Doc on plane diagnoses man's unusual condition midair
A few minutes after his flight reached cruising altitude, Dr. Alan Hunter responded to a flight attendant's call for a doctor on board. A passenger was having a stroke, or so it seemed, the attendant said. This was certainly urgent — a passenger having a stroke could be one reason for an emergency landing.
But the passenger, whose face was drooping on one side, wasn't having a stroke after all, Hunter determined. Rather, the passenger had an unusual yet typically temporary condition, resulting in part from pressure changes in the airplane. No emergency landing was needed, and with Hunter's help, the patient was soon feeling fine. ...
Hunter, who is an internal medicine doctor at Oregon Health & Science University, said he had never seen a case like this before. To alert other doctors about this condition, Hunter described the case in a report published Monday (Jan. 27) in the journal Annals of Internal Medicine. ...
When Hunter responded to the call, the patient told Hunter that he'd had a sudden headache and pain and a sense of fullness in his ears, as well as slurred speech and drooling. But the case didn't look like a stroke, Hunter said. When people's faces droop on one side during a stroke, usually either the top or the bottom of the face is affected. In this case, the entire right side of the patient's face was drooping. And the patient was young and healthy looking, making stroke less likely, Hunter said. The patient also mentioned that he'd just recovered from a cold.
"Ultimately, it just made sense that it was a pressure-related phenomenon" rather than a stroke, Hunter said. ...
Because Hunter suspected that the patient's symptoms might be due to a clogged eustachian tube, he had the patient swallow a few times. He also gave the patient some extra oxygen. Within minutes, the patient was back to normal.
At the time, Hunter didn't know exactly what condition he had just treated. But after he got off the plane, he did some research and found something called facial barotrauma, a condition that seemed to fit the current case. Most often described in scuba divers coming up from the deep, facial barotrauma occurs when a patient experiences a drop in pressure, and a blocked eustachian tube reduces blood and oxygen flow to one of the facial nerves. In the case of a diver, that pressure drop occurs as the patient swims toward the surface and water pressure lessens; in the case of an airplane passenger, it happens as the plane rises and atmospheric pressure drops.
According to Hunter's research, this phenomenon happens only if the eustachian tube is somehow dysfunctional. ...