by Neil Bauman, Ph.D.
A lady wrote:
We just visited our ENT for my son’s biannual hearing test. My husband asked the doctor if he could do another cat scan. He told the doctor we wanted to make sure whether my son had LVAS or not because we want to fly. My doctor told us he has other patients with LVAS and most of the parents take their children on flights. So, to reassure us that it is perfectly fine for our son to fly, he told me I should join a support group and talk to other parents to see what their opinion is. Thus, I decided to join your Large Vestibular Aqueduct Syndrome (LVAS) list because the reality of not flying is starting to sink in.
Your doctor gave you good advice. Few doctors know much about LVAS, but there is a wealth of collective wisdom on the LVAS list.
Here are two rules of thumb.
1. If your child is not affected by rapid pressure changes—such as from driving up or down a mountain, or when a fast-moving high or low pressure weather system moves in, or diving down to 6 feet or so underwater, or blowing on a woodwind or brass musical instrument, then the chances of him having ear problems related to LVAS and flying are almost nil.
2. In order to know what will likely happen in the future, you have to look at your child’s past history. If none of the situations in rule 1 (above) apply, try a flight and see what happens. If he doesn’t have any problems, then you can likely fly to your heart’s content without any problems in the future.
A lot of kids with LVAS do indeed fly, and with no harmful side effects I might add.
We did an informal survey on our LVAS list some months ago. Nineteen people responded that they had flown with a child with LVAS. Of the 19 that have flown, only 2 experienced a hearing loss which may have been related to flying.
The first child lost her hearing 12 days after flying and experienced a permanent loss. The family was unable to identify another reason for her loss such as head trauma or a virus. However, this child had flown twice before with no apparent loss.
The second child was fine on the way to the destination, but suffered a loss on the way home after transferring planes (in a high altitude location—Denver—flying to a low altitude location—Seattle). She suffered a “vestibular attack” (i.e. eyes squeezed shut, wanting to lie prone, vomiting nonstop). An audiogram a week later indicated a drop of 15 dB. Prior to this trip her hearing was progressive in nature. This child had also flown prior to this incident with no apparent hearing loss.
As you can see, most kids with LVAS can fly with no hearing side effects, and even those that did experience side effects had flown before without any problems.
Thus, you do not need to unduly restrict your LVAS child from flying unless past history indicates it is not a wise choice.
If you would like to learn more about LVAS or join the LVAS on-line support group, go to http://www.hearinglosshelp.com/articles/lvas.htm.
I’m an adult (61 years) with an enlarged vestibular acqueduct on my right ear. I have a mixed hearing loss, both conductive and sensorineural. The loss is moderate, severe to profound. The loss occurred in my early 30s and became worse over the years, however, it has remained stable over the last 15 years. The last long air travel ( Melbourne to Hawaii occurred in 1991. Since then, there have been only 3 hour flights. Next year I intend to travel from Melbourne to LA, then shorter flights from LA to NY, then to Las Vegas, to San Francisco and back to Melbourne, Australia. I’m concerned as to how air travel will affect my hearing. Any advice will be much appreciated.
Hi Teresa:
When you have LVAS, it is not the duration of the flight that is the problem, but the rapid changes in air pressure that occur in the half hour or more after take off and the half-hour or more before landing. During this time some people wear Ear Planes–ear protectors that slow down the speed of the pressure changes. I’d recommend them. They are usually available in drug stores.
The other things is to be sure your sinuses are clear. If you are congested, better not to fly, or at the very least, take a decongestant a half hour before you fly and before you descend to keep your ears open so the pressure can equalize.
And chewing gum is a good idea so you keep swallowing and thus regularly opening your Eustachian tubes–also to keep the pressure equalized. Yawning at intervals will work just as well–if you remember to do it.
That’s about all I can think of to minimize any risk of hearing loss from flying.
Cordially,
Neil
Thanks Neill for your invaluable advice. In the past I have been doing the swallowing of chewing gum at the specified times you mentioned. I will certainly take on board your other great suggestions.
Many thanks,
Teresa.
I’m am 13 years old and have had LVAS since I was about a year old. I’m terrified of flying but really want to visit my aunt in England. My doctors always tell me I can’t fly. I have no other symptoms of LVAS other than hearing loss that I know of other then occasional memory loss.
Hi Riley:
Why do your doctors say you can’t fly? Do they have any really good reasons, or are they just saying that in their ignorance?
Has your hearing changed significantly over the years? Are you sensitive to pressure changes and lose hearing because of that?
If your hearing has remained stable over the years, then likely flying won’t affect your hearing. That is why I want to know what kinds of events/things have caused your hearing to drop in the past (if any). That would give an excellent idea of whether it is safe for you to fly or not.
Let me know.
Cordially,
Neil
My 14 year old has the opportunity to fly with his Boy Scout troop on a small, non pressurized aircraft. He has an enlarged vestibular aqueduct on thr Eilat and bilateral mondini defects. Should he fly on small air crafts? He has done well on larger, pressurized planes.
Thanks,
Christine
Hi Christine:
Normally, commercial planes are pressurized to around 6,000 feet plus or minus a 1,000 feet or so. By law they have to be pressurized to 8,000 feet or less. So since your son has no problems in commercial planes, I doubt he’d have any problems as long as the plane flew no higher than 6,000 feet above sea level.
The only problem I potentially see is that small planes can have faster changes in pressure as they ascend and descend as compared to commercial planes which have a slow, constant rate of pressure change.
Having said that, I’d be inclined to let him go. My first plane ride was as a Scout in a Beaver float plane. Often small planes only fly 2,000 to 3,000 feet above the ground so he shouldn’t have problems.
This only applies if his ears are clear. If he has a cold or allergies or is otherwise congested, I’d vote against flying at that time.
Cordially,
Neil
Hello
I find this site very interesting et useful. Thanks a lot for these informations.
I recently have a baby, three months old, and he has the large vestibular aqueduct syndrome. He is now in China, but I am going to France soon and want to take the baby with me, but considering the 12-hour flight, I wonder if ithe flying will affect his hearing?
Will he still be able to fly when he grows up? Does the flying affect his hearing?
Also, can this hearing loss caused by large vestibular aqueduct syndrome be treated? Or is there any effective way to reduce hearing loss?
Thank you very much for your response.
Have a nice day.
Daniel
Hi Daniel:
My best advice is to make sure he is not congested at all before flying.
You are asking a lot of questions (understandable), but hard to answer until you have more information on his hearing history–and that takes a few years to learn.
If flying causes hearing loss now, then probably it will in the future, and vice versa.
The only treatment I know of is they give Prednisone (a steroid) if hearing loss occurs to see whether hearing will return. Sometimes it does and other times it doesn’t. Mostly, I think it helps.
There isn’t much you can do to prevent hearing loss in the sense that if you protect against all possible contingencies, he’d have to live in a bubble–and that’s not living. So you protect against what you can–avoiding bumps to the head and things like that. When he gets older, wear a helmet when playing or riding a bike if that is one of the things that cause further loss.
And if he does lose most of his hearing in the future, there is still hope as people with LVAS aften do very well with cochlear implants.
Cordially,
Neil
Dear Neil,
Thank you very much for your quick reply and you are so kind!
Now i’m not so worried and looking for information about LVAS everywhere, and thank you very much for your help.
Maybe I will come back to you for other questions about LVAS.
Thanks again and have a nice day.
Best regards,
Daniel
Hi there!
What a great website!
My son is 17 and has LVAS in both ears with mild to moderate hearing loss. We’ve flown many times through the years without problems (unless he’s congested). He’s about to turn 18 and wants to go skydiving. Any suggestions or hesitations with doing that??
Thanks so much!!!
Hi Lisa:
If he’s had no problems with rapid changes in air pressure in the past, then I don’t see that skydiving will cause any problems.
Just two cautions.
One, swallow several times on the descent to equalize the air pressure in your ears to minimize pressure changes.
Two, don’t forget your parachute! LOL
Cordially,
Neil
Hello, how is your son doing? Is it possible to get in contact with you? My daughter is 11. And has EVA both ears. I woukd be happy to be in contact
Hi Neil/Dr. Bauman,
This is the first helpful website that I’ve seen about EVA and flying. This is consistent with my experience – two of the flights that I had issues were landing in Seattle. I also have pain in my ears when diving in the water.
I have a question – I haven’t flown since I had vestibular issues in 2018, and luckily the pandemic made it easy to avoid flying since then. I just got a cochlear implant (I believe implanted through the round window)- not worried about hearing, but have you seen people still get vestibular issues after flying with a CI?
Thanks! Lina Reiss
P.S. Check out my story in Hearing Health Foundation Magazine:
https://hearinghealthfoundation.org/blogs/unlocking-the-key-to-my-problems-with-balance
Hi Lina:
Your story is very interesting. Too bad you or your doctors didn’t think of EVAS sooner.
EVAS is certainly another of the third window syndromes. I’m curious whether you had both sensorineural and conductive hearing loss.
As I understand it, the sensorineural component of EVAS hearing loss is the result of malformations in the inner ear that show up as higher-frequency hearing loss. The conductive component of EVAS hearing loss results from acoustic energy being dissipated through the enlarged vestibular aqueduct (third window). This shows up as a low-frequency air-bone gap on the audiogram.
In one study, 6% of the people with EVAS experienced vertigo. I’m sure a larger percentage experience various other balance problems.
I wish I could answer your question, but I can’t remember. A few years back, I had an EVAS group on Yahoo. We had hundreds of members and thousands of posts and I know that numbers of people had cochlear implants following hearing loss from EVAS. We discussed vestibular problems, but I can’t remember specifically whether any of them with CIs had vestibular problems from flying.
Thinking about it logically, the CI surgery doesn’t change/affect the vestibular aqueduct as far as I know, so I’d think it doesn’t change the chances of having vestibular problems either due to changes in air pressure.
Have you noticed any differences when going up or down mountain roads or chairlifts between before and after your CI surgery.
If you have no problems with rapid chances in elevation in a vehicle now, then I doubt you’ll have problems with flying now either.
Cordially,
Neil
Hi Neil,
Thank you for the helpful response. I don’t have any problems with elevators or big hills anymore, though at the onset of the problems I did experience the same disturbing ear fullness after descents, such as the OHSU skytram. I avoided all of those for a year, and somehow that got better and I have ridden the tram again without having those same issues. Perhaps some kind of membrane healed (I found your other article about the possible mechanisms of damage interesting).
So I’m hopeful that I will be able to fly again given that these symptoms are better. I will give it a try with Earplanes and decongestant. Might also pay attention to choosing connections that are not at low elevations.
That’s too bad the Yahoo group is gone – sounds like that was a great resource.
Thanks again for all your great articles!
P.S. I want to add that the vestibular issues happened after these multiple flights AFTER a year of triathlon training (Olympic length). I had wondered at the time if that contributed, especially straining on cycling uphills where I also noticed ear fullness after the issues started. I am now more careful when cycling or doing other strenuous activity, and appreciate your other articles mentioning that as a contributor in other triathletes with EVA.
Lina
Hi Lina:
As I’ve said so often to people with EVAS, things that you have done in the past that caused ear problems will likely do so in the future–all things being equal. So I think you can see patterns in the past you want to avoid or modify. I think you can fly again with Earplanes and maybe a decongestant–but better not to fly if you are congested and avoid having to take decongestants. And not really straining at anything is probably a good strategy. Just do your exercises at a level that doesn’t cause you ear problems.
I wish you well.
Neil
Hi Neil,
First of all, I am from the Netherlands. Apologies in case my grammar is not perfect.
As a child of 5 years old I once fell on my left ear (table). That same year I was hit on my left ear by a confused man. At the time, doctors indicated that my cochlea would be damaged. I am now 33 years old and I went back to the hospital last month. Hoping that something can be done about my ear years later (better technique). At the age of 4, a scan was never made. So at the age of 33 the docter decide to make a MRI. The MRI scan gave the answer that I have LVAS in my left ear (with the right ear everythins is fine). LVAS would have caused the hit and fall have damaged my cochlea and that is the reason that I can no longer hear anything with my left ear. However, I have never in my life (with flying, with 25 years of contact sport, various hits / bumps against my head) ever suffered from anything. In fact, the hearing test I had to make every year until I was 18 years old, are unchanged at the age of 33. I therefore doubt very much whether I have LVAS. The MRI scan indicates yes, what do you think about this? Also the doctor tells me that there is a change I would turn complete deaf. Also on the right side because the LVAS on the left side. They tell me that happens most of the time and its inexplicable why it happens. Sounds strange to me because the right ear and cochle are fine / normal.
Thanks for your response!
Rene
Hi Rene:
No need to apologize as your grammar is great.
Often, LVAS only shows up in one ear. The enlarged vestibular aqueduct is the only physical sign of LVAS, but LVAS is genetic. So far, they have only identified the PDS gene, but it is obvious that other (unknown) genes are also involved. Thus, there are still a lot of unknowns about LVAS.
Furthermore, different doctors see or don’t see LVAS in certain scans. It seems they have different criteria for the size of the aqueduct.
Normally, if a blow to the head (or whatever) causes hearing loss, in the future, that severe or worse head trauma will also cause hearing loss. Since you have had all sorts of head trauma from your years of contact sports with nothing happening to your hearing, like you, I doubt whether you really have LVAS–or at least it is not severe by any means.
How much can you hear with your left ear? If it was completely deaf, then you wouldn’t see a change in your hearing with successive head trauma since there is not hearing left to lose, although you might experience some balance problems such as dizziness and vertigo.
You don’t mention any balance problems resulting from contacts in your contact sports.
Personally, I disagree with your doctors and think that since your good ear is ok now, it won’t be affected by LVAS and thus won’t lose hearing in the future from that cause.
As far as I know, there is basically nothing that you can do about the LVAS damage already done–assuming it was LVAS in the first place. (Another scan and another doctor may come to a different conclusion than LVAS.)
Personally, I wouldn’t worry about this as it hasn’t changed in many years, so I don’t see any reason for it to change in the future.
Cordially,
Neil
Hello, I’m from Taiwan, I can’t speak English, so I use the translation, if there is any grammatical error, I would like to apologize to you in advance.
I think the content of your article is very helpful to me. In Taiwan, there are few such websites where we LVAS patients can communicate and consult. Thank you very much!
My child is six years old and confirmed to have Lvas, I have always wanted to take him to travel to Japan or Korea by plane. But i am very worried that flying will cause his hearing loss, which will deteriorate to the point of wearing CI.
Listen to what you said above, whether flying will cause hearing loss, even if the probability is not high, it depends on everyone’s physical fitness, but I have never taken him on a plane.
How do I know if my son’s ears are sensitive to changes in air pressure when flying?
Is there any way to observe it?
For example, is there any reference value for taking the express elevator in Taiwan 101 Building?
Thank you, Dr., for your patience in reading. If I can listen to your advice, I will be full of emotion!
Hi Steven:
You don’t know ahead of time whether your son’s ears are sensitive to air pressure changes when flying.
What you do is go by what has happened to his hearing in the past. For example, if he has LVAS and doesn’t have any hearing loss so far, there is a good chance he won’t have any hearing loss in the future from LVAS.
However, if he gets bouts of hearing loss when he exerts himself, or when there is a sudden change in air pressure as a storm moves in, then you know his hearing is sensitive to changes in air pressure.
Your idea of going to the top of the Taiwan 101 building in the elevator would give a greater change in air pressure much faster than he would experience in an airplane. So if that doesn’t affect his ears and hearing, flying in a plane probably won’t either.
However, if he is sensitive to changes in air pressure, just going up to the top of the building could result in hearing loss and that is what you want to avoid.
A better idea is to protectg his hearing, by getting some “earplanes” ear protectors. These protect your ears from sudden changes in air pressure. So if he wears them from before takeoff until after landing, he has a good chance of not having hearing loss from pressure changes while flying, or from going to the top of a tall building in a elevator.
You can get them online and in some stores. Just search for “earplanes ear plugs” and you’ll find a number of listings for them.
Cordially,
Neil
Hi Dr. Neil
Thank you very much, I am surprised that you are willing to reply to me. I am very grateful to hear your suggestions and sharing. You have given me and my children hope and strength. I wish you all the best, thank you very much.
Hi! I have EVA, and had a sudden hearing loss (-90db) in my right ear without any clear cause 1 year ago. I just woke up one morning, and every sound was extremely painful, my voice sounded far away and metallic. An emergency doctor sent me to get an audiogram and I was put on steroids (a very strange and sometimes terrible experience, especially going off it). A CT scan revealed EVA in my right ear. My hearing recovered 100% after 2-3 weeks.
I have flown a few times in my life, and it has never caused hearing loss. However, I normally experience ear fullness when going up mountain roads etc., but I figured that was normal.
I have two questions it would be great if you had the time to answer:
1. What can cause sudden hearing loss when no head trauma, changes in barometric pressure or strenous exercise etc. precedes it? Just stress?
2. I was curious about the comment from Rene from the Netherlands and your reply. Do I understand correctly if there is a risk of hearing loss in both ears, even though the EVA is just in the right ear? If so, are there any sources/research where I can read more about this?
Thanks for this website, it has been a huge help for me coping with this diagnosis the last year.
Best wishes,
Andrea from Norway
Hi Andrea:
EVA is one of the few conditions where you can have a massive hearing loss and then regain it all (or most of it) in the next two weeks. Normally, a massive sudden hearing loss only comes back 5 or 10 dB, so you could expect if you had a 90 dB loss, you’d get back to 85 or 80 dB, not back to normal or near normal as you can with EVA.
Question 1–This is a good question. One possibility could be a surge in your CSF pressure. Most people with EVA know the event that caused them to lose hearing so this is a bit strange.
Question 2. It is possible, but not common. They don’t know a lot about EVA and the genetics involved. So that may have more to do with the hearing loss than the size of the aqueduct.
There are a number of references at the bottom of the main article on EVA at https://hearinglosshelp.com/blog/large-vestibular-aqueduct-syndrome/ that may answer your question. Sorry, I can’t be more specific.
Cordially,
Neil
Hello,
I would like to explain my situation.
Please pardon my English.
More than 10 years ago, I suffered a severe migraine attack and as a result my hearing loss went profound. The doctor suggested the cochlear implant. I was given a very serious thought and the doctor claimed that it would help me. I went ahead with the surgery. After surgery, there are side effects until today, it is not been solved yet. About 3 years later, I couldn’t carry on with the implant, so at the results, I decided to have cochlear implant removal.
The side effects are like something is not connected well and nerve pain. Whenever I fly on the plane and the plane is about to landing, the air pressure changes, I start to have loud noises known as tinnitus. Because of this, occasionally there was severe dizziness, something like vertigo and ended up in hospital.
Another issue, whenever I yawn or stretch my body, I feel there is noise in my ear, something like pressure is not working well and not connected as well too.
I also note that my nerve is weak, because of this, I tend to have paresthesia. I suspected that it is related to the cochlear implant.
I also acknowledge that I am unable to do tricking, flip humans or when my head bends down due dizziness or something like orthostatic hypotension.
I also think there is fluid in my ear, however when I went for CT scan or MRI, they showed that there is nothing wrong.
I understand that I have LVAS.
Prior to the cochlear implant, no such thing ever happened to me. It began to have a lot of side effects after the surgery.
I began to research the symptopns,
I am not sure which one I am suffering from.
1) Vertigo
2) Benign Paroxysmal Positional Vertigo (BPPV)
3) Labyrinthitis
4) Vestibular Neuronitis
5) Meniere’s Disease
6) Perilymph Fistula (PLF)
7) Vestibular Migraine
8) Motion SIckness
8) Eustachian Tube dysfunction
9) insufficient blood flow
10) Middle ear effusions
11) Middle ear infections
12) Acoustic Neuroma
13) fluttering ear
14) Middle ear myoclonus (MEM)
15) patulous eustachian tube
16) hypothyroidism
17) Ear Barotrauma
18) hyperacusis
19) otosclerosis
20) pulsatile tinnitus.
I am wondering if there is any treatment for it.
I hope to hear from you soon.
Hi Archie:
I’m curious. Why did the migraine result in hearing loss? Did you take a medication that caused the hearing loss? Or was it a lack of blood getting to your ears? Or what? Do you know?
Was the cochlear implant causing you pain or what? Is that why you had it removed. I take it that you never heard sounds well with it–correct?
When flying, can’t your swallow and the air pressure in your middle ears equalize? If not, I can understand getting muffled hearing and as a result, getting tinnitus at that time.
If the cochlear implant removal left a “third window” so that pressure changes in your middle ear leak through to your balance system, the pressure changes could be interpreted there as balance signals. When that happens your brain is confused and the result can be vertigo.
It sounds like your Eustachian tubes are not working properly such that when you yawn, your Eustachian tubes don’t momentarily open allowing air pressure to equalize. Thus you have that feeling of fullness/pressure in your ears.
How do you know you have LVAS? Did you have a CT scan that showed that?
From what you say, it seem likely that the cochlear implant surgery, or the surgery to remove the cochlear implant (or both) damaged your middle/inner ear so that you now have these problems.
Obviously you have vertigo, likely due to damage to your vestibular system, but I don’t think you have BPPV. If you had it, just rolling over in bed could bring on vertigo. And if you had BPPV, performing the Epley maneuver could fix it.
I doubt you have labyrinthitis, vestibular neuronitis or Meniere’s disease. Your symptoms don’t seem consistent with these conditions.
A perilymph fistula is a possibility if removing the CI left a “hole” that is now leaking.
You may have vestibular migraines since you had migraines when this whole thing started.
Probably not motion sickness.
You could have Eustachian tube dysfunction if your neck is not in proper alignment, and/or the trigeminal nerve is not working properly.
If your neck is not in proper alignment, that can affect blood flow to your ears.
I doubt you have middle ear effusion or middle ear infections. Nor acoustic neuromas as that should have shown up on an MRI or CT scan.
Numbers 13,and 14 are unlikely as you have not mentioned any fluttering sensations.
Patulous Eustachian tube problems should show up as hearing your own voice as too loud. You haven’t mentioned that, so this is unlikely.
I can’t speak to hypothyroidism as that is not in my areas of expertise.
LVAS and barotrauma go together so if you have LVAS, you likely have pressure problems.
You haven’t mentioned that normal sounds are now much too loud so I doubt you have hyperacusis.
I don’t see anything that indicates you have otosclerosis.
You haven’t mentioned you hear pulsatile tinnitus.
I think you have migraine related conditions and/or conditions related to damage from the CI surgeries.
What do you think of my assessments of the above. Which ones see right to you or are good possibilities? Maybe we can narrow down the possibilities because the correct treatment depends on a correct diagnosis.
Cordially,
Neil
Hi Dr. Neil,
My daughter is 8 and has EVA in both ears. She has lost hearing in her right ear 7 times and it has returned each time. 2 of these times the loss was from being in elevation. The other 5 times were unknown why. Left ear has been stable. Since we know she is affected by elevation, does that mean we should avoid flying? We have been scared to try.
Hi Caprice:
First, what do you mean by elevation? How high was she to cause the EVA to kick in? Most planes are pressurized to the air pressure found somewhere between 5,000 and 8,000 ft. Around 6,000 to 7,000 feet is probably most common.
With EVA it’s not necessarily the altitude that causes the hearing loss, but the rapidity of change in altitude. Thus for example, say she was sensitive to pressure changes found at 6,000 feet and you drove down the mountain quickly, the increasing pressure may be too much for her ears. But say you walked down, that would take you some hours and the pressure change would be gradual–and likely not cause problems.
Here are two things to consider when flying. First, she should NOT fly if her ears are congested as clogged ears are not conducive to maintaining normal pressures. You could give her a decongestant an hour before take off and another one an hour before landing to ensure her ears are not congested in the least. Second, if she flies, get her some Ear Planes at your local drug store or on-line. These are like ear plugs but they don’t allow rapid pressure changes–so your daughter may find that those are all she needs to prevent hearing loss from pressure changes from flying (or driving up and down mountains for that matter).
Cordially,
Neil
Hi. My daughter is 11. Do you want to be in contact?