Superior Canal Dehiscence (SCD) is a rare inner ear condition that can significantly impact an individual’s hearing and balance. This condition presents unique challenges, particularly when considering activities involving changes in atmospheric pressure, such as air travel.
Understanding Superior Canal Dehiscence
Superior Canal Dehiscence is characterized by an abnormal thinning or absence of bone in the temporal bone, specifically overlying the superior semicircular canal of the inner ear. This semicircular canal is one of three fluid-filled loops that help regulate balance and stabilize vision during head movements. Normally, the inner ear has two primary openings, the oval and round windows, for sound and pressure transmission.
With SCD, this bony defect creates an additional, abnormal opening, often referred to as a “third window”. This “third window” disrupts the normal mechanics of the inner ear, allowing pressure and sound to be abnormally transmitted. This can lead to a range of symptoms, including autophony, where internal body sounds like one’s own voice, heartbeat, or even eye movements are heard unusually loudly. Individuals may also experience sound-induced vertigo or disequilibrium, known as Tullio phenomenon, and pressure-induced vertigo, which can be triggered by activities like straining or coughing.
How Air Travel Affects Superior Canal Dehiscence
Changes in atmospheric pressure during air travel pose a particular challenge for individuals with SCD. As an airplane ascends and descends, cabin pressure fluctuates, which can directly affect the pressure within the inner ear. The “third window” created by the dehiscence allows these pressure variations to abnormally stimulate the inner ear’s balance and hearing structures.
During ascent, pressure in the middle ear typically equalizes by air flowing out through the Eustachian tube. However, descent can be more problematic as the middle ear needs to re-inflate, which becomes harder with rapid pressure changes. For those with SCD, this can exacerbate symptoms such as severe vertigo, disequilibrium, and unstable vision, known as oscillopsia. Hearing changes, including heightened sensitivity to sound (hyperacusis) and intensified autophony, can also occur. In some documented cases, air travel has been associated with serious complications like pneumocephalus in patients with SCD.
Strategies for Flying with Superior Canal Dehiscence
For individuals with SCD considering air travel, certain strategies may help mitigate symptoms. Pressure equalization techniques are often recommended; chewing gum, yawning, or performing the Valsalva maneuver (gently blowing out with a pinched nose and closed mouth) can assist in equalizing pressure in the middle ear, particularly during descent.
Wearing earplugs, such as those specifically designed for air travel, can also be beneficial by slowing down pressure changes and reducing sound-induced symptoms. Noise-canceling headphones may further help by minimizing external auditory stimuli that could trigger or worsen symptoms like hyperacusis. Staying well-hydrated before and during the flight is generally advised, and avoiding decongestants should be considered as they can sometimes worsen symptoms for some SCD patients.
When to Seek Medical Advice and Avoid Air Travel
It is advisable for individuals diagnosed with Superior Canal Dehiscence to consult with a medical professional, such as an otologist or neuro-otologist, before planning air travel. A specialist can assess the severity of symptoms, evaluate individual risk factors, and provide personalized recommendations regarding the safety of flying. This consultation is important for determining if air travel is appropriate given the specific characteristics of one’s condition.
Air travel might be discouraged or contraindicated in certain situations. These include experiencing severe or easily triggered symptoms, having a recent history of inner ear surgery, or if symptoms are significantly worsened by minor pressure changes. While some individuals with mild SCD may manage air travel with precautions, others may find the potential for debilitating symptoms or risks too high, necessitating alternative transportation or considering surgical treatment to repair the dehiscence.