I am a general aviation pilot. Frequently, about two days after flying, I experience severe pain in my right ear. Upon turning my head to the side and seemingly stretching the muscles in my neck, the pain increases, feels almost like a tearing pain, then "pops" and the pain is relieved. I experience no pain or problems while flying even though I can sense pressure changes during descents. It sounds like barotitis, but is it usual for the effects of barotitis to occur two or more days after flying? Could you suggest ways for preventing this condition that do not interfere with alertness and coordination during flying. Also, could you suggest ways to relieve the pain when it occurs two or more days after flying. Thank you.
Reply: ----------------------
It would be quite unusual for barotitis to present in this fashion. Generally symptoms of barotitis are experienced at the moment there is significant pressure differential which typically occurs during descent in airplane flight. I also would be unable to explain why a middle ear pressure disturbance would cause ear pain that is exacerbated by turning your head as you have described. I suspect that it is more likely that you are experiencing a musculoskeletal disturbance involving the deep neck musculature near their attachment at the skull base. Ear pain caused by musculoskeletal conditions is not uncommon. A common example is temporo-mandibular joint syndrome (TMJ). Perhaps it is possible that certain repetitive upper extremity motions used during your airplane flight activities might be responsible. If you are not sensitive or intolerant to non-steroidal anti-inflammatory medication, you might try to prevent the symptoms by using over-the-counter Advil, Nuprin, Alleve, etc. for a couple days after flying.
Barotitis problems on the other hand can usually be minimized or prevented by avoiding flight if possible when upper respiratory symptoms are present, frequently auto-inflating ("popping") one's ears as soon as ear pressure is felt, chewing gum, and or sipping a beverage (palate movement during swallowing opens and closes the eustachian tube). Certain medications are often quite helpful including decongestants such as Sudafed and in particular topical nasal decongestant sprays such as Afrin or Neo-synephrine. Over-the-counter decongestants which do not contain anti-histamines may be acceptable for pilots - such as low dose pseudoephedrine, eg Sudafed. Anti-histamines not only would be of little if any benefit, but also are probably never acceptable for pilots. Afrin is probably one of the best medications to use in the prevention of barotitis - the long-acting form should be used an hour or so before flight. It does not have any significant potential for systemic side effects and therefore is generally safe for pilots and passengers alike. Such sprays are designed for limited short term use and should not be used on a regular basis for more than 3 consecutive days or nasal irritation may develop.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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