Pain on the Plane – a new solution?

Eardrum with grommet

Ear and nose specialists call this “barotrauma”. This is the severe pain that can be experienced in a plane on ascent and descent. It is because of external atmospheric pressure changes – or more correctly, the inability to adapt to these changes.

The middle ear and nasal / facial sinuses are small cavities housed within the bone of the skull. They all communicate with the atmosphere via small channels which are supposed to allow air pressure to equalise within the cavity when the outside pressure goes up or down – keeping the pressure within the cavity constant. The trouble begins when the small channel becomes blocked. This can easily happen due to sinusitis or even the common cold and it prevents the sufferer from equalising when the plane descends or on take off. I say “sufferer” and mean it – this can be excruciating! It can even result in a ruptured eardrum, or severe facial pain. The pain can last for days. Sometimes, the cavity may fill with thin, watery fluid, called an effusion which results in muffled hearing – as if underwater. If this happens to pilots or cabin staff, they are not allowed to fly until the problem is rectified. The problem may be a “one-off” but you may be unlucky and suffer most times you fly. Babies can suffer the same problem and frequently one can hear the distressing screams of infants in severe pain when a plane is landing. Parents must feel so helpless if this happens to their child. Earplugs are unfortunately completely useless.

As ENT surgeons, we recommend using decongestant nose-drops before (and during flights, on long-hauls) if you suffer from this. It doesn’t always work for everyone though.
Nonetheless, there are more definitive solutions: One is to insert ventilation tubes in the eardrums (called “grommets” in UK). This is a minor procedure which causes little pain and the tiny tube within the eardrum (pictured). This works well, but it does mean that you cannot allow water into the ear canal , as it can go through the tube and cause infection of the middle ear.

Another, more modern solution, involves dilating the ear (or sinus’ ) ventilating channel. This can be done with an endoscopic balloon that is gently fed (by means of a fibre) into the channel (called the “Eustachian tube” for the ear, or “Sinus ostium” for the sinuses) and dilating it, in the same way that Cardiologists will dilate a blocked coronary artery in the heart. It leaves no incisions, scars and is virtually painless. This is known as Endoscopic Eustachian Tuboplasty (or Endoscopic Sinus Balloon Ostium Dilatation). Of course the procedure doesn’t work for everyone and if one doesn’t work, the other is still an option.

If you frequently suffer pain on flying, this may be your solution. Both techniques are covered by insurance. Call and book an appointment to see Mr. Marais

Posted in: ENT, Uncategorized

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