Cabin Altitude and Barotraumatic Otitis in Commercial Aircrew

Whether the lower cabin pressure altitude used by modern long-haul aircraft shortens recovery after barotraumatic otitis (BO) remains uncertain. We assessed the association between cabin altitude [6000 ft (≈1829 m) vs. 8000 ft (≈2438 m)] and BO-related sick-leave duration in airline crew.

We conducted a retrospective study of 4271 BO episodes among Air France pilots and cabin crew (2015-2024). Analyses were restricted to long-haul operations. Exposure was cabin altitude class inferred from aircraft type; the outcome was workdays lost per episode. We fitted linear models and count models that account for overdispersion and excess zeros, adjusting for sex, crew role, season, and calendar year.

Across episodes, 8010 workdays were lost, with a right-skewed distribution (median 1-2 d; mean ≈ 5.5 d). No association was observed between cabin altitude and sick-leave duration; in count models the estimated ratio was 1.02 with a 95% confidence interval of 0.91-1.14, and results were consistent across specifications. Male sex was associated with shorter absences (about -2.5 d; 95% confidence interval -4.6 to -0.5), and pilots with longer absences than cabin crew (about +9.4 d; 95% confidence interval +0.5 to +18.2). Findings for BO were stable over time.

This study suggests that cabin altitude, while relevant to in-flight comfort, is unlikely to be a major determinant of BO recovery in operational practice. Individual factors (e.g., sex and crew function) appeared more influential. Limitations include the fact that exposure was only defined by aircraft type and lack of unmeasured operational factors; future prospective studies integrating technical flight data are required. Scaramuzzo P, Comesse M-A, Klerlein M. Cabin altitude and barotraumatic otitis in commercial aircrew. Aerosp Med Hum Perform. 2026; 97(2):100-105.