Many of us fly abroad for leisure, others frequently for business, for some however it may be a family obligation that necessitates flying. There are many fears that surround flying, one such fear is that flying will cause sinus related or ear related conditions. 

Air pressure changes that occur when flying at different altitudes affect the natural pressure within the ear canals causing it to either increase or decrease.

When flying, pressure changes will cause your ostium (exit pathway) to become blocked. This blockage can be a result of increase mucus which does not drain causing inflammation in the tissues surrounding the ostium. It is this blockage that forces air to find an alternative route to be passed out of the sinus cavities.

Should an individual who has had an injury to the face or nasal area fly, the result could be as severe as meningitis. Meningitis is where the layer (meninges) that protects the spinal cord and brain becomes inflamed.

In severe cases, subcutaneous air will collect in the soft tissues and can cause temporary blindness. Should this collection of subcutaneous air be infected with bacteria or viruses, it can enter the brain cavity via an injury or rupture that has occurred in the nasal area. This will cause the condition of meningitis.

Another condition caused by flying and a decrease or increase in pressure within the sinus cavities is known as Barotraumas.  This can occur during ascending or descending in an aircraft.

What is Barotraumas?

Barotraumas is caused when there is an injury to the middle ear or when there is a quick change in ear pressure. This change in pressure can take place both inside or outside of the body. Barotraumas usually occurs when an individual moves from an environment with a high pressure to an environment with a lower pressure or vice versa in quick succession.

Who is more likely to develop Barotraumas?

1. Businessman and youngsters, in fact anyone that loves to travel in an airplane can develop barotraumas.
2. Cases are also commonly found in scuba divers. 

How does Barotraumas occur?

Any sinus condition can result in an increased mucus production and inflammation of the surrounding tissues as these expand and block the exit for mucus or air to pass through.
Increased pressure within the ears can therefore not effectively pass through, resulting in pressure building up within these cavities and disequilibrium between the external pressure and the pressure within the ear cavity. When increased air is trapped and cannot escape it causes damage to the delicate tissues of the ear and as a result, barotraumas occurs.

Barotraumas can still occur if no sinus condition is present as increased pressure causes strain or compression on certain apparatuses such as the tympanic membrane and Eustachian tube. This therefore makes it difficult to equalize pressure within the ear.

It is not only the middle ear that can be affected by an increase in pressure. The lung and gastrointestinal tract can also be affected.

Symptoms of Barotraumas

1. Dizziness and nausea
2. Bleeding from the ear drum
3. Pain is often experienced in the nasal passages, sinus cavities or ear region. Any associated pain usually occurs after the plane trip or scuba diving.
4. A feeling of blocked ears
5. Tinnitus or ringing heard in the ears
6. Perforated or ruptured tympanic membrane (ear drum)

If one should experienced these symptoms an ENT should be seen ASAP to obtain a correct and confident diagnosis. Vestibular testing and hearing testing should be done to confirm the diagnosis.

Treatment of Barotraumas

There are various treatments available for barotraumas.

1. Treatment for Outer ear Barotraumas consists of removing the blockage or what ever substance such as wax which is causing the blockage. Diving or flying should be avoided until the ear canal and the ear drum is fully functional.
2. Treatment of the middle ear Barotraumas should be directed at stopping any bacterial or viral infections in the ear or Eustachian tube as this tube connects the nasopharynx to the middle ear canal. The middle ear should be kept dry. Decongestants may be prescribed to unblock the Eustachian tube and promote thick mucus drainage. If pus appears antibiotics can be recommended.
3. Tympanic membrane perforations that are caused due to barotraumas can and will heal on their own, but if the individual has any Eustachian conditions recovery will be prolonged.  
4. If barotraumas is experienced in the inner ear, hospitalization and examination is called for as any injury to the inner ear apparatuses will call for much more drastic actions, like surgery to be taken.
5. Ear plugs are said to help with Barotraumas, but when placebo ear plugs were researched, no significant difference was found in the ear plugs treating or preventing barotraumas.

Should any procedure be carried out on an individual that has been suffering from Barotraumas, diving or flying should be avoided until individual has fully healed.