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American Journal of  Medical 
Science and Innovation (AJMSI) 

Assessment of  Knowledge Regarding Airplane Ear Preventive Measures among Air 
Travelers of  Najran University’s Staff

Ahmad Zaker M Almagribi1*

Volume 3 Issue 1, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i1.2419
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: January 25, 2024
Accepted: February 22, 2024
Published: February 26, 2024

Passengers before air travel should be frequently advised on the possible preventive 
measures to reduce any sort of  ear discomfort. A cross-sectional survey-based approach was 
adopted to assess the prevalence of  OBT, source of  information on preventive measures 
for OBT, and respondents’ level of  knowledge of  preventive measures for aeroplane ear 
discomfort. 206 respondents i.e., air travellers of  Najran University’s staff  were sampled 
using a purposive sampling technique. Results highlighted that the prevalent symptoms 
of  ear discomfort during air travel, which are most commonly observed such as ear pain, 
popping noises, reduced hearing, dizziness, and ringing noises in the ear. Also, findings 
explored that OBT is the severe health issue caused during air travel however mild concerns 
include pain or loss of  hearing, vertigo and ear discharge. Most respondents were aware of  
‘Chewing gum or sweets’ and ‘Yawning or swallowing’ as prevention measures, and ‘Blowing 
against a pinched nose (Valsalva maneuver)’ as preventive measures for ear discomfirt during 
air travel. ‘Internet’ (11.2%), ‘Posters/Leaflets in aeroplanes’ (7.8%), ‘Posters/Leaflets in 
airports’ (6.8%), and ‘Social Media’ are the most common sources of  information for 
preventive measures to reduce prevalence of  OBT. Adopting passive methods like yawning, 
moving the jaw, swallowing, etc. are quick techniques to deal with ear discomfort.

Keywords
Otic Barotrauma (OBT), 
Airplane Ear Preventive 
Measures, Public Knowledge, 
Eustachian Tube Function, 
Middle-Ear Barotrauma

1 Department of  Surgery, College of  Medicine, Najran University, Kingdom of  Saudi Arabia
* Corresponding author’s e-mail: dr.ahmad.zaker@hotmail.com

INTRODUCTION
A number of  individuals fly both private and commercial 
flights on a regular basis, as the airlines are reportedly 
serving more than 100,000 passengers every day. These 
individuals are exposed to otic barotrauma (OBT) 
and seek help from an otolaryngologist. A practising 
otolaryngologist possesses knowledge of  barometric 
changes essential for identifying ear infections (Mitchell-
Innes et al., 2014; Wu & Kozin, 2024). OBT is a traumatic 
injury of  the tympanic membrane and the middle ear 
resulting from an existing high-pressure differential 
between the external environment and the middle ear. 
This pressure is commonly experienced when slight 
changes in pressure are faced during air travel due to 
different elevations. The mild symptom is slight aural 
discomfort due to the increased adoption of  air travel, 
with number of  passengers increasing from 310 million 
to 3.7 billion every year for the last 50 years, with 1 million 
flying each moment (Naouri et al., 2016). 
Eustachian tube dysfunction is estimated to be around 
30% in children and 10% in adults. It is experienced 
when cabin air pressure is at cruising altitude at sea level 
being lower than air pressure. This cabin air pressure 
at typical cruising altitudes (11 000–12 200 m) is equal 
to atmospheric air pressure (1800-2400 m) (Naouri et 
al., 2016; WHO, 2007). OBT is also referred to as the 
pathological change which results from poor eustachian 
tube function due to factors like increased likelihood 
of  middle-ear barotrauma and degree of  mastoid 
pneumatisation (Mitchell-Innes et al., 2014). Other 
symptoms include pain or loss of  hearing (Naouri et al., 
2016), vertigo and discharge in severe cases (Michael et al., 

2021), long-term morbidity such as tympanic membrane 
perforation in rare cases (Ryan et al., 2018), sensorineural 
and conductive hearing loss 5 and perilymph fistula 
(Bhattacharya et al., 2019).
Nevertheless, it is fortunate that a number of  aeroplane 
ear preventive measures exist, such as swallowing 
and yawning for performing the Valsalva maneuver. 
However, it is evident with limited benefits in reducing 
ear discomfort linked with OBT in adults due to a lower 
level of  awareness among the public. Past studies have 
highlighted the symptoms, causes and preventions 
of  OBT, but limited research is available on public 
awareness for OBT causes and prevention in Saudi 
Arabia. Therefore, the current research was conducted to 
analyse the public perceptions of  the knowledge of  OBT, 
identifying symptoms’ frequency and awareness levels 
for prevention measures among academic staff  who are 
frequent air travellers of  Najran University, Saudi Arabia. 
A cross-sectional survey-based approach was adopted to 
cater for the following objectives:

1. To assess the respondents’ level of  knowledge of  
preventive measures for aeroplane ear discomfort.

2. To investigate respondents’ source of  information 
on preventive measures for OBT.

3. To estimate the prevalence of  OBT among the 
public in Saudi Arabia.

LITERATURE REVIEW
In a survey-based study, distributing an online 
questionnaire among commercial aircrew of  three 
airlines in Finland, the researchers examined the most 
common symptoms of  middle ear (ME) barotraumas, 



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which may affect flight safety. Among 1789 respondents, 
1516 reported experiencing ME barotraumas during 
flight, among which 5% had to undergo a surgical 
procedure due to an increasing number of  upper 
respiratory tract infections. A common factor reported 
is poor performance subjected to Toynbee and Valsalva 
maneuvers (Lindfors et al., 2021). 
It is reported that OBT is one of  the most reported 
medical complications of  aviation caused by to middle 
ear’s traumatic inflammation. The cross-sectional 
research was conducted to examine the quick response of  
travellers at the departure or arrival airport departments 
to identify their knowledge of  the positive signs or 
symptoms of  OBT. The suggestive preventive measures 
include chewing gum, the Valsalva maneuver, frequent 
swallowing and yawning to relieve ear tension (Almufarrej 
et al., 2023).
The vaccine-preventable emergencies and tropical 
infectious diseases are the mainstay of  pre-travel 
consultations. However, accidents and injuries, which are 
known as non-communicable diseases, also occur during 
travel, and therefore public should be aware of  these as 
well. Results showed that 1 in 100,000 travellers die due 
to trauma (40%) and other diseases (60%), among which 
<3% are also associated with infectious diseases. These 
infections can be prevented with awareness of  effective 
measures (Potin et al., 2023). 
A serious threat to flight safety is health incapacitation 
therefore a study a study was carried out examining the 
upper respiratory infection (URI) and ear-nose-throat 
(ENT) barotrauma among commercial pilots. Results 
were collected within one year from 463 pilots. These 
results reported that URI symptoms increased to 50.1% 
and ENT barotraumas to 55.5%. Consequently, pilots 
taking decongestant medicine increased to 59.5% (Boel 
& Klokker, 2017).
Another study highlighted that a common infection 
observed among air travellers is barotitis media (BM), 
which is the key cause of  severe discomfort and sometimes 
permanent balance and hearing deficits. A questionnaire-
based survey was provided to 97 respondents identifying 
their travel history, advice-seeking behaviours before 
travelling and BM knowledge for effective air travel 
experience. Results showed that persistent ear pain and 
duration of  the last flight are significantly associated with 
knowledge of  participants of  BM (Michael et al., 2021).
In a systematic review, it is discussed that among flight 
attendants and physical health risk factors, the most 
prevalent physical risk factors include abnormal air 
pressure and ionising radiation. The most prevalent 
outcomes due to abnormal air pressure include 
barotrauma and cerebral blood flow. The change is 
characterised by low oxygen concentrations accompanied 
by an increase in altitude and a decrease in atmospheric 
pressure (Russo et al., 2023).

METHODOLOGY
Study Design
This study is a cross-sectional online survey-based research 
conducted between March 2023 to May 2023 among 
academic staff  of  Najran University to explore their 
knowledge on awareness and symptoms of  OBT during 
air travel. A quantitative research design was adopted 
in the current study since knowledge patterns among 
targeted respondents were observed from numerical data. 
Quantitative research is essential for seeking data from 
a broader population, providing findings with higher 
generalisability and objective answers (Taherdoost, 2022). 
Therefore, to draw a statistical pattern on the awareness 
of  respondents regarding OBT and the symptoms 
identified most commonly during air travel, a quantitative 
research design was used.

Sample Size and Population
The targeted population of  the research included air 
travellers to observe their OBT awareness and symptoms. 
For this purpose, the academic staff  of  Najran University 
who have travelled at least once by air were considered 
eligible for the research. Purposive sampling is a sampling 
technique used to target the respondents who are 
selected “on purpose” to provide specific outcomes in 
the research (Mweshi & Sakyi, 2020).Therefore, a total of  
206 respondents who agreed to participate in the research 
were sampled using a purposive sampling technique to 
assess the knowledge regarding aeroplane ear preventive 
measures among air travellers of  Najran University’s staff.

Data Collection and Analysis
In this research, data was collected through a primary 
source such that close-ended surveys were conducted to 
get the first-hand opinion of  respondents on knowledge 
of  aeroplane ear preventive measures. Google form-
based questionnaires containing 10 questions with 
multiple choices to investigate research objectives 
were distributed among the sampled respondents with 
messages containing informed consent to participate or 
not and details about research aims and data security. 
SPSS 26.0 was used for data analysis, applying frequency 
analysis to the gathered data and highlighting the most 
frequent symptoms and preventions during air travel 
among the public in Saudi Arabia.

RESULTS
Demographics
The respondents were asked a few questions relevant to 
their gender and age demographics and their job designation 
in their organisation to limit any biases in results. 
Table 1 depicts the gender demographics of  the 
respondents. It shows that the majority of  respondents, 
i.e., 54.9%, were male, whereas 45.1% were female out 
of  the 206 academic staff  who participated in the study.



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Table 2 below shows the age demographics of  the 
respondents. It can be viewed in the table that the majority 
of  the respondents, i.e., 30.1% (62), each belonged to 
the age group of  36-40 years and greater than 40 years. 
Besides, 19.9% (41) lied in the age group 31-35, 17.0% 
(35) were aged between 26 and 30 years; however, only 
2.9% (6) respondents were aged between 20 and 25 years.

The research respondents were also asked about their 
job roles at the Najran University. As shown in Table 3, 
26.2% (54) respondents were assistant professors, 10.7% 
(22) respondents were associate professors, and 11.2% 
(23) respondents were in Masters at the time of  data 
collection. However, 51.5% (106) of  respondents marked 
‘other’ when asked about their job role.

Table 1: Gender Demographics
Frequency Percent Valid Percent Cumulative Percent

Female 93 45.1 45.1 45.1
Male 113 54.9 54.9 100.0
Total 206 100.0 100.0

Table 2: Age Demographics
Frequency Percent Valid Percent Cumulative Percent

>40 62 30.1 30.1 30.1
20-25 6 2.9 2.9 33.0
26-30 35 17.0 17.0 50.0
31-35 41 19.9 19.9 69.9
36-40 62 30.1 30.1 100.0
Total 206 100.0 100.0

Table 3: Respondents’ Job Roles
Frequency Percent Valid Percent Cumulative Percent

Assistant professor 54 26.2 26.2 26.2
Associate professor 22 10.7 10.7 36.9
Master 23 11.2 11.2 48.1
Other 106 51.5 51.5 99.5
Professor 1 .5 .5 100.0
Total 206 100.0 100.0

Objective 1: To Assess the Respondents’ Level of  
Knowledge of  Preventive Measures for Aeroplane 
Ear Discomfort
A few questions were asked relevant to research objective 
1, investigating the respondents’ level of  knowledge on 
preventive measures for aeroplane ear discomfort.

How Often Do You Fly?
It was essential to ask respondents about how often they 

fly to make sure results reflect their true flight experiences 
in terms of  symptoms observed and prevention taken for 
OBT.
Table 4 shows that the majority of  the respondents, 
i.e., 51.9% (107), mentioned that they at least fly once a 
year, 23.8% (49) mentioned they travel up to 3 times per 
year, 14.6% (30) up to 6 times per year, and 8.3% (17) 
stated they travel up to 12 times per year. However, only 
3 respondents claimed they have never air travelled yet.

Table 4: Respondents’ Frequency of  Air Travel
Frequency Percent Valid Percent Cumulative Percent

I have never flown yet 3 1.5 1.5 1.5
Up to 12 times per year 17 8.3 8.3 9.7
Up to 3 times per year 49 23.8 23.8 33.5
Up to 6 times an year 30 14.6 14.6 48.1
At least once a year 107 51.9 51.9 100.0
Total 206 100.0 100.0



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Which Prevention Mention Measure are You Aware 
of, Mark All that Apply?
The research respondents were asked to mark all that 
apply in terms of  the prevention measures they have 
known or used during air travel for OBT. As shown in 
Table 5, it was observed that 23.8% (49) respondents 
marked ‘none of  the above’, reflecting that they have 
not heard of  any prevention before. However, 23.8% 
(49) respondents mentioned that they are aware of  
‘Chewing gum or sweets’, reflecting that it is the most 
common measure the general public is aware of  for 
treating OBT during air travel. Furthermore, 15.5% 
(32) were aware of  both ‘Chewing gum or sweets’ and 

‘Yawning or swallowing’ as prevention measures, 12.1% 
(25) respondents have heard of  ‘Chewing gum or sweets’, 
‘Yawning or swallowing’, and ‘Blowing against a pinched 
nose (Valsalva maneuver)’ depicting these 3 as the most 
common known preventions.
However, the results also showed that the least heard 
prevention measures by the respondents include ‘Otrivin’ 
and ‘Decongestant, i.e. lorinase’ reported along with any 
other reported prevention as well including ‘Chewing 
gum or sweets’, ‘Yawning or swallowing’, ‘Otrivin’, 
‘Decongestant, i.e. lorinase’, ‘Blowing against a pinched 
nose (Valsalva maneuver)’.

Table 5: Prevention Measures Respondents Have Heard
Frequency Percent Valid Percent Cumulative Percent

Blowing against a pinched nose (Valsalva maneuver) 9 4.4 4.4 4.4
Chewing gum or sweets 49 23.8 23.8 28.2
Chewing gum or sweets, Blowing against a pinched 
nose (Valsalva maneuver)

11 5.3 5.3 33.5

Chewing gum or sweets, Otrivin 2 1.0 1.0 34.5
Chewing gum or sweets, Yawning or swallowing 32 15.5 15.5 50.0
Chewing gum or sweets, Yawning or swallowing, 
Blowing against a pinched nose (Valsalva maneuver)

25 12.1 12.1 62.1

Chewing gum or sweets, Yawning or swallowing, 
Decongestant i.e. lorinase, Blowing against a 
pinched nose (Valsalva maneuver)

1 .5 .5 62.6

Chewing gum or sweets, Yawning or swallowing, 
Otrivin

2 1.0 1.0 63.6

Chewing gum or sweets, Yawning or swallowing, 
Otrivin, Blowing against a pinched nose (Valsalva 
maneuver)

1 .5 .5 64.1

Chewing gum or sweets, Yawning or swallowing, 
Otrivin, Decongestant i.e. lorinase, Blowing 
against a pinched nose (Valsalva maneuver)

4 1.9 1.9 66.0

None  of  the above 49 23.8 23.8 89.8
Otrivin 3 1.5 1.5 91.3
Otrivin, Blowing against a pinched nose (Valsalva 
maneuver)

1 .5 .5 91.7

Yawning or swallowing 13 6.3 6.3 98.1
Yawning or swallowing, Blowing against a pinched 
nose (Valsalva maneuver)

4 1.9 1.9 100.0

Total 206 100.0 100.0

Would You Consider Using these Measures Now?
Table 6 depicts that the majority of  the respondents, i.e., 
32.0% (66), said ‘Maybe’ when asked whether they use 

these measures or not, 30.1% (60) marked ‘Definitely 
Yes’, 24.8% (51) marked ‘Probably Yes’, 8.3% (17) stated 
‘Probably No’ and only 4.9% (10) marked ‘Definitely No’.

Table 6: Measures Considered by Respondents
Frequency Percent Valid Percent Cumulative Percent

Definitely No 10 4.9 4.9 4.9
Definitely Yes 62 30.1 30.1 35.0
Maybe 66 32.0 32.0 67.0



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Objective 2: To Investigate Respondents’ Source of  
Information on Preventive Measures for OBT
The respondents were asked questions relevant to 
sources of  information for them regarding the preventive 
measures for OBT. 

Which of  the Following Sources of  Information are 
You Aware of  for Air Travel? Mark All that Apply
Table 7 depicts that the most common sources of  
information for air travellers include ‘Internet’ (11.2%), 
‘Posters/Leaflets in aeroplanes’ (7.8%), ‘Posters/Leaflets 

Probably No 17 8.3 8.3 75.2
Probably Yes 51 24.8 24.8 100.0
Total 206 100.0 100.0

Table 7: Source of  Information for OBT Prevention Measures
Frequency Percent Valid 

Percent
Cumulative 
Percent

Internet 23 11.2 11.2 11.2
Internet, Social media 15 7.3 7.3 18.4
Internet, Social media, and Other 3 1.5 1.5 19.9
Posters/Leaflets at airports 14 6.8 6.8 26.7
Posters/Leaflets at airports, Internet 3 1.5 1.5 28.2
Posters/Leaflets at airports, Internet, Social media 6 2.9 2.9 31.1
Posters/Leaflets at airports, Posters/Leaflets in aeroplanes 2 1.0 1.0 32.0
Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Internet

3 1.5 1.5 33.5

Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Internet, Social media

1 .5 .5 34.0

Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Posters/Leaflets in GP practices/hospital, Internet, Other

1 .5 .5 34.5

Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Posters/Leaflets in GP practices/hospitals, Internet, Social media

2 1.0 1.0 35.4

Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Posters/Leaflets in GP practices/hospitals, Social media

1 .5 .5 35.9

Posters/Leaflets at airports, Posters/Leaflets in aeroplanes, 
Social media

1 .5 .5 36.4

Posters/Leaflets at airports, Posters/Leaflets in GP practices/
hospitals, Social media

1 .5 .5 36.9

Posters/Leaflets at airports, None of  the above 1 .5 .5 37.4
Posters/Leaflets at airports, Social media 1 .5 .5 37.9
Posters/Leaflets in aeroplanes 16 7.8 7.8 45.6
Posters/Leaflets in aeroplanes, Internet 3 1.5 1.5 47.1
Posters/Leaflets in aeroplanes, Internet, Other 1 .5 .5 47.6
Posters/Leaflets on aeroplanes, Internet, Social media 2 1.0 1.0 48.5
Posters/Leaflets in aeroplanes, Internet, Social media, Other 1 .5 .5 49.0
Posters/Leaflets in aeroplanes, Social media 2 1.0 1.0 50.0
Posters/Leaflets in GP practices/hospital 4 1.9 1.9 51.9
Posters/Leaflets in GP practices/hospitals, Internet 1 .5 .5 52.4
None of  the above 53 25.7 25.7 78.2
Other 32 15.5 15.5 93.7
Other, None of  the above 1 .5 .5 94.2
Social media 12 5.8 5.8 100.0
Total 206 100.0 100.0



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in airports’ (6.8%), and ‘Social Media’ (5.8%). However, 
1.9% also reported ‘Posters/Leaflets in GP practices/
hospitals’ as their source of  information for prevention 
measures during air travel.

Do You Agree Getting More Information will be 
Useful?
Table 8 below presents that upon asking respondents 
whether the providing more information will be useful or 

Table 8: Usefulness of  Provision of  More Information
Frequency Percent Valid Percent Cumulative Percent

No 6 2.9 2.9 2.9
Not sure 27 13.1 13.1 16.0
Yes 173 84.0 84.0 100.0
Total 206 100.0 100.0

not for them regarding OBT prevention. Most of  them 
(84.0%) responded ‘Yes’ to the asked question, 13.1% 
(27) were not sure about it and only 2.9% (6) responded 
‘No’.

Objective 3: To Estimate the Prevalence of  OBT
The prevalence of  OBT was also determined among the 
target respondents by inquiring about the most common 
symptoms of  OBT suffered during air travel.

Mark All those Apply from the Symptoms Following 
You have Faced During Air Travel?
Table 9 below presents the responses of  students 
identified when they were asked about the symptoms 
they have ever observed while flying. It is observed that 

17.0% (35) respondents mentioned ‘Ear pain’ as the most 
common symptom during air travel, 8.7% (18) mentioned 
‘Ear pain’ as the most repeated symptom, and 7.3% (15) 
marked ‘Popping noises’ as a common symptom suffered 
during air travel. However, 3.4% (7) mentioned suffering 
from ‘Ringing noises in the ear’, 2.4% (5) mentioned 
‘Dizziness’, and 0.5% (1) mentioned ‘Ear discharge’ while 
on an aeroplane. Nonetheless, 32.5% (67) of  respondents 
mentioned that they did not suffer from any of  the listed 
symptoms.
A few respondents marked more than one symptom to 
be suffered from during air travel. For example, 3.9% (8) 
respondents mentioned ‘Ear pain, Dizziness’ and ‘Ear 
pain, Popping noises’ together as the symptoms they 
suffered while flying.

Table 9: Most Common Symptoms of  OBT  Suffered During Air Travel
Frequency Percent Valid 

Percent
Cumulative 
Percent

Dizziness 5 2.4 2.4 2.4
Ear discharge 1 .5 .5 2.9
Ear discharge, Dizziness 1 .5 .5 3.4
Ear discharge, Ringing noises in the ear, Dizziness 1 .5 .5 3.9
Ear pain 35 17.0 17.0 20.9
Ear pain, Dizziness 8 3.9 3.9 24.8
Ear pain, Ear discharge 1 .5 .5 25.2
Ear pain, Popping noises 8 3.9 3.9 29.1
Ear pain, Popping noises, Dizziness 1 .5 .5 29.6
Ear pain, Ear discharge, Popping noises 2 1.0 1.0 30.6
Ear pain, Popping noises, Reduced hearing 2 1.0 1.0 31.6
Ear pain, Popping noises, Reduced hearing, Dizziness 2 1.0 1.0 32.5
Ear pain, Popping noises, Reduced hearing, Ringing noises in 
the ear, Dizziness

2 1.0 1.0 33.5

Ear pain, Popping noises, Ringing noises in the ear 1 .5 .5 34.0
Ear pain, Reduced hearing 8 3.9 3.9 37.9
Ear pain, Reduced hearing, Dizziness 2 1.0 1.0 38.8
Ear pain, Ringing noises in the ear 5 2.4 2.4 41.3
None of  the above 67 32.5 32.5 73.8
Popping noises 15 7.3 7.3 81.1
Popping noises, Dizziness 3 1.5 1.5 82.5



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Ear discharge, Popping noises, Dizziness 1 .5 .5 83.0
Ear discharge, Popping noises, Reduced hearing 1 .5 .5 83.5
Popping noises, Reduced hearing, Ringing noises in the ear 1 .5 .5 84.0
Popping noises, Ringing noises in the ear 3 1.5 1.5 85.4
Reduced hearing 18 8.7 8.7 94.2
Reduced hearing, Dizziness 2 1.0 1.0 95.1
Reduced hearing, Ringing noises in the ear 3 1.5 1.5 96.6
Ringing noises in the ear 7 3.4 3.4 100.0
Total 206 100.0 100.0

Have You had Previous Ear Surgery?
Lastly, respondents were also asked to mention if  they 
have had any previous ear surgery due to OBT suffered 
during air travel. Table 10 shows that the majority 
of  them responded ‘No’, i.e., 98.5%; however, 1.5% 

(3) respondents said ‘Yes’, depicting that knowledge 
regarding ear preventive measures is essential since it may 
limit even the small chance of  suffering from OBT such 
that an individual had any recent ear surgery should delay 
air travel.

Table 10: Respondents with Previous Ear Surgery
Frequency Percent Valid Percent Cumulative Percent

No 203 98.5 98.5 98.5
Yes 3 1.5 1.5 100.0
Total 206 100.0 100.0

DISCUSSION
Preventive Measures of  Airplane Ear Discomfort
The current research’s key objective is to identify the 
knowledge of  air travellers on the key interventions which 
could be undertaken while feeling aeroplane discomfort. 
The results of  the current research showed that 
respondents were aware of  a few preventive measures like 
chewing gum or sweets, yawning or swallowing, blowing 
against a pinched nose (Valsalva maneuver), otrivin, and 
decongestant, i.e. lorinase. Notably, in past research, it 
is addressed that rapid free fall causes ambient pressure 
change, equalising the middle ear pressure. It can be 
prevented by the Valsalva maneuver, which is a process 
helpful in severe cases; however, it requires an oxygen 
mask. Therefore, adopting passive methods like yawning, 
moving the jaw, swallowing, etc. are quick techniques to 
deal with ear discomfort (Naouri et al., 2016; Sannigrahi 
et al., 2018).
Similarly, Bhattacharya et al. (2019) highlighted chewing, 
swallowing and yawning as helpful measures which should 
be taken during landing and taking-off  since they activate 
eustachian tubes’ muscles bi-laterally. Nonetheless, it is 
recommended not to sleep during the descent and ascent 
of  flights as it is the period which may create sudden 
pressure change. Earplugs also assist in equalising the 
pressure slowly when ear discomfort is felt against the 
eardrum (Bhattacharya et al., 2019). Valsalva maneuver 
is one such effective prevention which is beneficial for 
crucial ear discomfort conditions such as the prevalence 
of  aerotitis media (Sharma et al., 2020). However, another 
research highlighted that if  yawning, jaw movements, and 
swallowing do not prevent ear discomfort, then the air 
should be forced into the cavities of  the middle ear by 

raising nose and mouth pressure to occlude the nostrils 
(Bagshaw & Illig, 2019).

Sources of  Information on Preventive Measures for 
Ear Discomfort During Air Travel
Health information should be delivered by effective 
means or sources of  measures of  preventive measures 
through websites, leaflets, personal communication and 
advertisements (Mitchell-Innes et al., 2014). Concurrently, 
the recent research findings suggested that air travellers 
should be communicated with basic preventive measures 
as only a few respondents mentioned the sources of  
information, including Posters/Leaflets at airports, 
Posters/Leaflets in aeroplanes, Posters/Leaflets in GP 
practices/hospitals, Internet, and social media. In this 
aspect, Mitchell-Innes et al. (2014) examined that flight 
leaflets are the most effective source for OBT since they 
are provided during the onset of  facing any symptoms of  
ear discomfort during travelling.  Some other sources for 
air travel health advice include the Internet, brochures, 
books, travel agents, and newspapers (Naouri et al., 2016). 
Another study pointed out that for the public, education 
leaflets should be posted on the official website as a 
significant source for informing about ear discomfort. 
However, social media is also a useful resource (Ho et al., 
2017).

Prevalence of  OBT
Ear discomfort during flight or aeroplane air is common 
whether the travellers are flying in business class or 
getting leg space; the problem is often faced. The current 
research highlighted the prevalent symptoms of  ear 
discomfort during air travel, highlighting symptoms 



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which are most commonly observed such as ear pain, 
popping noises, reduced hearing, dizziness, and ringing 
noises in the ear. Similarly, past research highlighted that 
air travel symptoms include fullness, pain, discomfort, and 
moderate to mild loss of  hearing. However, severe hearing 
loss, severe pain, vertigo, tinnitus, and hemotympanum 
are the symptoms affected individuals face in severe cases 
(Bhattacharya et al., 2019). Nevertheless, another painful 
ear disorder experienced during air travel due to external 
pressure’s rapid change is called aerotitis media, which 
leads to pain, vertigo, tinnitus and hearing loss (Sharma 
et al., 2020). Besides, some of  the risk factors for tinnitus 
and hearing loss other exposure to high noise and low 
pressure in aircraft include hypertension, acoustic trauma, 
flying time, smoking and diabetes mellitus causing hearing 
loss (Muyassaroh et al., 2021). Respondents were also 
asked if  they have had any previous ear surgery and few 
of  them responded ‘Yes’. Consequently, Bhattacharya et 
al. (2019) highlighted in their research that individuals 
suffering from sinusitis, recent ear surgery, common cold, 
ear infection or nasal congestion should reschedule travel 
plans or use decongestants an hour or 30 minutes before 
travel to limit the change of  ear discomfort.

CONCLUSION
The pressure changes during air travel is one of  the most 
common challenge which causes barotrauma or OBT. 
Considerably, equilibration is achieved normally by jaw 
movements, swallowing, chewing or yawning. Also, prior 
to the flight the use of  an oral decongestant limits the 
incidence of  OBT which is generally recommended to 
passengers. The research highlighted that it is important to 
increase the awareness on the prevention measures during 
air travel to limit ear discomfort among passengers. The 
common symptoms are often mild but they can get worse 
like trouble hearing, feeling that eat is blocked, dizziness, 
severe ear pain and ear discharge. These can cause severe 
issues and an ear surgery is required therefore taking early 
measures is important to secure the eardrum. Therefore, 
education leaflets should be posted on the official website 
of  airlines as a significant source for informing about ear 
discomfort.

Limitations and Future Implications 
The research sample size was limited to the academic 
staff  of  Najran University however for generalisability 
for broader Saudi population, the future research can 
be enhanced by considering diverse demographics to 
limit any bias. Additionally, the recent study was limited 
to survey-based research however in the future it ca be 
improved using open-ended interviews to support survey 
findings with in-depth perceptions. The current research 
highlights the most common symptoms observed during 
air travel and the commonly known preventive measures 
among public. It will be beneficial for the healthcare sector, 
aeroplane industry and researchers to increase the general 
awareness on measures which prevent OBT and other 
challenges pertinent to ear discomfort during air travel.

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