How Air Travelers Can Cope With Earaches, Other Ills

After a skiing trip to Reno, Roxanne Yamaguchi was taking a roundabout route home to Manhattan Beach. Having booked her reservation at the last minute, the 32-year-old marketing director for a medical clinic wasn’t able to get a nonstop flight.

Her itinerary would take her from Reno to San Francisco, where she had to change planes, and then on to Los Angeles. Normally, she wouldn’t have minded, but she had a cold.

By the time she landed in San Francisco, her ears were aching. “I was afraid to get on the second flight,” Yamaguchi recalled, “but I had to get back to work. The (ear) pressure built up so much, I started crying on takeoff.”

As Yamaguchi’s experience suggests, flying may be the fastest way to travel, but it’s sometimes not without health consequences. Ear problems top the list of usually minor--but distressing--ills for air travelers. But hearing-related difficulties are hardly the only issue.

Other common in-flight problems, according to Dr. Maria Simonson, medical research director for the International Flight Attendants Assn., include air sickness, dehydration, indigestion, muscle cramps, dry eyes and jet lag. Even one of these usually minor health hazards is enough to turn the friendliest skies snarly.

Unconventional Treatment

Yamaguchi was ready to tough out the ear pain when a flight attendant suggested an unconventional treatment: Place two steaming washcloths in plastic foam coffee cups, and hold a cup by each ear. “It relieved the pressure,” said Yamaguchi, who later learned she had aerotitis, a painful ear condition caused by air-pressure changes. In her case, it took two weeks to resolve.

Flying with a cold increased Yamaguchi’s chances of coming down with ear problems, Simonson said, noting that ear problems are more prevalent in people with upper-respiratory infections who fly.

“Most people with a cold have congestion of the Eustachian tubes (the slender structures between the middle ear and the upper part of the throat which equalize pressure on both sides of the eardrum),” explained Dr. James Benecke, an ear specialist at the Otologic Medical Group in Los Angeles. Congested Eustachian tubes are less likely to work properly.

While the steaming cup treatment probably isn’t harmful, Benecke said he recommends other, more scientifically based preventive measures to help adults prone to ear problems avoid painful earaches aloft.

“I recommend the use of a decongestant (containing) pseudoephedrine (key ingredient in Sudafed and other over-the-counter products) for 24 hours before flying (four times daily),” he said, “and an over-the-counter nasal decongestant such as oxymetazoline hydrochloride (key ingredient in Afrin) on flight day. The normal duration of a nasal decongestant is 12 hours. If the flight is more than 12 hours, use the spray again.”

Most ear problems originate, Benecke said, when the Eustachian tubes don’t work properly, and the decongestants help keep them open.

If the ears feel like they are closing during takeoff or landing, other experts recommend the Valsalva maneuver: With nostrils pinched together and the mouth firmly shut, blow hard. (Anyone with a history of ear surgery or disease, however, should consult a physician before using this technique.)

Another Good Idea

Offering a baby a bottle is another good idea, Benecke added, because “the sucking motion causes movement of the palate and other muscles attached to the Eustachian tube.” He recommends older children and adults chew gum to help keep the tubes open.

“There are many muscles attached to the Eustachian tubes,” Benecke said. “The more you can exercise those muscles, the better chance of opening the Eustachian tubes and keeping them open.”

Preflight medications might also help passengers prone to motion sickness. In addition to oral anti-motion sickness drugs such as Dramamine (dimenhydrinate), there is now Transderm Scop, a circular disc impregnated with scopolamine, a sedative.

Available only by prescription, the disc is applied to a patch of skin behind the ear prior to flight to allow continual release of the medication. “It needs to be put into place about 8 to 10 hours before (the flight) just to be sure they (passengers) get adequate absorption of the medication,” Benecke said.

Treatment Not for Everyone

The new treatment, while handy, isn’t for everyone. Benecke reserves it as a last-resort treatment, for patients unable or unwilling to use the oral anti-motion sickness drugs. “Some patients have had extreme drowsiness (with Transderm Scop),” he said. “Some do well. It’s hard to predict.

“Patients who have glaucoma should not use it,” he cautioned. “It can aggravate it by altering the intraocular pressure.” Patients with cardiac problems should consult with their heart specialist before considering use of the Transderm Scop treatment, he added.

Blurring of vision, drowsiness and drying of the mouth are the most common side effects, Benecke said. Some users have reported skin sensitivity to the patches.

Passengers prone to motion sickness are also wise to choose aisle seats rather than window seats, experts said.

Another passenger bugaboo, dehydration, is worsened if passengers extend the cocktail hour cross country, experts agree. “To minimize dehydration (an abnormal depletion of body fluids) drink fruit juice, club soda and sparkling water,” said Bobbie Rausch, a dietitian at Centinela Hospital Medical Center in Inglewood. “Avoid caffeine and alcohol.” Symptoms of dehydration may include muscle cramps, scanty urine, thirst, weakness, exhaustion, delirium and other problems.

Indigestion, another problem encountered aloft, might be avoided by taking advantage of the special light meals many airlines now serve. “Passengers bring a lot of illnesses on themselves,” Simonson said. “They overeat, overdrink and wear tight clothes,” which can decrease circulation and increase discomfort.

Passengers on flights of four or five hours’ duration are prone to muscle cramps, backaches and leg pains, Simonson said, although how long it takes for these problems to occur varies greatly from individual to individual.

While aisleway aerobics may be impractical, walking up and down the aisle and in-seat exercises may help. American Airlines even includes exercises for “relaxed travel” in its in-flight magazine.

Among the exercises recommended: “Loosen the seat belt slightly and lean over the floor as if to pick up something you’ve dropped or to adjust packages under the seat in front of you. Reach down as far as possible and then sit up slowly. This stretches the lower back and back of the thighs.”

The dry air in an airplane cabin can make contact lens wearers feel like they have “calluses on their eyeballs,” Simonson said. To offset that dry-eyed feeling, “use a lubricant advised by your ophthalmologist,” she suggested.

Several organizations, including the National Academy of Sciences and the Aviation Safety and Health Assn., are studying the problem of stuffy cabin environments that may bring on dry eye and other problems in addition to speeding the spread of infection. Their recommendations to the Federal Aviation Administration and the U.S. Senate may soon improve cabin environments.

Once passengers reach their destination, many complain of jet lag--that exhausted feeling that occurs when the body’s internal clock is disrupted. “Jet lag is the result of the body’s own circadian rhythm being offset from normal environmental rhythms,” said Donna Arand, assistant director of the UCLA sleep disorders clinic.

Jet lag is most common, said Dr. Elliott Phillips, medical director of the sleep disorders center at Holy Cross Hospital in Mission Hills, during trips involving a three-hour or more time difference between destinations.

Remedies suggested for jet lag can be as plentiful as cumulus clouds at 30,000 feet.

For short trips, the key is to stay on your own local time, said Phillips. “If a trip is to be a week or less, stay on local time as much as possible. If the trip is more than week, and you’re going eastbound, trying waking up an hour earlier every other day (until you’re operating on destination time). If the trip is westbound, stay up an hour later each day (until you’re operating on destination time).”

Another alternative is the so-called “anti-jet lag diet.” Developed by Charles Ehret, a senior scientist at the Argonne National Laboratory in Argonne, Ill., the diet was first popularized about 10 years ago and is based on decades of Ehret’s research on the daily biological rhythms of animals. The first step, Ehret maintains, is to determine breakfast time at the destination on the day of arrival. Four days before that breakfast time, begin a feast/fast diet regimen, alternating days of high-protein breakfasts and lunches and high-carbohydrate dinners with “fast” days of light meals including salads, light soups, fruits and juices.

Resetting Body’s Clock

On the anti-jet lag diet, caffeine and alcohol, allowed only during specified times, depending on whether the trip is eastbound or westbound, help reset the body’s clock, Ehret said, while the high-protein meals stimulate the body’s active cycle and the high-carbohydrate meals stimulate sleep. The fast days of light meals help deplete the liver’s store of carbohydrates, he added, and ready the body clock for resetting. (To receive a free copy of the diet send a self-addressed, stamped envelope to the Office of Public Affairs, Argonne National Laboratory, 9700 S. Cass, Argonne, Ill., 60439.)

Mary Lee Chin, a Denver-based registered dietitian, suggests another dietary regimen for travelers who want to reduce the chance of jet lag. They should eliminate foods, beverages and drugs with caffeine three days before the flight, she said. Beginning two to four days before, she suggests travelers alternate days of light meals with days of heavier meals, ending up by eating light on flight day. On heavy meal days, total calories consumed in three meals should be about 2,000 to 2,500 calories, depending on body size and activity. The calorie total on light days should be about 800 to 900.

On all days, Chin advises high-protein breakfasts and lunches and high-carbohydrate suppers (for the same reasons Ehret cited).

“Avoid alcohol on the plane and before,” she advised. “Don’t drink any caffeinated beverage on the day you arrive and plan to eat your meals on local (destination) time.”

Many fliers are too impatient or too busy to change their diet or their sleep patterns prior to a plane trip, as even experts who recommend those measures admit. For such travelers a new, short-acting hypnotic drug, triazolam (Halcion), may eliminate jet lag. In a study conducted at the Center for Insomnia Research at the Stanford University School of Medicine and other centers, triazolam, first marketed in 1983, reversed the kind of insomnia that results from jet lag.

The researchers compared the use of triazolam with flurazepam (Dalmane) and found that the longer-acting flurazepam remained in the volunteers’ bloodstream the next day, impairing their alertness, while the shorter-acting triazolam did not.

Another study, reported in a recent issue of the British journal Lancet, concluded that the use of a short-acting hypnotic may be beneficial for the first night or two after a westbound flight and for a few nights after an overnight eastbound flight.

Sleep Adaptation

The researchers studied brotizolam (in the same drug family as triazolam but not available in this country) and concluded that sleep adaptation took longer after an eastbound flight. It is easier for fliers to lengthen a day (such as westbound travelers do) than to shorten it, they also found. They advised travelers to choose a daytime flight when possible and noted that the use of short-term hypnotics, which are generally free of side effects, can aid adaptation to a different time zone.

Experts in this country agree that short-term hypnotics, used properly, can be a boon for air travelers. Phillips, for instance, recently found the use of triazolam to be a lifesaver. On the night before Thanksgiving, he took an overnight flight from Los Angeles to Chicago. “I took the pill literally as I strapped myself in,” he said. “It takes effect very quickly, within five to 10 minutes. I barely remembered the plane taking off. I changed planes in Houston--I have no real memory of that--and arrived in Chicago the next morning.” By the time the plane landed, he said, he felt refreshed, not lethargic.

“Most people wake up wide awake (after taking triazolam),” he said. “But some people have a rebound effect and feel wired.”

Because of the drug’s unpredictable effects, other sleep researchers strongly caution people against taking triazolam on the plane as Phillips did. “We recommend using it to assure yourself of a good night’s sleep prior to the day when alertness is essential,” said Wesley Seidel, one of the Stanford researchers. “The only time to use it is once you’re in a new destination and want to get a good night’s sleep.”

Seidel, Phillips and other experts emphasize that the role of triazolam for jet lag is short-term. “A sleeping pill like triazolam can assure one of good sleep while one is waiting for one’s biological clock to catch up with the new time zone,” said Seidel.

For all types of minor health problems aloft, Simonson stresses the importance of asking the flight attendants for help. “That’s what they’re there for,” she said. “A lot of people think they’re there just to bring drinks and pillows.”