Whatever those lush advertisements from the airlines tell us about its comfort, flying gives rise to fear, however well disguised, among passengers. The safety statistics, the pleasant ambience and the state-of-the-art technology have never quite calmed everyone's nerves between check-in and safe arrival. A serious medical condition can also put flying out of reach of the sensible. So should tinnitus oblige you to go by sea or road? Air pressure, after all, changes greatly thousands of feet up in the sky and passengers' ears do 'pop'. Could the swift pressure changes affect the ears to such an extent that tinnitus is either started or increased?
The conventional wisdom is that flying is not a threat. A pressurised aircraft cannot affect the inner ear, where the cause of tinnitus is believed to lie. Anyone afraid that the noise of the engines will make tinnitus louder can avoid much of the noise by selecting a seat in front of the wing. Soft ear-plugs can also help. People with ear-worn masking devices should wear them during flight.
Hearing-aids should also continue to be used in planes. It is sometimes said that tinnitus increases on an air voyage, but this can have an innocent explanation. A blocking of the Eustachian tube can cause an apparent enhancement of the permanent noises, but this disappears as soon as the tube is cleared. In very rare cases the change of pressure is thought to affect the inner ear, but any adverse change to the tinnitus is also temporary.
What happens to the middle ear can be alarming and is largely unavoidable. Perhaps the worst sensation involves the ear drum. The middle ear contains the vital tiny bones which conduct all sound to the inner ear. It is normally filled with air at the same pressure as the surrounding air. At the start of a flight the pressure in the plane slowly reduces, but the higher pressure in the ear simply blows the internal air down the Eustachian tube, which runs to the back of the nose. As the plane descends to land, however, the factors are reversed. The air in the middle ear is lower than that in the plane.
As a result, the Eustachian tube can become obstructed and the small throat muscles which usually open it may not be up to the task. The ear drum is pressed inwards and there is a discomforting sensation. But the condition nearly always corrects itself as the tube clears. The ear drum is much stronger than generally imagined and can easily withstand fairly small changes in pressure, however alarming they can be.
To help air passengers avoid difficulties with the Eustachian tube, the BTA has suggested four rules to follow:
1. Make sure you are awake before the aircraft begins its descent (the initial descent from cruising altitudes may be an hour or so before landing). The Eustachian tube does not open effectively during sleep.
2. Keep swallowing, using a glass of water (or your favourite beverage!) at regular intervals; if necessary every 15 to 30 seconds. If this does not clear the ear, pinch the nose between finger and thumb and gently blow air down it with the mouth closed, but without releasing any air.
3. Avoid flying with a cold. With any infection around the nose and throat, the lining of the Eustachian tube is swollen and blocks more easily. If you are forced to travel with a cold, use nasal decongestant drops or spray on the advice of your doctor. Use the decongestant before and during the flight.
4. If you are worried about your Eustachian function and whether it is normal, it is very easy to check on this by a simple test called impedence audiometry. These tests are available at audiology departments, and quickly measure whether your Eustachian tube is normal, and your middle ear pressure is the same as the surrounding atmosphere.
Whatever practical advice is given and taken, there remains a real psychological problem for people strongly fearful that flying brings a tinnitus risk. They wonder – and worry – if the risk outweighs the convenience and speed of air travel.
And if they suffer from depression or anxiety because of their tinnitus, the problem magnifies itself and the worry grows. What is probably intended to be an enjoyable experience, such as a start to a holiday, takes on a nightmarish quality. Some take the firm decision never to fly, and are delighted to find that more leisurely modes of travel bring their own therapeutic compensations. To find out more, you can check out Tinnitus Flying.
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