personalities, he tirelessly sought to convey to his students and colleagues.

Participation of aeromedicine specialists in complex forensic medical examination in aviation accidents

The problem of flight safety and aviation injury were considered, data on aviation accidents in Civil aviation were shown, the main causes of aviation accidents were presented: technical failure, difficult meteorological conditions, deficiencies in flight organization and «human factor». The conditional classification of aviation injury was presented. Detection of primary injuries is especially important for aeromedicine (head impact on dashboard, bone fracture at the ankle, «loss of vital space», laceration between 1st and 2nd fingers from the control wheel), that determine the pattern of pilots' actions in an emergency situation. A three-link flight medical support system was remained to prevent flying under the influence of alcohol, drugs and psychoactive substances. The Department of Aerospace Medicine developed the algorithm of pilots' examination suspected of using toxic substances. The materials of pilot's psychological examination after an aviation accident in the state of posttraumatic stress disorder are presented.

The 1st International Conference of Aerospace Medicine (September 22-24, 2022, Paris, France)

The 1st International Conference of Aerospace Medicine (September 22-24, 2022, Paris, France)

Mining attention distribution paradigm: Discover gaze patterns and their association rules behind the visual image

Background and ObjectiveAttention allocation reflects the way of humans filtering and organizing the information. On one hand, different task scenarios seriously affect human's rule of attention distribution, on the other hand, visual attention reflecting the cognitive and psychological process. Most of the previous studies on visual attention allocation are based on cognitive models, predicted models, or statistical analysis of eye movement data or visual images, however, these methods are inadequate to provide an inside view of gaze behavior to reveal the attention distribution pattern within scenario context. Moreover, they seldom study the association rules of these patterns. Therefore, we adopted the big data mining approach to discover the paradigm of visual attention distribution. MethodsWe applied the data mining method to extract the gaze patterns to discover the regularities of attention distribution behavior within the scenario context. The proposed method consists of three components, tasks scenario segmented and clustered, gaze pattern mining, and association rule of frequent pattern mining. ResultsThe proposed approach is tested on the operation platform. The complex operation task is simultaneously segmented and clustered with the TICC-based method and evaluated by the BCI index. The operator's eye movement frequent patterns and their association rule are discovered. The results demonstrate that our method can associate the eye-tracking data with the task-oriented scene data. DiscussionThe proposed method provides the benefits of being able to explicitly express and quantitatively analyze people's visual attention patterns. The proposed method can not only be applied in the field of aerospace medicine and aviation psychology, but also can likely be applied to computer-aided diagnosis and follow-up tool for neurological disease and cognitive impairment related disease, such as ADHD (Attention Deficit Hyperactivity Disorder), neglect syndrome, social attention differences in ASD (Autism spectrum disorder).

Оказание медицинской помощи больным и пострадавшим с использованием санитарной авиации в Республике Крым

Summary. The aim of the study is to evaluate the work of aviation medical teams of the Territorial Disaster Medicine Center of the Republic of Crimea in the field of sanitary aviation evacuation and rendering emergency consultative medical aid to the patients and victims of emergencies. Materials and research methods. Materials of the study — service documentation on the work of the department of the emergency consultative medical aid of the territorial disaster medicine center of the Republic of Crimea in 2019-2021. Research methods – analytical and statistical. Results of the study and their analysis. Sanitary aviation evacuation of patients and victims of emergencies in the Republic of Crimea is performed on the Ansat helicopter by a full-time aviation medical team of resuscitation profile with attraction — if it is necessary — of other specialists. The results of the work of the sanitary aviation of the Republic of Crimea in 2019-2021 are presented. Based on the results of the study, proposals were made to improve the quality of air ambulance evacuations. Among them: organization of short-term courses on acquainting aviation medical teams members with basics of aviation medicine, aviation ergonomics and psychophysiology of flight crews’ activity; training of flight crew (pilot, navigator) in basics of air ambulance evacuation; conducting “on the ground” with non-members of aviation medical teams instructional lessons and trainings on the rules of airborne medical equipment operation, etc.

This Month in Aerospace Medicine History: December

This Month in Aerospace Medicine History: December