Strokes on a plane? On-board facial paralysis wasn't what it seemed

Alan J. Hunter from Oregon Health & Science University was a passenger on a recent airline flight when he responded to a flight attendant's request for a "doctor on board." The flight attendant suspected that a young male passenger was having a stroke, which would require an emergency landing. However, upon examination, the physician made an unusual diagnosis. The case report is published in Annals of Internal Medicine.

A medical emergency during a commercial airline flight may require an unplanned landing, which disrupts travel plans and is very costly. Therefore, it is important to know the difference between a true medical emergency and something that does not require an unplanned aircraft landing.

Dr. Hunter found the plane passenger suffering from sudden-onset ear pain, slurred speech, drooling, and complete right-sided facial droop. The man had lost his forehead wrinkles and could not close his right eye, but had no mental symptoms and still had his physical strength. When the man reported that he had recently recovered from a cold and that his symptoms began during ascent, Dr. Hunter determined that there was no reason to deter the plane. The man's symptoms were caused by declining atmospheric pressure in the cabin causing a relative increase in middle ear pressure from a blocked Eustachian tube that was transmitted to the branches of the seventh nerve as they ran through his middle ear. According to Dr. Hunter, this condition is described as facial barotrauma. It occurs during ascent in scuba divers and infrequently while flying, during land travel at high altitudes, after certain operations on the middle ear, and with some structural disorders of the middle ear. The paralysis usually resolves within 15 to 30 minutes after maneuvers to reduce middle ear pressure, such as yawning, swallowing with pinched nostrils, and the Valsalva maneuver. Breathing oxygen-enriched air improves tissue oxygenation, which also helps.