Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not mechanical pressure-equalizing devices relieve or reduce ear pain and pressure in aircraft passengers during flight.

STUDY DESIGN: A review of two double-blind control trials and one case control study published between 1988 and 2010 in the English language.

DATA RESOURCES: Double-blind control trials focused on the use of pressure-equalizing ear plugs (PREP) and a case control study on the Otovent® auto-inflation device for the prevention of barotrauma in aircraft passengers were found using Cochraine Library, Medline, and PubMed.

OUTCOMES MEASURED: Outcomes measured include subjective reported level of pain on a visual analog scale; otoscopic findings reported according to the Teed scale classification, a graded scale of middle ear barotrauma; subjective questionnaires which focused on a number of subjective pressure symptoms during flight.

RESULTS: The Otovent® study showed that 76% of the 43% of adults who used the device reported relief from Otovent® use. Although children reported a higher incidence of barotitis than adults in the study, they were not trained to use the device and therefore were not included in that part of the study. While both PREP studies show that PREP has no effect on ET function, one study concludes
that PREP has a positive effect on subjective state in those suffering from pressure equalization problems, while the other concludes that PREP did not demonstrate any effect other than noise reduction.

CONCLUSIONS: The Otovent® device may be an effective way to relieve barotrauma. However, since a single study has been conducted with few subjects, more research with larger study groups as well as education for children on how to use the device is necessary to give a recommendation. Since the two PREP studies showed no positive effect on ET function and found conflicting subjective results, a recommendation for PREP cannot be made. Future studies with larger subject groups could help to answer the question of whether or not mechanical devices have any positive effect on barotrauma and the discomfort it causes to aircraft passengers and pilots.