Ear Pain and Its Treatment in Hypobaric Chamber Training in the Japan Air Self-Defense Force
Nobuhiro Ohrui, Akihiko Takeuchi, Andrew Tong, and Masashi Iwata
Aeromedical Laboratory, Japan Air Self-Defense Force, Tachikawa, Tokyo, Japan
Background: We have documented that ear pain is the most prevalent physiologicincident during hypobaric chamber training in the Japan Air Self-Defense Force. Ear pain may increase also in flight in the future because it is closely related to allergic rhinitis. Therefore, it is very important to know the characteristic of ear pain and the efficacy of its treatment. Methods: The incidence of ear pain was calculated in each training profile from 1990 to 1998. Type III chamber flightrecords were further analyzed for the characteristics of ear pain: relationship with a trainee occupational category, time of occurrence of ear pain, and efficacy of treatment. Results: Of 17,935 exposures, 740 trainees (4.1%) had ear pain. Of 7,047 trainees, 429 (6.1%) complained of ear pain especially in Type III, totaling 625 times. Fighter pilots and cargo pilots complained of ear pain onetwelfth and one third
the number of times, respectively, compared with passengers. Of the 625 episodes, 616 (98.6%) occurred during descent. Three kinds of treatment were administered until the pain was relieved in the following order: Valsalva maneuver, Politzer bag, and decompression. The efficacy rates were 35.8, 92.3, and 83.9%, respectively. Only 5 trainees (0.07%) could not complete trainingdue to ear pain despite treatment. Conclusion: The combination treatment of Valsalva maneuver, Politzer bag, and decompression is very effective for relieving ear pain encountered during hypobaric chamber training. A health specialist needs to understand ear pain and its treatment in hypobaric environment such as aircraft. Key Words: Aircrew trainingVDecompressionVFlightVHypobaric chamberVPhysiologic incidentVPolitzer bagVValsalva maneuver. Otol Neurotol 29:518Y521, 2008.
OBJECTIVE We have documented that ear pain is the most common physiologic incident in hypobaric chamber training in the Japan Air Self-Defense Force (JASDF), accounting for 76% of total physiologic incidents. In addition, the incidence of ear pain has been gradually increasing over time (1). Furthermore, ear painepisodes may increase in the future because its occurrence is causally related to allergic rhinitis, the most common type of allergic disease increasing throughout the world (2). Importantly, ear pain can distract an aircrew member during actual flight, and this situation may lead to aircraft accidents (3). Furthermore, because more people may travel via air and allergic rhinitis may increase in thefuture, similar situations may also occur more often in civil aviation. Therefore, it is very important to investigate the characteristic of ear pain and its treatAddress correspondence to Akihiko Takeuchi, M.D., Ph.D., Miyamotocho Medical Clinic, 2-26-16 Miyamotocho, Tokorozawa, Saitama 359-1143, Japan (the present institution and address); E-mail: email@example.com; Address reprintrequests to Nobuhiro Ohrui, Ph.D., Aeromedical Laboratory, Japan Air Self-Defense Force, 1-2-10 Sakaecho, Tachikawa, Tokyo 190-8585, Japan.
ment in hypobaric chamber training simulating a flying environment. In this study, we examined the characteristic of ear pain in hypobaric chamber training: relationship with a trainee occupational category (3 groups: fighter pilots, cargo pilots, andpassengers), time of occurrence of ear pain, and treatment efficacy. PATIENTS The JASDF has 6 protocols for hypobaric chamber training: Types I, II, and III; High AltitudeYLow Opening (HALO)-A; HALO-B; and rapid decompression (RD) (Fig. 1). The incidence of ear pain was calculated in each training profile from 1990 to 1998. Moreover, Type III training records were further analyzed for the characteristics...