Travel and Vestibular Disorders Helpful Strategies to Consider in Planning a Trip

Home , Balance disorder, Vestibular system

PO BOX 13305 · PORTLAND, OR 97213 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · WWW.VESTIBULAR.ORG

The Vestibular Disorders Association when the airplane is descending to land— (VEDA) receives frequent inquiries moving from low atmospheric pressure about the effects of travel on a person’s down to Earth’s higher air pressure. vestibular disorder:  “Will travel increase symptoms?” When middle-ear pressure can’t be  “Should I avoid travel?” equalized, a painful vacuum effect sucks  “What is the best form of travel?” and stretches the eardrum inward. This  “What can I do to minimize can affect hearing because the stretched discomfort while traveling?” eardrum cannot vibrate naturally when sound reaches it. For most travelers, this Travel conditions that may be problematic is a temporary and minor annoyance. For for a person with a vestibular disorder others, it can cause longer-lasting pain include those that involve exposure to and problems with hearing and rapid altitude or pressure changes, equilibrium. certain motion patterns, or disturbing lighting. Travel decisions that Problems with rapid pressure changes are accommodate a person’s vestibular also associated with ground travel (by disorder will depend on the type of car or train) that spans a major elevation vestibular disorder, the method of change, such as driving over mountain transportation (e.g., train, boat, airplane, passes. Rapid ascents and descents in automobile), and the conditions and elevators can also be problematic, as can planned activities at the destination. water activities that involve deep descents —because water pressure increases with Rapid altitude or pressure change depth. Ear problems are the most common medical complaint of air travelers, Vestibular disorders associated with according to the Association for Research sensitivity to pressure changes include in Otolaryngology—Head and Neck perilymph fistula and those that affect Surgery. Rapid changes in air pressure regulation of inner-ear fluid pressure, during air travel can make it difficult for including secondary endolymphatic some people to equalize middle-ear hydrops and Ménière’s disease. pressure. This problem often occurs as the airplane ascends but is more common Motion patterns

Some forms of transportation (e.g., trains of traveling. The physician can review any and boats) involve repetitive motions appropriate restrictions and recommend such as rocking, swaying, or rotating. precautionary measures. Possible Adjusting to this motion—or to the lack of strategies include those described in the the motion after it has stopped—can be following sections. especially difficult for a person with mal de débarquement syndrome or for a Strategies to help with pressure changes person who has developed movement  Decongestants (e.g., Sudafed) or and postural compensation strategies in nasal sprays—used prior to beginning response to a chronic vestibular disorder air travel and again before the (e.g., BPPV, vestibular neuritis, or airplane starts to descend—may help labyrinthitis). Processing and adjusting to clear the nasal passages and thus such troublesome motion patterns are help equalize middle-ear air further complicated when there is an pressure. Most decongestants and absence of visual cues that confirm the sprays can be purchased without a movement relative to a stationary object prescription. However, people with (such as when a person is inside a below- certain health conditions, such as deck cabin on a boat). high blood pressure, heart disease, and excessive nervousness, and Visual sensitivity women who are pregnant, are Visual sensitivity can result from many advised to consult a physician before types of vestibular disorders. using such medications. Compensation for vestibular dysfunction  Do not ride in an unpressurized often results in increased reliance on aircraft. vision as the brain suppresses the signals  When traveling in an airplane, pay sent from the vestibular system. Thus, attention to pressure changes that exposure to bright, dim, or flickering light might require you to “pop” your ears can cause discomfort and disorientation (open the Eustachian tube). This for a person with a vestibular disorder. means staying awake while the plane Such conditions are encountered in most is descending so you can actively daily activities; however, the fatigue open the Eustachian tube by associated with traveling to unfamiliar yawning, swallowing, or chewing places can increase a person’s reaction to gum. Yawning frequently during unanticipated visual disturbances. descent is very effective; swallowing water from a bottle is also helpful— Travel restrictions and suggestions always prepare for this need by carrying bottled water with you. People who are sensitive to pressure  Prior to boarding a train for a long- changes and motion problems should distance trip, ask the ticketing agent consult a physician about the advisability to print a list of the elevations at

each station along your route. Pay  In passenger trains with seating on attention to that list as you travel so two levels, sit on the lower level, you remain awake and mindful of where there is less sway (rocking elevation changes that may require motion). some of the strategies mentioned  When traveling by boat, prevent or above for equalizing middle-ear minimize seasickness by remaining pressure. on deck and focusing on the  When booking a hotel room, ask if horizon (rather than staying in a the hotel is a high-rise building. If it below-deck cabin). This helps is, choose a room on a lower level so coordinate sensory information you aren’t subjected to about balance because it provides uncomfortable elevator rides to and visual confirmation that the boat is from your room. moving with respect to the  Consider booking vacations in fixed horizon. locations that have terrain and  Similarly, when traveling by train weather conditions suitable to your or automobile, avoid activities such comfort level. For example, if your as reading or working on a symptoms worsen in excessively computer. Focus your vision warm or humid climates or if you are outside of the car, at the moving prone to motion sickness in a car on scenery. When possible, sit in the curvy roads, avoid destinations with front seat, facing in the direction of these conditions. travel.  Avoid vacation activities that involve  If you struggle with mal de rapid pressure changes, such as débarquement, after the end of scuba diving and diving deeply into a any activity involving constant pool. movement (such as a car, train, or boat ride), take a walk while Strategies to help with motion patterns focusing on the horizon.  If you have experienced mal de  If you are traveling long distances débarquement and your symptoms in a train that makes occasional have resolved, you might prevent a stops at intermediate stations, take recurrence by avoiding the activity a few minutes to disembark from that caused the initial onset. the train to walk up and down the  Ask your physician if motion platform. This way, your body can sickness medication would be adjust or “check in” to the appropriate to use while traveling. sensation of functioning on solid

ground. Similarly, when driving a Strategies to help with sensitivity to light long distance by car, make and sound frequent stops to get out and walk.

 If you have a balance problem and often disorienting for those with are traveling to an unfamiliar visual sensitivity that can occur with place, pack items that will help you a vestibular disorder. If your travel manage uncomfortable light and plans include renting a car, prior to sound disturbances. These might signing the rental agreement, insist include sunglasses, a hat with a on sitting in the front seat of the visor, a flashlight, and ear plugs. proposed vehicle so you can test  Standing in long lines and walking the comfort of the windshield’s through airport terminals or train optics. stations can be tiring for a person with a balance disorder because © Vestibular Disorders Association these large, open, echo-filled spaces are disorienting. In this VEDA’s publications are protected under circumstance, you might find it copyright. For more information, see our permissions guide at www.vestibular.org. helpful to use a cane or hold onto the extended handle of a suitcase. This document is not intended as a substitute  Some automobiles have curved for professional health care. windshields that have distortion at the lower corners. This is merely annoying for most persons, but it is

PO BOX 13305 · PORTLAND, OR 97213 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · WWW.VESTIBULAR.ORG

Did this free publication from VEDA help you?

Thanks to VEDA, vestibular disorders are becoming S SUPPORT VEDA A recognized for their impacts on lives and our economy. We see new diagnostic tools and research studies, more Membership, 1-year accessible treatments, and a growing respect for how $ 40  Basic $110  Professional life-changing vestibular disorders can be. Memberships include electronic & online newsletter & free publications. For hard copies, include optional shipping fees. VEDA provides tools to help people have a better $ 5 … Shipping (domestic) quality of life: educational materials, support networks, $ 15 …Shipping (international) professional resources, and elevated public awareness. $______Please indicate your desired Your support of VEDA matters. Please help us to subscription amount here. continue providing such great help by becoming a Optional Contribution member or donor. I’d to support VEDA with a donation (instead of or in Members receive an information packet; discounts on addition to membership). purchases; a subscription to VEDA’s newsletter, On the Level, containing information on diagnosis, treatment, $______Please indicate your desired research, and coping strategies; and the option of subscription amount here. communicating directly with others who understand the  Check this box if you prefer personal impacts of a vestibular disorder. Professional that your donation remain members also receive the option to list training anonymous. opportunities on our site, bulk-discounted prices on $______patient education materials, and a listing on VEDA’s $ Total provider directory, the only of its kind serving patients seeking help from a vestibular specialist.

PAYMENT INFORMATION If you prefer, you can make your purchases online at http://www.vestibular.org.  Check or money order in US funds, payable to VEDA (enclosed)

 Visa ______ MC Card number Exp. date (mo./yr.)  Amex ______Billing address of card (if different from mailing information)

MAILING INFORMATION Name ______

Address ______City ______

State/Province ______Zip/Postal code ______Country ______

Telephone ______E-mail ______