an autodidact meets a dilettante…

it’s all about Boyle’s Law, apparently (P1V1 = P2V2)

Aerosinusitis, also called barosinusitis, sinus squeeze or sinus barotrauma is a painful inflammation and sometimes bleeding of the membrane of the paranasal sinus cavities, normally the frontal sinus. It is caused by a difference in air pressures inside and outside the cavities.

The above quote is from Wikipedia, and it describes something I experienced on two flights recently (see previous post), though I experienced it, or felt I experienced it, in the ears (I’ve learned not to trust my own perceptions). On the first flight, I experienced a build-up of pressure until a sudden change as of a bubble bursting in some inner cavity, and then everything was fine. I’ve had similar, but less intense, experiences in a car when driving up into the hills near my home. In fact, they’ve been so mild that I’ve often looked forward to them as a physical sensation, and I know it’s common because people would ask around – have your ears popped yet? On my second flight, the pressure built up again on the descent, and I fully expected the bubble to burst as it always did. But the pain just increased, to an excruciating level, so that my face was all scrunched up and I was gasping, squealing and whimpering like a pup. By the time we landed, though, the worst of the pain was gone, and it gradually got better over the next hour or so, and although I could still ‘feel’ it 24 hours later, it was more a memory of a feeling than the thing itself. I don’t know whether my pain was severe or relatively mild as I’ve never felt other people’s pain. This was one of the first things I had ‘deep’ thoughts about as a child. When I was nine or ten years old I fell, while running, and bashed my shin against the edge of our front porch, and I still think that was the most extreme pain I’ve ever felt in my life. I screamed and screamed, and amongst the comforting remarks came the inevitable ‘come on now, stop squealing, it’s not that bad’. Of course this made me angry and resentful but it also raised the questions, ‘am I over-reacting? Would others react like this in the same circumstances? Would they feel the same pain? How could we ever know?’ And along with those questions was one that always ate at me, and probably still does – can I control my pain, can I obliterate it with the power of my mind? I’d sell my soul, FWIW, for total control. But that’s a rather too large side-issue for this post. The Wikipedia article, though, does classify aerosinusitis in terms of pain, along with other more measurable symptoms:

Grade I includes cases with mild transient sinus discomfort without changes visible on X-ray. Grade II is characterized by severe pain for up to 24 h, with some mucosal thickening on X-ray. Patients with grade III have severe pain lasting for more than 24 h and X-ray shows severe mucosal thickening or opacification of the affected sinus; epistaxis or subsequent sinusitis may be observed.

Annoyingly, my own intense but transitory experience doesn’t fit into any of those grades. I also find that this extremely technical article makes no mention at all of ear pain. Much of the focus is on the frontal sinuses, situated behind the brows and connected to the nose or nasal meatus, which naturally makes me uncertain about where my pain was located. Interestingly, the frontal sinuses still haven’t come into existence at birth, and aren’t fully developed until adolescence, and some 5% of people don’t even have them, which just complicates matters for me. As is mentioned above, the frontal sinuses are part of a whole labyrinth of hollows, bones, cartilaginous membranes and passageways known as the paranasal cavities. I’m hoping that the inner ear, or more accurately the middle ear cavity – technically called the tympanic cavity, is also part of that.

Though ‘ear-popping’ seems to be commonplace, aerosinusitis usually occurs in people who have head colds, or as the article puts it, it’s ‘typically preceded by an upper respiratory tract infection or allergy’. Of course, with my bronchiectasis, I’m effectively in a more or less permanent state of infection, so this may be a problem for me every time I fly.

So, what remedy? Well, the problem for me seems to be with the tympanic cavity or eustachian tube on one side. When I was eight, I perforated my ear drum and had to have an operation. I was told afterwards that I should never hold my nose tight while blowing it, as people do (making that horrible honking nose), as this might damage my eardrum. I remember being fascinated by this connection between the nose and the ears, and of course I’ve always followed the doctor’s advice. I didn’t want to blow my brains out of my ears.

Wikipedia suggests using decongestants or painkillers for mild forms of barotrauma, as does this useful site, which deals more with popping ears. First and foremost, though, it suggests gargling with warm salt water, which was my mother’s advice for many medical problems (she was a nurse).

I’m resisting any description of what I went through as ‘mild’.

Working the eustachian tube or tympanic cavity seems to be a good idea, for example by regular swallowing, chewing gum, sucking sweets, yawning, etc.

Sudafed is highly recommended. I’ll bear that in mind next time.