Flight-induced barotrauma in otorhinolaryngology: A review

Abstract

Barotrauma is defined as tissue damage caused by pressure differences between an unven­tilated space within the body and the surrounding gas or fluid. The most frequent cause of barotrauma is air travel, and a progressive increase in cases over time is expected. The most frequently affected organs are the ear, paranasal sinuses, and facial nerve. The pathophy­siology of flight-induced barotrauma is based on exposure to sudden changes in altitude and pressure associated with upper respiratory tract infections and/or Eustachian tube dysfunction. The most frequent symptoms are otalgia, hypoacusis, tinnitus, dizziness, and peripheral facial palsy. Many forms of barotrauma are self-limiting and preventable throu­gh simple techniques such as swallowing fluids or performing Valsalva maneuvers during ascent or descent phases. The treatment of barotrauma can be either conservative, medical or surgical, according to patient’s characteristics, severity of the condition, and recurrence. This includes the use of oral and topical decongestants, auto-inflation devices, surgical te­chniques, among others. Most of these interventions are based on expert recommendations and algorithms extrapolated from clinical guidelines for the management of other similar pathologies. This review presents key pathophysiologic and clinical findings, treatment op­tions, and preventive measures for flight-induced otorhinolaryngologic barotrauma, based on available evidence.