Common Health Problems for Pilots

Minor on the ground, worse in the air

The organising principle of this lesson: the in-flight environment can turn minor symptoms into major ones. A slightly stuffy nose at sea level becomes acute ear pain in the descent; mild indigestion becomes doubling pain at cabin altitude, where trapped gas has expanded by a third. A cold or flu is the standing example, and the syllabus wants its three target areas named: the middle ear, the sinuses and the teeth — swollen, congested mucous membranes block the pressure-equalising passages of the first two, and dental gas pockets do the rest. The medical manual's blunt advice is the rule to carry: do not fly with a cold or nasal stuffiness.

The companion rule says when to pick up the phone: a pilot should seek advice from an aeromedical examiner (AME) or aeromedical centre (AeMC) whenever an illness or its symptoms leave fitness to fly in doubt, whenever symptoms persist or a condition needs treatment before a duty, and after any pressure injury, before returning to the flight deck. Flying on regardless risks converting a days-long nuisance into a chronic, career-touching condition.

Barotrauma: the trapped-gas family

Barotrauma is pain or injury caused by the expansion and contraction of gas trapped in the body's cavities as the outside pressure changes — in the middle ear, the sinuses, the gut and the teeth. The pain can be severe enough to interfere with control of the aircraft, and the mechanism differs by cavity, which is exactly what the exam asks you to differentiate.

The middle ear first, because it completes the hearing lesson's anatomy. The Eustachian tube equalises pressure between the middle-ear chamber and the environment, but its throat end is slit-shaped and works as a one-way flutter valve: excess pressure inside pushes it open easily, arriving pressure holds it shut. In the climb the expanding middle-ear air vents itself with an occasional click and no effort. In the descent the valve works against you, which is why otic barotrauma is worse going down: the rising outside pressure cannot get in, the eardrum bows painfully inward, and hearing dulls. The pilot must open the tube deliberately by swallowing, yawning, moving the jaw, or a gentle Valsalva manoeuvre (blowing against pinched nose and closed mouth — gently, since a violent one can trigger pressure vertigo). Severity tracks the rate of descent, and the worst of it lives at low altitude where the pressure curve is steepest, cabin descents included. Unrelieved, the symptoms run from pain radiating to the temples through temporary deafness, tinnitus and vertigo to a ruptured eardrum; if nothing clears the block, the answer is to land as soon as practicable and see an aviation medical specialist, and to fly again only when fully recovered.

The other three members of the family, each with its own direction and its own defence:

Sinus barotrauma — the sinuses connect to the nose by narrow ducts that a cold or flu swells shut; the trapped air then cannot equalise, usually biting in the descent, though unlike the ear the climb can hurt almost as much (a blocked duct traps gas in both directions, with no flutter valve to make one of them easy). The pain starts around the eyes and temples, waters the eyes, can bring a nosebleed, and has incapacitated pilots outright. The immediate action is to climb back to the altitude where the pain began and descend again as slowly as possible.

Aerodontalgia, barotrauma of the teeth — healthy teeth hold no air, but poor fillings and abscesses can harbour gas pockets that expand as pressure falls, so the teeth hurt in the climb. Good dental care is the whole prevention.

Gastrointestinal barotrauma — stomach gas escapes upward and large-intestine gas downward, but gas in the small intestine has no easy exit and expands in the climb, causing pain that has caused fainting. The defence is dietary: before flight, avoid the gas producers (raw apples, cabbage, cauliflower, beans, beer, heavily spiced dishes), eat slowly, keep portions modest, skip the chewing gum.

Gastrointestinal upsets

Acute gastroenteritis from food poisoning or contaminated water is the most common cause of in-flight incapacitation — gastrointestinal trouble accounts for roughly half of all in-flight incapacitations. The onset is usually abrupt and violent: nausea, vomiting, abdominal cramps and diarrhoea, with fluid loss heading toward dehydration; an insidious onset is the more dangerous form, because the pilot degrades before noticing. The major sources are known by name: unhygienic preparation and poor storage, undercooked or rancid meat, unwashed salads, unpeeled fruit, seafood, and locally made ice cream and mayonnaise.

The precautions are a professional discipline, not a traveller's suggestion:

Crew members eat different meals, on the ground and in flight, so one bad dish cannot take both pilots.
Leave about 90 minutes between eating and flying — enough time for the first symptoms of food poisoning to declare themselves on the ground.
Eat only properly cooked food in clean surroundings; fruit and vegetables only if you peel them yourself; treat seafood, local ice cream and mayonnaise as off the menu.
Drink from capped bottles or cans with the seal checked (refilled bottles are a known trick), and refuse ice cubes made from local water.

Obesity and diabetes

Obesity is an excess of fatty tissue, measured by the body mass index: weight in kilograms divided by height in metres squared, with obesity starting around BMI 30 (a little lower for women in the textbook tables). The syllabus lists what the excess costs a pilot: a raised chance of coronary problems and of developing diabetes, reduced tolerance of G forces, joint and limb problems, general circulatory problems, a reduced ability to cope with hypoxia and decompression sickness, and sleep apnoea — the breathing-stops-in-sleep condition that quietly manufactures daytime fatigue.

Type 2 diabetes is the adult-onset form, and pilots are not protected from it any more than anyone else. Its engine is insulin resistance: the pancreas still makes insulin but the body stops answering it, with obesity, poor diet and a sedentary life the principal risk factors — an occupational description a long-haul roster fits uncomfortably well. It can run symptomless for years while its complications build: vascular (damaged retinal vessels toward blindness, blocked arteries toward heart attack and stroke, kidney failure) and neurological (numbness and lost feeling, especially in the feet). For the licence it means stringent, individually assessed monitoring, with demonstrated stability and blood-glucose self-testing around duties; unmanaged, it is disqualifying.

The pilot's back

A career spent strapped into a seat produces its own pathology: unspecific back pain and the slipped disc are the typical pilot back problems. The counters are unglamorous and effective: a good sitting posture, the seat's lumbar support correctly set to preserve the spine's natural curve, good general physical condition, in-flight exercise where the operation allows it, and physiotherapy for treatment when prevention has failed.

Eating, drinking and blood sugar

The healthy diet the syllabus wants is conventional and testable: balanced, with carbohydrates supplying more than half the calories (grains, vegetables, fruit, potatoes), the rest from lean meat, fish and low-fat dairy, and fat kept low. Breakfast matters (about a quarter of the day's intake), because the alternative is flying on an empty stomach, and that has a name: hypoglycaemia, low blood sugar from missed meals or fasting. Its symptoms read like a cockpit hazard list: headache, lack of energy, shakiness, sleepiness, poor concentration, and fainting at the far end. The avoidance is regular meals; the short-term fix is simply a snack.

Hydration is the same discipline in liquid form. Cabin air is exceptionally dry, and creeping dehydration shows up as headache, fatigue and degraded concentration long before thirst insists. Drink water regularly through the duty, not just when thirsty — thirst is a late warning, not an early one.

Tropical operations

Operating in tropical climates stacks several problems at once: heat and humidity (with sunburn, heat exhaustion and accelerated dehydration), variable standards of hygiene, unsafe water supplies, food spoilage where refrigeration is scarce, and diseases with insect couriers. The syllabus names the incapacitation sources: poor hygiene standards, water quality, insect-borne diseases, parasitic worms, rabies and other diseases from animal contact, and sexually transmitted diseases, markedly more prevalent in some destinations and increasingly drug-resistant.

The disease list worth knowing by name: malaria (mosquito-borne, recurrent cyclic fever, still one of the world's biggest killers), cholera and typhoid (contaminated food and water), yellow fever (mosquito-borne, vaccination gives ten years' immunity), hepatitis (A from food and water, B and C from blood), tuberculosis (airborne, resurgent) and tetanus. Vaccinations are the crew member's own responsibility, arranged with a medical brief before first travel to such areas.

Against the mosquito: long sleeves and long trousers after dusk, insect repellent, sprayed rooms, nets where provided, windows shut in air-conditioned hotels — and antimalarial prophylaxis started about a week before travel and continued four weeks after leaving, chosen with aeromedical advice.
Against parasites: no bare feet on damp ground, no swimming in rivers or lakes, scrupulous personal hygiene.
Against animal-borne disease: no casual contact with animals; rabies rides in saliva and untreated it kills.
Against carrying the problem home: aircraft departing from risk areas are treated with insecticide before take-off, arrival authorities may require the discharged aerosol cans as proof of spraying, and regular fumigation is mandatory — so that the disease-carrying insects themselves are not flown between continents.