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Air Travel and Dizziness 

Timothy C. Hain, MD Last update: June 18, 2009

Airplane Travel

Many people are concerned about airplane travel when they are dizzy. They are worried both that they may become even more dizzy when they fly, as well as that their underlying condition causing dizziness may be affected by flying. In most cases, these fears are unjustified. Flying does two things -- it may induce motion sickness, and it may stimulate the ear through pressure changes.

In small planes, dizziness may come from either or both mechanisms. In larger planes, the main risk from flying to the ear is from pressure fluctuations in the cabins. Large airplanes generally have less of these, and small unpressurized airplanes have the most.

CONDITION FLYING
Perilymph fistula Should avoid if possible as potential for worsening hearing or dizziness.
Mal de Debarquement syndrome Should avoid is possible, and aim for short flights if necessary with stop over in between.
Eustachian tube malfunction Flying may cause ear pain
BPPV (benign paroxysmal positional vertigo) Potential for temporary dizziness, especially if seats are reclining. Not a major risk.
Labyrinthitis or vestibular neuritis OK to fly
Bilateral vestibular loss OK to fly
Acoustic Neuroma OK to fly
Menieres disease Potential for temporary dizziness related to pressure fluctuation
Central vertigo Usually OK to fly.
Perforation in ear drum OK to fly, and in fact perforated ear is likely to have less trouble than normal ear.
"Chronic ear:" -- secretory otititis media, atelectasis, previous cholesteatoma. OK to fly (Sade et al, 2003)
Undiagnosed dizziness Usually OK to fly

 

Management of pressure fluctuations:

If you can reasonably avoid flying, don't when you have a cold or your nose is stuffed up. If you have to fly, try to keep your Eustachian tube open at times when the pressure in the cabin is changing -- usually for 30 min just after going up and for 30 minutes just prior to landing.

We suggest avoiding riding in unpressurized aircraft.

Simple methods of opening the Eustachian tube are swallowing or chewing gum. You may wish to carry a bottle of water with you. We do not reccomend more forceful maneuvers in which air is forced into the middle ear as there is some risk of injuring the ear drum.

Sade et al (2003) recently advanced the hypothesis that ear vulnerability to pressure fluctuation (barotrauma) is correlated with the amount of mastoid pneumatization -- how well aerated the bone is behind the ear. It is too soon to say whether this idea is indeed correct.

Medications:

Decongestants such as decongestant nose drops (available over the counter) may help by opening up the nasal passages. These preparations are not recommended in persons with hypertension however. Antihistamines such as Dramamine (Tm) can also be taken before getting on the airplane may help manage pressure fluctuations by keeping the Eustachian tube open. There are many other antihistamines (such as meclizine) that can also be used in this situation. Use of nasal steroids for several days before flying may help quiet down an allergy.

Ear Plugs:

There is a commercial product branded "Ear Planes", which is an ear plug that slowly lets air into and out of the ear canal. Many people say that they think that this simple device helps. They are sold in most pharmacies, and in convenience stores in the airport.

Tubes:

A ventilation tube being placed in the ear drum.

Pressure fluctuation problems can be avoided by having a tube placed in the ear drum. This is a "last resort" procedure as it requires minor surgery and may make the person more prone to getting infections.

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References:

Sade J, Ar A, Fuchs C. Barotrauma vis-a-vis the "chronic otitis media syndrome": two conditions with middle ear gas deficiency Is secretory otitis media a contraindication to air travel? Ann Otol Rhinol Laryngol 2003 Mar;112(3):230-5

Air Travel and Dizziness
Copyright October 6, 2013 , Timothy C. Hain, M.D. All rights reserved. Last saved on October 6, 2013