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The middle ear is a small cavity located in the bone of the skull. It is closed off from the external ear canal by the eardrum. Normally, pressure differences between the middle ear and the outside world are equalized by a tube leading from inside each ear to the back of the throat on each side, called the Eustachian tube. These tubes are usually closed, but open during chewing, yawning, or swallowing to equalize pressure. Even a slight difference between external pressure and middle ear pressure can cause discomfort. [Figure 16-2]
During a climb, middle ear air pressure may exceed the pressure of the air in the external ear canal, causing the eardrum to bulge outward. Pilots become aware of this pressure change when they experience alternate sensations of “fullness” and “clearing.” During descent, the reverse happens. While the pressure of the air in the external ear canal increases, the middle ear cavity, which equalized with the lower pressure at altitude, is at lower pressure than the external ear canal. This results in the higher outside pressure, causing the eardrum to bulge inward.
This condition can be more difficult to relieve due to the fact that the partial vacuum tends to constrict the walls of the Eustachian tube. To remedy this often painful condition, which also causes a temporary reduction in hearing sensitivity, pinch the nostrils shut, close the mouth and lips, and blow slowly and gently in the mouth and nose.
This procedure forces air through the Eustachian tube into the middle ear. It may not be possible to equalize the pressure in the ears if a pilot has a cold, an ear infection, or sore throat. A flight in this condition can be extremely painful, as well as damaging to the eardrums. If experiencing minor congestion, nose drops or nasal sprays may reduce the risk of a painful ear blockage. Before using any medication, check with an AME to ensure that it will not affect the ability to fly.
In a similar way, air pressure in the sinuses equalizes with the pressure in the flight deck through small openings that connect the sinuses to the nasal passages. An upper respiratory infection, such as a cold or sinusitis, or a nasal allergic condition can produce enough congestion around an opening to slow equalization. As the difference in pressure between the sinuses and the flight deck increases, congestion may plug the opening. This “sinus block” occurs most
16-5
Figure 16-3. The semicircular canals lie in three planes and sense motions of roll, pitch, and yaw.
Y
AWROLLYAWPITCHPITCHROLLThe semicircular tubes are arranged at approximately right angles to each other in the roll, pitch, and yaw axes.Vestibular NerveEndolymph FluidAmpulla of Semicircular CanalHair CellsCupolaSemicircular CanalsOtolith Organ
frequently during descent. Slow descent rates can reduce the associated pain. A sinus block can occur in the frontal sinuses, located above each eyebrow, or in the maxillary sinuses, located in each upper cheek. It will usually produce excruciating pain over the sinus area. A maxillary sinus block can also make the upper teeth ache. Bloody mucus may discharge from the nasal passages.
Sinus block can be avoided by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the sinus openings. Oral decongestants have side effects that can impair pilot performance. If a sinus block does not clear shortly after landing, a physician should be consulted.
Spatial Disorientation and IllusionsSpatial disorientation specifically refers to the lack of orientation with regard to the position, attitude, or movement of the airplane in space. The body uses three integrated systems working together to ascertain orientation and movement in space.
• Vestibular system—organs found in the inner ear that sense position by the way we are balanced.
• Somatosensory system—nerves in the skin, muscles, and joints, which, along with hearing, sense position based on gravity, feeling, and sound.
• Visual system—eyes, which sense position based on what is seen.
All this information comes together in the brain and, most of the time, the three streams of information agree, giving a clear idea of where and how the body is moving. Flying can sometimes cause these systems to supply conflicting information to the brain, which can lead to disorientation. During flight in visual meteorological conditions (VMC), the eyes are the major orientation source and usually prevail over false sensations from other sensory systems. When these visual cues are removed, as they are in instrument meteorological conditions (IMC), false sensations can cause a pilot to quickly become disoriented.
The vestibular system in the inner ear allows the pilot to sense movement and determine orientation in the surrounding environment. In both the left and right inner ear, three semicircular canals are positioned at approximate right angles to each other. [Figure 16-3] Each canal is filled with fluid and has a section full of fine hairs. Acceleration of the inner ear in any direction causes the tiny hairs to deflect, which in turn stimulates nerve impulses, sending messages to the brain. The vestibular nerve transmits the impulses from the utricle, saccule, and semicircular canals to the brain to interpret motion.
　
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