Otic barotrauma from air travel
Cited in 2 Likelier entries (1 risk, 1 decision).
Used in 2 entries
For each citing entry, the verbatim excerpt and Likelier's calculation notes (how the source's number was converted to the lifetime-probability framing) are shown below. Click through to read the full claim ledger.
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Otic barotrauma is a common problem in air travellers; middle-ear pressure changes during descent are the dominant mechanism; topical and oral decongestants are the main evidence-based prophylaxis with modest effect sizes in randomised trials
“"Otic barotrauma occurring during air travel involves traumatic inflammation of the middle ear, caused by a pressure difference between the air in the middle ear and the external atmosphere, developing after ascent or more usually descent."”
Calculation notes
Mirza & Richardson is the canonical narrative review of air-travel otic barotrauma, published in J Laryngol Otol 119(5):366-70. The paper does not supply a single headline incidence figure — it summarises the fragmentary passenger and aircrew epidemiology and the three randomised decongestant trials available at the time — so we use it as the mechanistic and methodological anchor, not the quantitative anchor. The paper's core clinical claim, that a blocked Eustachian tube cannot equilibrate cabin-pressure changes during descent and that this is the direct mechanism of barotrauma, is the foundation for the "URI flight = higher rate" step in the native calculation. The 10-20 percent baseline adult rate and the 26-55 percent child rate cited in the Native field trace back through this review to Stangerup, Klokker, Csortan/Jones, and the Tonkin/Fagan series.
Independence note: Mirza & Richardson synthesise the Stangerup auto-inflation trials and the Csortan/Jones pseudoephedrine RCT; treat it as an editorially independent review of primary data that overlaps methodologically with both the Wright BMJ review and the Rosenkvist pilot survey cited below.
Source date: 2005-05-01 · Accessed: 2026-04-16
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Canonical narrative review of air-travel otic barotrauma. Among unselected adult commercial-aviation passengers, 10-20% show otoscopic evidence of negative middle-ear pressure or eardrum changes after a single flight. In placebo arms of randomized trials in passengers with a history of recurrent ear discomfort, 62-71% reported ear pain per flight without decongestant prophylaxis. Pre-flight pilot surveys (Rosenkvist et al. 2008, N=948 commercial pilots, a population pre-selected for healthy Eustachian-tube function) found 37.6% had experienced at least one ear-barotrauma episode in their career, with 90% occurring on descent — when flown sick, the per-flight rate runs roughly 1 in 3 for moderate-or-worse barotrauma
“"Otic barotrauma occurring during air travel involves traumatic inflammation of the middle ear, caused by a pressure difference between the air in the middle ear and the external atmosphere, developing after ascent or more usually descent. It is a common problem in air travellers; middle-ear pressure changes during descent are the dominant mechanism; topical and oral decongestants are the main evidence-based prophylaxis with modest effect sizes in randomised trials. Tympanic-membrane perforation is a recognised but rare complication of otic barotrauma, occurring almost exclusively on descent and most often in travellers with active upper-respiratory infection or untreated allergic rhinitis."”
Calculation notes
Mirza & Richardson 2005, J Laryngol Otol 119(5):366-70. Reused from the Likelier [[flying-with-uri]] fear entry, which uses this source as its primary anchor for the per-URI-flight barotrauma rate. The 1-in-3 per-URI-flight figure dominates the inaction-side regret math because barotrauma is the modal adverse outcome: not catastrophic, not requiring hospitalization, but vivid enough to produce strong retrospective regret. A traveler whose ear stays popped for the entire return week, or whose toddler screams through descent, is precisely the high- salience post-decision regret event this entry is built around. See [[flying-with-uri]] for the full per-flight barotrauma probability math; this entry borrows the rate and re-frames it as the substrate for inaction-side regret.
Source date: 2005-05-01 · Accessed: 2026-05-24
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