ENT Flashcards
ENT conditions that can interfere with aviation
Barotrauma eg barotitis, barosinusitis Allergic rhinitis Sinusitis Hearing loss Vertigo
Most common ENT disorders in ADF
Nasal obstruction and sinus disorders Snoring and sleep apnoea Tonsillitis, infectious mononucleosis Otitis external Other - barotitis, hearing loss, throat symptoms, middle ear problems, epistaxis
Presentation and symptoms of Barotitis
Presentation: inability to equalise the middle ear with the Atm due to Eustachian tube dysfunction
Cause: URTI, allergy, anatomical defects, tumours
Symptoms and signs
- pain on descent
- aural fullness
- hearing loss
- bloody discharge
- tinnitus and vertigo
Aeromedical concerns of barotitis.
- effect on environment on condition
- effect of condition on environment
The condition
- incapacitation
- distraction
- alternobaric vertigo
- hearing loss/communications
The environment
- Altitiude/pressure profile
- Boyle’s Law
- use of headsets/earplugs
- Valsalva with aviator’s mask
Important things to ask and look for when assessing barotitis
Hx of URTI or allergy - underlaying cause Concurrent barotrauma Likelihood of reverse ear block Otoscopic - Erythema of TM - Punctate haemorrhages - serous exudate - Haemotympanum - perforated TM - look for Grade of barotrauma
Investigations, treatment and referral for barotitis
Audiometry Tympanometry Nasal endoscopy Allergy testing CT scan sinuses - should have specialist involvement at this stage Remember adenoids
Tx
- Tx URTI - decongestants and antibiotics
- politxerisation
- myringotomy
- ventilation tubes eg grommets
Carry decogestants in future
Aeromedical disposition for barotitis
Military
- TMUFF while investigating
- TMUFF if symptomatic and until cause established
- Grommets disqualify for flying while they are in.
- need to be clear to return to flying eg perforation healed
CASA
- based on function. Applicants should be able to ventilate the middle ear.
- Perforations of the tympanic membrane are acceptable
Cause of sinus barotrauma
Usually history of URTI or chronic sinusitis
Inability to equalise sinuses and atmosphere resulting in shearing of sinus mucosa and submucosal haemorrhage caused by negative pressure
How does Sinus barotrauma present
More common than on descent - persistent pain - sometimes tenderness - epistaxis in 15% of people May be acute or chronic Affects the frontal sinuses in 80% of cases Maxillary sinus next most common
Aeromedical concerns for sinus barotrauma
- condition
- environment
The condition
- pain is severe
- incapacitating
The environment
- altitude/pressure profile
- Boyle’s Law
- normally on descent
Treatment and aeromedical disposition for sinus barotrauma
Tx - nsala and oral decngestants, analgesia, steroids, saline sprays, flushing, surgery
Military
TMUFF while determining cause
Return to unrestricted flying if correctable cause is fixed
Ground trails as need
Desensitisation therapy can take up to 3 years
CASA
Acute sinusitis temporarily unfit
if underlying chronic sinusitis must be referred to treated
Investigation for allergic rhinitis
Total IgE
RAST egress mix, dust/mite mix, mould mix
Skin scratch/prick - allergist
CT sinus
Aeromedical disposition for allergic rhinitis
Military
- TMUFF while symptomatic
- good control of symptoms with approval meds compatible with flying
Likely UAMECR
CASA
- Minimal issue for CASA
- Managed by GP or DAME
Aeromedical disposition of sinusitis
Military
- acute sinusitis, TMUFF while symptomatic only
- chronic sinusitis TMUFF, MECR required
CASA
- same as military
Vertigo
Effect of condition on aviation
Effect of aviation on conditions
Condition
- incapacitating
- many possible diagnosis
- impairs balance and movement
- impairs vision
Environment
- Acceleration forces
- head movements
- spatial disorientation
- loss of aircraft control
