Risk of sinus or middle ear barotrauma during flight

There is a potential risk of sinus or middle ear barotrauma in those with risk factors (mucosal oedema, bacterial infection, thick mucus).

Upper airway infections can impair the ability to equalise pressures between the middle ear and oropharynx via the eustachian tube. This can result in barotrauma to the tympanic membrane, particularly at the time of descent. If travel is necessary, and the patient has lost their usual ability to equalise the pressure with the Valsalva manoeuvre at sea level, consider an intranasal or oral decongestant. Use at least 10 minutes (for intranasal decongestants) or 30 minutes (for oral decongestants) before ascent or descent to allow onset of action. Anecdotal evidence suggests that semipermeable earplugs may be helpful; earplugs are available from pharmacies. In patients with chronic rhinosinusitis, using saline nasal sprays and nasal irrigation may be helpful.

Children are especially at risk of middle ear barotrauma. Parents and carers should be advised to encourage their children to blow their nose, drink water, or chew or suck (eg on a lolly or dummy), particularly during descent. In infants, breastfeeding may help equalise pressures between the middle ear and oropharynx via the eustachian tube.

Any patient who experiences deafness, vertigo or bleeding from the external auditory meatus after flying must be examined by a doctor.