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Middle Ear Barotraumas in Commercial Aircrew

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BACKGROUND: Middle ear (ME) barotraumas are the most common condition in aviation medicine, sometimes seriously compromising flight safety. Considering this and the ever-increasing amount of commercial aviation, a detailed overview is warranted.

METHODS: In this survey study, an anonymous, electronic questionnaire was distributed to commercial aircrew of the three major commercial airlines operating in Finland (N 3799), covering 93% of the target population (i.e., all commercial aircrew operating in Finland, N 4083). Primary outcomes were self-reported prevalence, clinical characteristics, and health and occupational effects of ME barotraumas in flight. Secondary outcomes were adjusted odds ratios (OR) for frequency of ME barotraumas with respect to possible risk factors.

RESULTS: Response rate was 47% (N 1789/3799), with 85% (N 1516) having experienced ME barotraumas in flight. Of those affected, 60% had used medications, 5% had undergone surgical procedures, and 48% had been on sick leave due to ME barotraumas (40% during the last year). Factors associated with ME barotraumas included a high number of upper respiratory tract infections [3 URTIs/yr vs. 0 URTIs/yr: OR, 9.02; 95% confidence interval (CI) 3.9920.39] and poor subjective performance in Valsalva (occasionally vs. always successful: OR, 7.84; 95% CI 3.9715.51) and Toynbee (occasionally vs. always successful: OR, 9.06; 95% CI 2.6730.78) maneuvers.

CONCLUSION: ME barotraumas were reported by 85% of commercial aircrew. They lead to an increased need for medications, otorhinolaryngology-related surgical procedures, and sickness absence from flight duty. Possible risk factors include a high number of URTIs and poor performance in pressure equalization maneuvers.

Lindfors OH, Ketola KS, Klockars TK, Leino TK, Sinkkonen ST. Middle ear barotraumas in commercial aircrew. Aerosp Med Hum Perform. 2021; 92(3):182189.
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Keywords: ENT; Eustachian tube; Eustachian tube dysfunction; Valsalva maneuver; epidemiology; health surveys; survey

Document Type: Research Article

Publication date: March 1, 2021

More about this publication?
  • This journal (formerly Aviation, Space, and Environmental Medicine), representing the members of the Aerospace Medical Association, is published monthly for those interested in aerospace medicine and human performance. It is devoted to serving and supporting all who explore, travel, work, or live in hazardous environments ranging from beneath the sea to the outermost reaches of space. The original scientific articles in this journal provide the latest available information on investigations into such areas as changes in ambient pressure, motion sickness, increased or decreased gravitational forces, thermal stresses, vision, fatigue, circadian rhythms, psychological stress, artificial environments, predictors of success, health maintenance, human factors engineering, clinical care, and others. This journal also publishes notes on scientific news and technical items of interest to the general reader, and provides teaching material and reviews for health care professionals.

    To access volumes 74 through 85, please click here.
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