Flying and Health — Page 100, Lesson 149

I want to walk you through an important section on flying and health, specifically dealing with pressure-related injuries that can affect a pilot. Let's start with the ears. It is most important that pilots ensure, having suffered from otic barotrauma — that's pressure damage to the ear — that they are in a perfect state of health before returning to flying. If you resume flying before a complete recovery, this can lead to further damage to the system, which may result in a chronic state and the risk of infection. So the rule is clear: do not fly until you are fully healed. Now let's talk about "clearing the ears." Care must be used when you clear your ears by blowing down a held nose with the mouth closed — that technique is called the Valsalva Manoeuvre. A violent usage of this method may cause pressure vertigo, which is a spinning sensation caused by unequal pressure in the inner ear. So you want to be gentle. There are less severe methods for equalizing pressure in the middle ear during the descent. These include: the Frenzel Manoeuvre, which is similar to stifling a sneeze; swallowing with the nose held; yawning; and moving the lower jaw from side to side. These methods should only be used for equalizing pressure in the middle ear during the descent — not during the climb, because the pressure change is different. Should all these methods fail, a landing should be made as soon as practicable, and medical assistance should be sought from an aviation medical specialist. Now let's move to sinus barotrauma. Sinuses are cavities within the skull that are air-filled. Their function is to make the skull lighter and the voice resonant. They are situated above the eyes, in the cheeks, and at the back of the nose, and they are connected to the nasal cavity by narrow ducts. These tiny ducts can become swollen or obstructed, allowing air to become trapped within the sinuses. As with the ears, the sinuses can vent air more easily in the ascent than they allow gas to re-enter in the descent. So the painful results normally occur in the descent if the sinuses are infected by a cold or influenza. The pain normally starts around the eyes and spreads to the temples. It can be so severe as to render the pilot quite incapable of maintaining control of the aircraft. Fainting due to such pain is not unknown. Associated with the pain is a watering of the eyes, making vision difficult, and in addition, bleeding from the nose may occur. The immediate treatment is to return to the altitude where the pain first became apparent. The flight should then be terminated with a return to ground level at as slow a rate as possible. There is an important note here: unlike otic barotrauma, the pain suffered due to sinus barotrauma may be equally as acute in the climb or the descent. So it can hit you on the way up just as badly as on the way down. Finally, let's look at barotrauma of the teeth, also called aerodontalgia. Healthy teeth do not contain air, but gas pockets can form in old or poor fillings or abscesses. Aerodontalgia is most common in the ascent as the gas expands, perhaps pressing on a nerve, and can cause severe tooth pain. Good dental care and hygiene can prevent any problem.