I am a 46 year old male non-smoker with chronic allergic rhinitis. I currently take a non-sedating antihistimine and a steroidal nasal spray. However, when I fly on commercial airlines with the slightest cold or allergy my right eustachian tube blocks and causes eventual otitis media. My question is this: When is it necessary for an adult to have a myringotomy and tubes place in my eardrums? I have had about 3 - 4 of these occurences a year for the last seven years.
Answer ----------------------
The condition described is known as barotitis and is related to the inability of the eustachian tube to quickly compensate for rapid air pressure changes such as that which can occur with airplane flight or scuba diving. The primary function of the eustachian tube is to ventilate the middle ear and mastoid and to maintain a pressure equilibrium inside these chambers with the ambient air. During airplane flight the condition more commonly occurs during descent from low pressure at high altitude to high pressure at low altitude. In this situation the middle ear pressure has equilibrated to the low pressure and as descent occurs, the higher air pressure external to the middle ear creates the equivalent of a vacuum. If the non-rigid portion of the eustachian tube is excessively compliant, or if there is an underlying condition such as rhinitis, sinusitis, or pharyngitis that results in swelling of the eustachian tube lining, the eustachian tube is ineffective in rapidly equilibrating the pressure differential. If this pressure differential persists, fluid and occasionally actual blood can fill the middle ear space and ultimately become infected.
Many individuals experience barotrauma during airplane flight of varying degrees every time they fly. This is presumably related to an inherent problem with the compliance or muscular control of the eustachian tube. In most situations the condition is self-limited and can be alleviated by "popping" the ears by plugging the nose and building up air pressure in the upper part of the throat behind the nasal passages until the ear drum "pops" indicating pressure equalization. This maneuver is known as autoinflation and is safe as long as it is not done abruptly with undue force and as long as it does not cause significant dizziness.
Some individuals experience barotitis during flight only if they fly with a cold, rhinitis, sinusitis, or other upper respiratory condition which can result in mucosal swelling within the eustachian tube. The best advice here is to not fly with such conditions if not absolutely necessary. If one must fly with such conditions, the use of long-acting oxymetazoline (Afrin) nasal spray or 1/2% - 1% neo-synephrine nasal spray is strongly recommended prior to flight and, if a long flight, prior to descent. It is also helpful to chew gum, take frequent sips of a beverage, and/or frequently autoinflate the ears during descent. The nasal sprays mentioned here are rapid acting vasoconstrictors and act to shrink any swollen lining in the nasal passages thus improving the ability of the eustachian tube to ventilate the middle ear. They are designed for short term use and should not be used for more than 3-5 consecutive days or they may cause a "rebound" rhinitis.
I reserve the recommendation for tympanostomy tubes only for severe cases of barotitis where a fluid accumulation fails to resolve after 2-3 months. It is even less common to recommend tympanostomy tubes as a preventative measure and would typically be made only in cases where occupational requirements necessitate frequent airplane flight and barotrauma occurs frequently and in the absence of upper respiratory conditions.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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