Predictors of Ear Barotrauma in Aircrews Exposed to Simulated High Altitude

Introduction: Ear barotrauma is an adverse effect related to hypobaric exposure. Ear, nose, and throat (ENT) diseases are risk factors for barotrauma in aircrews trained in a hypobaric chamber, but excluding affected subjects from exposure does not abolish the risk in asymptomatic trainees. We investigated other possible predictors, including history of ENT diseases, ENT clinical abnormalities, altitude, and subject's age. Methods: After a complete ENT evaluation including otoscopy and tympanometry, 314 aircrews underwent hypobaric chamber training. Two altitude training profiles up to 35,000 ft (10,668 m) and 25,000 ft (7620 m), respectively, were used. Subjects were grouped according to if they were asymptomatic, had acute barotitis, or reported delayed ear pain the day after the exposure. Results: There were 7 men who had acute barotitis (incidence of 2.3%) and 28 men who had delayed ear pain (incidence of 9.2%). A significant association resulted between history of ENT diseases and delayed ear pain and between abnormal ENT findings and acute barotitis in subjects exposed to the higher profile. Altitude was associated with increased risk of delayed ear pain. Delayed ear pain was associated with older age in subjects exposed to the lower altitude and younger age in subjects exposed to the higher altitude. Discussion: Our data suggest that in subjects exposed to 35,000 ft (10,668 m), the history of previous ENT diseases and younger age may be valid predictors of delayed ear pain, while abnormal ENT findings may predict acute barotitis. At 25,000 ft (7620 m), subjects with older age may have increased risk of delayed ear pain.