Facial nerve baroparesis is a rare phenomenon which has been reported during flight. It is thought to occur due to ischaemic neuropraxia on the facial nerve as middle-ear pressure increases in the presence of Eustachian tube dysfunction and force is transmitted through a dehiscent facial nerve canal.

This study presents an aviation-associated, right-sided facial nerve palsy as well as presenting the results of a systematic review that was performed on the available literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. This study systematically reviews the literature to discuss presentation, investigations performed and an approach to management of this rare condition.

This study identified 23 cases in the literature (including the case presented in this study) of facial nerve baroparesis.

Facial nerve baroparesis is a mostly temporary rare phenomenon that can be managed effectively with ventilation tube insertion. In the event of long-standing facial nerve palsy after descent of the aircraft, urgent myringotomy should be performed to prevent permanent facial nerve damage.

Barotrauma to the middle-ear cavity and paranasal sinuses is a relatively common flight-related health problem. Occasionally, it may result in severe mechanical or infectious intracranial complications; these have been rarely reported to date.

Four cases of acute bacterial meningitis following air travel are presented, and its pathogenesis is briefly described.

Neurological symptoms occurring after air flight should prompt proper investigation. Otitis media and sinusitis are common primary focuses of bacterial meningitis. Severe complications of air flight barotrauma may be underreported.

Topical nasal decongestants are frequently used as part of the medical management of symptoms related to Eustachian tube dysfunction.

This study aimed to assess the effect of topical xylometazoline hydrochloride sprayed in the anterior part of the nose on Eustachian tube active and passive opening in healthy ears.

Active and passive Eustachian tube function was assessed in healthy subjects before and after intranasal administration of xylometazoline spray, using tympanometry, video otoscopy, sonotubometry, tubo-tympano-aerodynamic-graphy and tubomanometry.

Resting middle-ear pressures were not significantly different following decongestant application. Eustachian tube opening rate was not significantly different following the intervention, as measured by all function tests used. Sonotubometry data showed a significant increase in the duration of Eustachian tube opening following decongestant application.

There remains little or no evidence that topical nasal decongestants improve Eustachian tube function. Sonotubometry findings do suggest that further investigation with an obstructive Eustachian tube dysfunction patient cohort is warranted.

This study aimed to assess the potential role of pneumatisation of the mastoid and its communicating air cells in the development of middle-ear barotrauma in aircrew members.

Seventy-nine aircrew members (158 ears) underwent temporal computed tomography. All were assessed before flying by clinical examination and audiology evaluation, followed by post-flight examination to detect barotrauma.

Aircrew members’ ears were divided into 3 groups based on barotrauma and temporal bone pneumatisation: 33 ears with barotrauma and temporal bone pneumatisation of 71 cm3 or greater (group A); 12 ears with barotrauma and temporal bone pneumatisation of 11.2 cm3 or lower (group B); and 113 ears with no barotrauma (group C). Mean pneumatisation volumes were 91.05 cm3, 5.45 cm3 and 28.01 cm3 in groups A, B and C, respectively. A direct relationship was observed between volume of temporal bone pneumatisation of 71 cm3 or greater and barotrauma grade.

Pneumatisation volume of the mastoid and its communicating air cells that ranges from 11.3 cm3 to 70.4 cm3 serves as a reliable predictor of the avoidance of middle-ear barotrauma associated with flying in aircrew members who have normal resting middle-ear pressure and good Eustachian tube function.

The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma.

On the outward flight, half the participants wore ‘active’ devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device.

There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch.

Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.

To assess an alternative to bed rest and surgery for suspected perilymphatic fistulas using intratympanic blood injections.

A review was conducted of patients’ history, physical and audiometric data, before and after treatment by intratympanic blood injections performed from 2009 to 2015.

Twelve ears were identified, with trauma associated with air travel, water sports or nose blowing. Ten of these cases had hearing loss, six had vestibular symptoms. Four cases had audiological and vestibular symptoms, two had vestibular symptoms only, and six had audiological symptoms only. Time-to-treat varied from 1 day to 30 days. Magnetic resonance imaging scans were obtained for five cases. Ten cases received steroids. Six out of seven cases showed improvement of hearing loss. Five cases showed positive fistula test results, four with documented resolution. Seven cases had full resolution of all symptoms, four had near-full resolution and one had no improvement.

Intratympanic blood injections offer an effective alternative to conservative or surgical therapy. Advantages include sooner time-to-treat, lower financial costs and decreased psychosocial burdens. It allows a more flexible and liberal use of a potential definite treatment for perilymphatic fistula.

To explore the role of the nine-step inflation/deflation tympanometric test and resting middle-ear pressure range as predictors of barotrauma in aircrew members.

A prospective, non-randomised study was conducted on 100 aircrew members. Resting middle-ear pressure was measured and the nine-step inflation/deflation test performed on all subjects before flights. Subjects were allocated to two groups according to resting middle-ear pressure range (group A, within the range of +26 to +100 and −26 to −100 mmH2O; group B, −25 to +25 mmH2O). All aircrew members were assessed after flights regarding the presence and the grade of barotrauma.

In both groups, the sensitivity and specificity values of the entire post-inflation/deflation test were close to those of the post-deflation part of the test. The post-deflation test had a higher negative predictive value than the post-inflation test. Ears with resting middle-ear pressure lower than −55 mmH2O experienced barotrauma, regardless of good or poor post-inflation or post-deflation test results.

In an aircrew member, a resting middle-ear pressure within the range of −55 and +50 mmH2O, together with good post-deflation test results, are considered reliable predictors for fitness to fly.

Otic barotrauma is common among air travellers and can cause severe otalgia, perforation of the tympanic membrane and hearing loss. Many prevention measures exist, with varying evidence to support their use. There are no data to establish if air travellers are aware of them or indeed use them. We aimed to establish air travellers' knowledge of such prevention measures.

We surveyed air travellers at two UK airports by means of a questionnaire. Answers to the questionnaire were collected over a two-week period.

Overall, 179 air travellers with a mean age of 28 years (range: 15–72 years) completed the questionnaire. There were 66 female and 113 male air travellers. The majority (84 per cent) complained of symptoms while flying and 30 per cent were not aware of any prevention measures. Barotrauma-related symptoms were reported in 25 per cent of air travellers who were unaware of any prevention measures. Nearly all air travellers (86 per cent) indicated that more information regarding prevention measures would be useful.

Air travellers are often not aware of prevention measures to avoid otic barotrauma, and the majority suffer as a result. Increasing public awareness of simple prevention measures would have a significant impact on air travellers.

We report three cases of recurrent, unilateral facial palsy associated with air travel.

The three cases are presented, along with a brief literature review concerning barotrauma and its association with air travel and facial palsy.

All three patients experienced unilateral facial paralysis during air travel, accompanied by additional symptoms which varied between cases. Symptoms resolved spontaneously in all cases. Two patients received ventilation tube insertion to prevent further recurrence. Computed tomography scanning revealed no bony defect in two patients, while the third exhibited dehiscence of the facial canal which may have contributed to the condition.

Available evidence suggests that eustachian tube dysfunction can contribute to increased pressure within the middle ear, leading to neuropraxia of the facial nerve. Cases of facial paralysis associated with air travel are under-reported. Since there is no evidence-based management protocol for this condition, further investigation of its pathology is encouraged in order to improve our understanding.

People suffer unique health problems in high altitude areas, due to such factors as elevation, aircraft ascent and descent, extreme cold, hypoxia, hypobaria, and low relative humidity. This study was conducted to evaluate ENT morbidity at high altitude.

Serving soldiers introduced to a high altitude environment who presented with various ENT symptoms were examined to identify ENT disease. In addition, patients undergoing hyperbaric chamber therapy, tracheostomy and treatment of cold injuries were also examined for ENT problems.

The following were detected: 13 cases of otic barotrauma, 11 cases of sinus barotrauma, three cases of vertigo, six cases of pinna frostbite, three cases of barotrauma caused by hyperbaric chamber therapy, an unusually high incidence of epistaxis, and innumerable patients with high altitude pharyngitis.

Diseases of the ear, nose and throat contribute significantly to high altitude morbidity. In a military context, health education of troops is necessary to avoid such problems.

To evaluate potential pre-dive parameters in relation to paranasal sinus barotrauma in sports self-contained underwater breathing apparatus divers.

The pre-dive and follow-up records of 46 healthy sports self-contained underwater breathing apparatus divers were analysed.

In the routine pre-dive examination of diving candidates with no symptoms of rhino-sinus disease, rhinoscopy, sinus radiography and nasal endoscopy indicated no signs of rhinitis and/or sinusitis. Any signs of paranasal sinus barotrauma were noted, and several parameters were evaluated in relation to occurrence of barotrauma.

Of the studied parameters, a history of sinusitis and of middle-ear barotrauma was significantly more frequent in divers in the barotrauma group (p < 0.05).

In divers undergoing a routine pre-dive examination, paranasal sinus barotrauma was not related to sex, alcohol consumption, smoking, decongestant use, mild nasal septal deviation, or inability to perform the Valsalva or Toynbee manoeuvres. However, divers with a history of sinusitis or middle-ear barotrauma may be more prone to paranasal sinus barotrauma. A more detailed pre-dive examination may be useful for such individuals.