Recurrent sinusitis and impairment of eustachian tube function in air passengers and crew

Chronic and recurrent sinusitis, and thus impaired tubular function, are usually caused by isolated lesions of the ethmoid cells. Purulent nasal secretions are transported over the openings of the tubes into the epipharynx. Inflammation and swelling of the mucosa of the tube openings causes stenosis or blockage. Inflammatory foci, usually hidden in the anterior ethmoid cell system, are not always apparent in a plain film of the paranasal sinuses. They appear only in a computed-tomography scan or in a conventional tomogram. Once the diagnosis has been made, a simple, guided endoscopic procedure suffices to alleviate a stenosis, open inflamed ethmoid cells, and restitute ventilation of the nasal sinuses and, thus, tubal function. Radical procedures on the maxillary and frontal sinuses, and plastic operations on deviated nasal septa (which impair the function of the nose and the nasal sinuses only in extreme cases), are thus often unnecessary. Septum deviations are irrelevant to the fitness-to-fly of air personnel as long as the tube and the ventilation of the sinuses function freely. The Valsalva maneuver with otoscopic visualization of the excursion of the eardrum is the most reliable test of tubal function. Tympanometry is used mainly for documentation.