Head Cold & Ear Trauma to Flight Crew Members

January 10, 2013

Head Cold & Ear Trauma to Flight Crew Members

"Never fly with a head cold." For flight crews in the commercial airline industry, this time-honored warning is difficult to follow and too often ignored. As the pressure to fulfill employment obligations mounts, airline flight personnel often feel the need to push themselves into the air when their stuffed-up head is telling them to stay on the ground. While, arguably, such decisions to go to work and "tough it out" may show an heroic commitment to the good old American work ethic, the ultimate physical consequence of such dedication can be barotrauma and a permanent, career-ending ear injury.

For example, a particular pilot chose to fly repeatedly with a "plugged-up" head. Despite frequent use of decongestant nasal sprays, this individual had been unable to clear the congestion, but flew anyway rather than risk disciplinary action by calling in "sick." Unfortunately, the crew member's condition did not improve. Instead it deteriorated, until this pilot no longer felt safe in the cockpit and was forced to take permanent disability leave.

While some people who perform sedentary work might not be as profoundly affected by such a deficit, damage to a pilot's sense of balance is nothing short of devastating. Although the symptoms of this injury are dramatic, its onset can be insidious and its diagnosis difficult. Indeed, in this case, the pilot involved appeared perfectly normal. Even the specialists who first examined this pilot failed to diagnose any physical defect. "It's all in your head," was their conclusion. Actually, this was correct, albeit accidentally so.

After several months, an ear specialist who was doing advanced work on the human sense of balance, identified the nature of the injury and described how it occurred. The internal pressure inside each human ear is equalized with its external surroundings through a passage which connects the middle ear with the throat, known as the Eustachian tube. If necessary, this passage can be opened by chewing gum, swallowing or yawning. Its function is more dramatically demonstrated by the "valsalva maneuver" in which we hold our nose, close our mouth, and blow air up into our ears.

So long as congestive colds are suffered on the ground, no trauma will harm the inner ear. However, if the air pressure surrounding a congested person is altered dramatically several times daily and for several days at a time, such as in a typical four day airline trip, the tissue which liens the inner ear may become stressed by these atmospheric pressure changes. This occurs because a plugged Eustachian tube won't allow the pressure inside the head to equalize with the changing cabin pressure of the aircraft. In most instances, such residual pressure differences are eventually equalized after several uncomfortable hours. Unfortunately, in a few instances, instead of dissipating, this difference in pressure stresses and cracks the tissue lining of the inner ear.

The medical term for such a crack is "perilymphatic fistula." This injury to the inner ear disrupts the fluid in the inner ear and, in turn, the signals received by the vestibular portion of the inner ear. It is its job to give the brain constant positional information, much like an internal gyroscope. Disrupting this signal effectively confuses and confounds our internal sense of positional orientation; i.e., our sense of balance. While such a loss will not disable a person entirely, it can and does deprive a pilot of his or her most important God-given sensory component: that acute awareness of positional orientation known as the "seat of the pants."

Pilots and flight attendants as an occupational group are uniquely prone to suffer this type of injury because of the number of atmospheric pressure changes they experience on the job daily. Although ear and hearing related injuries have always been considered a hazard of flight, this particular type of injury to the balance mechanism has not been well understood in the past. However, it can now be clinically proven, accurately diagnosed, and, in some cases, corrected surgically due to advancements in the diagnostic tools available.

Unfortunately, despite sophisticated new techniques, the inner ear structures involved are so minute and deeply embedded in the human head that they are difficult to reach and sometimes inaccessible to surgical correction. In these cases, the only treatment for such an injury is time on the ground. Sadly, some of these never heal. However, over time the mind learns to ignore the confused signal received from its inner ear and compensates by depending instead on visual cues. This adaptation helps the injured individual live with his deficit while on the ground, but it renders a flight crew member wholly dependent for their sense of balance on that which he or she can see.

While an experienced pilot can fly an aircraft by relying solely on instruments and, where available, external visual cues, it is doubtful that an experienced pilot would choose to fly an aircraft with such a limitation. Thus, in this fashion, an obscure injury to a tiny portion of the body causes a gigantic problem for the flight crew member who suffers it. Ironically, this type of career ending job injury is the easiest and simplest to avoid of all the pitfalls that confront each member of the flight crew on every trip.

All you need to do is remember that while the rest of the working world may take two aspirin and heroically go to work, you should never fly with a head cold.

Article provided by The Law Offices of William L. Barr, Ltd.
Visit us at http://www.williambarrlaw.com