CFI Instrument Practical Test Standards, FAA-S-8081-9B, June 2001

II. Technical Subject Areas

B. Aeromedical Factors

3. Middle ear and sinus problems
a. Ear block
1) During ascent, expanding air in middle ear normally opens eustachian tube, escapes through it to the nasal passages, equalizing middle ear and cabin pressures
2) During descent, pilot must periodically open eustachian tube to equalize pressures by
a) Swallowing
b) Yawning
c) Tensing muscles in the throat
d) Valsalva maneuver (attempt to blow through closed nostrils)
3) Upper respiratory infection (URI) ("cold" or sore throat) or nasal allergic condition can produce enough congestion around eustachian tube, so that difference in pressure between middle ear and cabin may build to level that holds eustachian tube closed, making equalization of pressure difficult or impossible, a condition commonly referred to as "ear block"
4) Symptoms/signs of ear block
a) Severe ear pain
b) Loss of hearing
c) May last hours to several days
d) Rupture of ear drum can occur in flight or after landing
e) Fluid can accummulate in middle ear and become infected (otitis media)
5) Prevention of ear block
a) Don't fly with a URI or nasal allergic condition
b) Decongestant sprays/drops usually do not provide adequate protection
c) Beware: oral decongestants may have side effects that impair pilot performance
6) Consult physician if ear block does not clear shortly after landing
b. Sinus block
1) During ascent and descent, air pressure in sinuses normally equalizes with cabin pressure through opening into the nasal passages
2) URI, nasal allergic condition or sinusitis can cause enough congestion around these openings so that the pressure difference between the sinuses and the cabin increases until the openings are plugged, a condition referred to as "sinus block" which occurs most frequently during descent
3) Usually produces excruciating pain over the sinuses (frontal and/or maxillary), pain in the upper teeth (maxillary), and, sometimes, bloody nasal discharge
4) Prevention
a) Don't fly with a URI, nasal allergic condition or sinusitis
b) Decongestant sprays/drops usually do not provide adequate protection
c) Beware: oral decongestants may have side effects that impair pilot performance
5) Consult physician if sinus block does not clear shortly after landing

Instrument Flying Handbook, FAA-H-8083-15, 1999
AIM 8-1-2

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