I am a 3rd year audiology student. Today, I had a patient walk in with ear pain. He was flying in 2 hours and wanted to know what I could do to help. I informed him about ear plugs and taking something like Afrin before flight. I looked at his ears, one tympanic membrane was retracted and the other was not visible due to otitis externa (from swimming in the ocean). A seal was unobtainable via tympanometry. I told him the patient that if he had a chance, to see a medical doctor, even though it might delay his flight. What would you tell a patient with those symptoms?
Any patient with ear pain, and particularly those in whom you suspect an ear infection, should be seen by a physician.
One of my immediate concerns would have been whether or not the patient is diabetic? The mortality rate for otitis externa in diabetics is very high, and these patients need to be medically evaluated and treated immediately. Further, as you could not see the eardrum, suppose there was an effusion or infection? If so, the patient will potentially experience horrific pain on descent. There is also a risk of sensorineural hearing loss when combining air travel and middle ear effusion. Bottom line, this type of patient cannot be missed, the risks are too high.
I would recommend you should tell the patient..."You need to see a physician before flying.'' Additionally, if you state anything less, the patient's problem can easily become your problem! I recommend you tell the patient he should not fly unless he is medically cleared to do so. I believe that as an audiologist (or an audiology grad student) your responsibility includes telling any patient with any pain, or any visible anomaly that medical evaluation and management is in the patient's best interest.
Finally, in this situation, it is very important to clearly note in the chart the patient's presentation and your caution to the patient, just in case he elects to fly, against your advice, and then blames you later for additional damage!
Brian Perry, MD
Ear Medical Group, San Antonio Texas.
Dr. Perry completed his residency in Otorhinolaryngology at Duke University, and a fellowship in Otology, Neurotology and Skull Base Surgery at The University of Iowa. He is currently in private practice in San Antonio, where he continues to publish on a variety of otologic topics.