Pain in ears when flying

The ear pain you experience — barotrauma of the ear — is the most common medical problem reported by air travelers. “Barotrauma” refers to injuries caused by increased air pressure.

Here’s why it happens. Your ear has three parts: the outer ear (including the ear canal), the middle ear and the inner ear. The eardrum comes between the outer ear and the middle ear. The middle ear is connected to the back of your mouth by a thin canal called the Eustachian tube. Air is constantly moving through the Eustachian tube and into the middle ear. This balances the pressure in the middle ear with that in the inner ear.

Ear barotrauma can occur when one (or both) of two things happen: the Eustachian tube becomes blocked or partially blocked, and the air pressure around you changes suddenly.

Air pressure gets lower at higher altitudes. When a plane takes off, and when it descends for landing, the altitude changes rapidly. While the plane has systems to reduce the sudden changes that occur during takeoff and landing, some still occur.

When a plane’s air pressure changes suddenly, it can create a vacuum in the middle ear that pulls the eardrum inward. This can cause pain and muffle sounds. In more severe cases, the middle ear can fill with clear fluid. In the most severe cases, the eardrum can rupture. Fortunately, this is rare.

Barotrauma is much more likely if you’re flying with a cold, infection or allergies. If these conditions block the Eustachian tube, the natural way you have of balancing pressures in your ear is compromised.

So if you are ill and have any flexibility, reschedule your flight until you are better. If you must fly, take a decongestant one hour before your flight or use a decongestant nasal spray, or both. Antihistamines may also help if you have allergies.

Special earplugs can slow down the pressure change that affects the ear. These might give your ears additional time to adjust to pressure changes.

If you experience the symptoms of barotrauma during a flight, try the following — and before the symptoms start (for most people, landing is worse than takeoff):

• Chew gum or suck on hard candy.
• Yawn and swallow frequently, tightening the muscles in the back of your throat as you do (you often can feel and hear the Eustachian tube pop open).

If these methods don’t work, pinch your nose closed, inhale through your mouth, and then try to push the air out through your nose while keeping it pinched shut. Don’t push hard, and stop as soon as one ear pops. If you blow too hard, you can tear your eardrums, so do it carefully.

If you continue to experience ear pain and stuffiness after landing, a decongestant spray may help.

Thin Asians at Risk for Diabetes Due to Hidden Body Fat

Type 2 diabetes can occur in many seemingly thin people from ethnic minorities....

Epidemiologist Gertraud Maskarinec, MD, from the University of Hawaii Cancer Center, Honolulu, presented the findings, which cover a number of studies from her group. Researchers showed that Japanese American women are twice as likely to be diagnosed with diabetes as whites, despite having lower body-mass indexes (BMIs). Dr. Maskarinec stated that, "Diabetes risk is higher in all ethnic groups than in whites, and of course some of this is just due to body weight, but evidence is now building that people of many races may be at increased risk of diabetes and cancer before they are even considered conventionally overweight." Meanwhile, Chittaranjan Yajnick, MD, from King Edward Memorial Diabetes Unit, Pune, India, also gave a talk on what makes Indians so susceptible to diabetes. "We have seen that Indians are often diagnosed with diabetes 10 years earlier and 5- to 10-units BMI thinner than whites," he noted. Both believe the explanation lies in "hidden" visceral fat found inside the body, between organs, in Asians and probably other ethnic groups too, but not in whites. This in turn affects the levels of adipokines secreted, such as leptin and adiponectin, which can have adverse metabolic effects. Dr. Maskarinec explained that, "The knowledge that Asians and other ethnic groups are at much greater risk for diseases associated with obesity, such as diabetes and many cancers, than whites, is not new." But more recently, researchers have begun to show that nonwhites who are not even particularly overweight or who are of "normal" weight are at much higher risk than whites. "People have talked about some kind of adaptation for white people, who have had a greater number of years to adjust to the type of food we are eating now," she postulated. As part of their research, Dr. Maskarinec and her colleagues used the Hawaii component of the Multiethnic Cohort (MEC) to examine the influence of BMI on diabetes incidence. They measured leptin and adiponectin by ELISA assay in 312 ethnically Japanese and 208 white women. Magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) were performed in 30 white and 30 Japanese cohort members. Overall, Japanese women had significantly lower BMIs (23.7 vs 25.3 kg/m2), leptin (15.0 vs 25.9 ng/mL), and adiponectin (11.7 vs 16.0 µg/mL) than whites (P<.0001 for all). But in adjusted models, Japanese were twice as likely to be diagnosed with diabetes as whites across all BMI categories: less than 22 kg/m2, 22.0 to 24.9, 25.0 to 29.9, and 30 kg/m2 or higher. The DXA and MRI scans of the 30 white and 30 Japanese women, published in 2011, showed much more trunk fat and percentage of abdominal visceral fat in the Japanese than in the white women. Japanese women had higher trunk-to-peripheral-fat ratios and a greater percentage of liver fat and were twice as likely to have fatty livers as whites, the data showed. "Greater central adiposity reflecting the adverse effects of visceral fat and/or patterns of adipokines may be responsible for the higher diabetes risk in Asians as compared with whites at the same BMI level," Dr. Maskarinec and colleagues concluded. Dr. Maskarinec also showed data on DXA whole-body scans obtained for 101 adult women (>30 years) and their 112 daughters (age, 10 - 16 years) in Hawaii, divided into all white, mixed of non-Asian descent, mixed of partly Asian, and all Asian, taken from another study by her colleagues published last year. These results confirmed previous reports of greater central adiposity in women of Asian ancestry and indicated that ethnic differences in adiposity were already present in adolescence. Dr. Maskarinec said ethnic differences in body-fat amount or distribution that develops early in life may be key, with some scientists believing the intrauterine environment plays an important role, although this latter concept is still just a hypothesis, she stressed. Dr. Yajnick is such a proponent of this theory: "All the risk factors for diabetes and adiposity, including blood chemistry, are present at birth," he told the meeting. His research includes evidence that Indian babies "are small but adipose; it's all about nutritional programming rather than the birth weight." Susceptibility to noncommunicable diseases such as diabetes "is thus not only genetic, but epigenetic," with the latter representing heritable changes caused by mechanisms other than alterations in underlying DNA and being "modifiable," he explains. "Only about 10% of diabetes can so far be explained by genetics, for example," he notes. And one factor he believes may be playing an important role in India is vegetarianism. People there consume high amounts of folate but are deficient in vitamin B12, creating a low-B12/high-folate intrauterine environment that "produces babies who are mostly insulin resistant." He is testing his hypothesis in the Pune Intervention trial, which began a year ago and involves giving adolescent boys and girls in the Indian region B12 supplementation. The participants and their offspring will be followed long term. Dr. Maskarinec is skeptical of this theory, noting that most ethnic groups around the world are not B12 deficient. The Japanese Americans she is studying, for example, have very high per-capita meat consumption, she says.