Hearing and subglottic stenosis
 

Hi

I am hoping for someone to assist me, particularly if familiar with CASA in Australia. I have profound deafness in my left ear due to an autoimmune disease. My specialists are confident that it is conductive and if they insert grommet into the ear they believe my hearing will be restored after draining the fluid. Is the flying with grommet tubes permitted?

Secondly from the disease I also have some narrowing of my trachea. Is there any restriction on this and what if I require to have surgery to expand my trachea if it narrows more??

Sorry Density, but your post is confusing. A grommet is a small washer placed in the eardrum so the fluid behind the drum in the middle ear can escape. It is due to failure of the drainage tube / chronic infection etc.

Autoimmune disease includes many illnesses. Deafness is normally from the inner ear

It suggests you have two separate problems, so you need to discuss this with your ENT surgeon to clarify and if so which is causing what !!! I doubt even a CASA will stop you flying with a grommet other than immediately after the 'operation'

However many autoimmune diseases do cause tracheal stenosis although in practice we do not see these patients needing operative management. In fact it is very rare. Surgery is normally only performed for symptoms such as breathlessness. In practice you would lose your medical from the stenosis way before needing surgery. If you become breathless that will be of interest in your medical, otherwise I cannot see it is an issue. BUT these diseases effect many other systems so you would be best advised to talk to the specialist looking after the autoimmune disease itself and learning of the likely progression / prognosis / issues.

If you have more information eg a specific diagnosis, we may be able to help you further. And I regret I am from the better side of the Tasman Sea so I cant help with specifics for your country.

Radgirl

Thanks for your response. Better side of the Tasman indeed. I flew in NZ for a year or so too and throughly enjoyed it. So as to clarify, I have been diagnosed with Granulomatosis with polyangiitis. The disease has resulted in severe pain and bleeding from the sinuses and ears, along with inability to clear my ears; as well as lung nodules. I was treated with high dose steroids and chemotherapy. It has been some 6 months since initial treatment and thankfully there is no pain whatsoever in sinuses or ears and my lung nodules are almost completely resolved. I am now on a very low dose of prednisone for maintenance (and legal according to CASA). The only thing that remains is fluid in the ear canal due to Eustachian tube dysfunction and associated deafness and some observed stenosis that has come about after everything has settled down (ENT noted possible fibroblast scarring). I was a little surprised as I don't have any issues with breathing at rest and I only notice a little wheezing when physically exerting myself with exercise. Hope this makes a little more sense.

P.S. I have noted that some ENT's can now perform a procedure that inflates a balloon in the Eustachian tube thereby eliminating the need to perform a myringotomy. Any information on this procedure?

If you have a "thick" sensation in the ear, I've had that and my mother too. We suspect it is a swelling of the inner parts of the ear that connects to the throat. Just as in your case, there were no visible reasons when the doc poked at the ear with his light-thingy.

It does disappear, but apparently can take up to two weeks. I got temporary relief by doing the pressurisation trick. I tried anti-swelling drugs but don't remember if they worked or not.

Specialists do get it wrong. Was he a consultant or a trainee? Alternatively you may have two problems but your story is very suggestive of otitis media aka glue ear aka fluid behind the eardrum

Moreover if you have had a general anaesthetic for your back this may well have produced glue ear - an ENT surgeon may not know this!!

Call the hospital, speak to the specialist's secretary and ask for either another consultation or a second opinion. Without waiting. If you are in the UK and are stone walled ring the chief executive's secretary and ask to make a 'formal complaint '

Sorry to have to advise this but it does work. I suspect once you get to see a specialist face to face and tell them this history and the fact you had a back operation they will look in your ear again and may find some fluid

Even if they do not you can then be reassured nothing has been missed

Thanks for the replies.

A fair amount has happened since my post. The main thing, thinking about the consultant's mention of pressure in the cochlea, I held my nose and applied fair positive pressure - it always cleared - but this time I left it sustained for half a minute or so. The improvement was astonishing, but not permanent of course.

That evening after my hike, I sat in the car and listened to a Chopin nocturne - the first time in months it would have been of any worth at all.

In haste now, but I'll certainly write to the chap and tell him about the general anaesthetic link and indeed my notion that I could squeeze some of the pressure out of the cochlea.

Oh, BTW, when I got my copy of his letter (describing me as this pleasant 76 year old gentleman! Yeah, right.:E) to my GP I saw his qualifications. BSc FRCS and a lot of other stuff.

I suppose I'd better be diplomatic in my persuasion efforts.

They call everyone "pleasant" unless you were unpleasant. Medical code :-)

The ent guys do use long term low dose antibiotics, (in our area, we use trimethoprim) for prophylaxis of glue ear in kids. I'm not convinced that the evidence is that robust, and it's likely that your perceived benefit was not related to what you took.

Not the right place to recommend specific treatments on here, but ask what your GP/ENT bod what they think of "Otovents."

If they agree, put up a video, it would add some cheer :-)

What a useful discussion, thanks! I have looked here, as I recent;y changed the prop on my plane from a two blade metal to a three blade composite, which turns 100 RPM more slowly. That should result in more quiet, but the reverse has occurred. (iI's noteworthy that my plane has the prop above and behind your head by about two feet). I had 420 hours on the plane with the two blade Hartzell, and never a problem. After the first flight with the new three blade, my ears were ringing (David Clark regular headset). The ringing, and feeling of pressure on my ears persisted into the evening. 'Next day, I flew again, more cognizant of RPM. I cruised at 2250 RPM, rather than the more common 2300 - 2400. My ears still/again bothered me that evening. 'Next day, I borrowed a Bose A20, and flew down to buy a new noise cancelling headset for myself. After an hour in the plane with the Bose, my ears were ringing. I bought a DC One-X noise cancelling, after trying three different headsets in the plane chocked an running. 'Got home, ears ringing, and feeling "swollen" that evening. 'Next day, 3M ear plugs inside the DC One-X. no difference.

After three hours in the plane yesterday, with "industrial" hearing defenders, and the 3M ear plugs, my ears are still ringing the next day. My ears fell swollen inside. I can hear fine, with a bit of ringing, but it feels like I have not cleared my ears following a fast decent.

With all that hearing protection, I have to wonder if the noise/vibration effect is resulting from entrance other than through my ears - top of my head?

I'm thinking of seeking out a audiologist, and ask for advice. Short of a solution, the three blade is coming off, and the old Hartzell is going back on - then I'll really be looking for the difference. I'm wondering about flying a spectrum analysis while this prop is still installed, to understand better.... Anyone know of software (PC or Iphone) which can do this? I may as well have something to compare when I have the Hartzell back on...

Making the comparison with the old prop is good science, if rather expensive.

Measuring sound in a cockpit is very difficult. Just the ambient noise would give some idea, but the device/mic would have to be positioned spot-on the same. I don't think a phone would be nearly sophisticated enough.

There is a chance you've developed an ear problem just at changeover time. Taking that into consideration was a good move.

Good luck.

I have a similar symptom in my left ear. Fluid in the middle ear. It has been called eustachian tube disorder. I have no problem with equalising pressures when flying (as a passenger). It has persisted for 3 years, but tends to clear in the summer. I live with it.

Actually for a 'relative' comparison it should work fairly well, you will not be seeing absolute values but the spectrum analysis will show what is happening.
A 'dashboard' holder for the phone should work to keep the positioning stable.

I don't have any specific recommendations for the phone app, have not looked at that for a while.

Could be that the new prop had an unfortunate peak at a resonance frequency in the cabin.

I strongly agree with checking out other causes, very easy to fall into the 'must be the last thing that changed' trap.

I often wondered about the crystal effect of fillings. I'm open to all ideas at the moment but have started to get the attention I'm needing. A squeaky wheel and all that. Sat watching telly news yesterday and realised I could hear every word. Just didn't notice at first. However, the fudge came back.

What I don't get is, if it's an over-pressure in the cochlea, then why does it vary in both ears at the same time? I'm having to play a very careful game of getting the information v teeing the surgeons orf.

Back to the eye guy tomorrow. My post-operative 20/20 has dipped in the subject eye which I hope only means the ensuing cataract is on its way. I can see Mizor and Alcor with ease with the left - and I went through the dual procedures with that several years ago.

It has to be said - if I'd not had antibiotics, gall-bladder removal, brachytherapy for prostate cancer, knee surgery, spinal surgery and three lots of eye surgery, I'd be weezing, gut clenching, cancer-wridden, limping, curved person that bumped into things a lot.

I'm hoping that by the time I'm 90 I'll have everything working a treat

ear tune with EASA first class medical
 

following pain in my left ear for a few months my ENT doctor wants to put a tube in my left ear, is this compatible with EASA first class medical ?

Tonsillitis/hearing issue
 

I went for my annual cc medical and wasn't feeling brilliant on the day. I'd had a fever, slight nausea and dizziness. The doctor appeared to be indifferent to this but after testing my hearing, he pronouncedme partially deaf and failed my medical! Later the same evening, I ended up with an extremely sore throat - almost unable to swallow and made an appointment with an out of hours doctor. I have been diagnosed with bacterial tonsillitis and put on a 10 day course of antibiotics.

I've never had an issue with my hearing before and would have thought at 27, my family and friends would have commented if they had noticed anything. Is it possible the positive test was as a result of the infection? Can tonsillitis affect your hearing? I've got another appointment ntment with a specialist next week to check but I'm gutted that this diagnosis will effect my career.

Yes.

So stay indoors, take the medicine and plenty of fluids then demand a new hearing test when you are better

On the face of it you do not need to see a specialist - we do not remove tonsils for one or occasional bouts of tonsillitis. The operation is even worse than the tonsillitis!!!!

Thank you very much for your reply Radgirl - that's really reassuring. I'm astounded that original doctor took no account of the fact I was clearly unwell during the assessment.

The specialist I'm seeing is basically to get a second opinion on my hearing so hopefully the tonsillitis will have cleared up sufficiently to get an accurate result.

Can he/she do that (probably a question best answered by radgirl)?

If you've failed a test, especially if is a machine measured one such as the darned "beep beep" hearing test I don't see how an AME can do anything other than fail you - it's tricky I know but the general opinion I have heard over the years is don't jeopardise yourself by presenting yourself for a medical if you are ill/under the weather (again just my humble opinion - what's the advice from an AME?).

Anyhow if it is any consolation I suffered from recurring tonsillitis probably for the best part of a year as as a kid ( ouch) , did not have tonsils removed even though it seemed to be the fashion at the time ( very late 1960s) and it cleared up fine - good luck with yours.

As you asked so nicely Wiggy !!!!

The tests and measurements in the medical wont demonstrate if you are feeling off colour but my doctor certainly looks in my throat which I suspect would have been a give away and the OP suggest he told the doctor who was 'indifferent'.

If I were the doctor and the candidate was desperate not to postpone the medical (license about to expire, upcoming rostas...) I would go ahead but stop if a test was failed where the failure was likely (almost certainly!!!) due to the temporary illness. Normally we commiserate and offer a new appointment

Yes Wiggy. It was one of the darned beep beep machines!

And the darned doctor also said me being under the weather wouldn't affect the hearing test, even when I queried it! Good point and lesson learnt about attending under the circumstances.

Thanks for the info about tonsillectomies - at the moment, they seem out of fashion unless its recurring so fingers crossed! Don't fancy going through that as well.

I fail the beep test every time , still flying though , there are various other tests you can do to demonstrate functional hearing , you can even wear a hearing aid now .